By Aleksandra Vujicic
Communications Coordinator, Department of Psychiatry
A pair of University of Iowa clinicians, who have devoted much of their careers to developing and studying the effectiveness of a treatment for borderline personality disorder (BPD), have released a new book that combines the empirical support behind the Systems Training for the Emotional Predictability and Problem Solving (STEPPS) program along with its international dissemination.
 Pictured above: Donald Black, MD, and Nancee Blum, MSW, with their new book Systems Training for Emotional Predictability and Problem Solving for Borderline Personality Disorder: Implementing STEPPS Around the Globe |
The STEPPS program was developed by clinicians at the University of Iowa in 1995 as a cognitive-behavioral, skills-based group treatment for patients with BPD. Since then, mental health care providers around the world have utilized the program, and there are currently several translations and adaptations of it.
Donald Black, MD, a Professor of Psychiatry and Nancee Blum, MSW, a social work specialist and Adjunct Instructor of Psychiatry, edited and recently released Systems Training for Emotional Predictability and Problem Solving for Borderline Personality Disorder: Implementing STEPPS Around the Globe.
Blum developed the STEPPS program along with Norman Bartels, MA, MPA, Don St. John, MA, PA, and Bruce Pfohl, MD, a professor of Psychiatry and Biostatistics.
“It has been extremely gratifying to have the opportunity to train clinicians both in the US and internationally, as well as assisting in the implementation in a variety of settings,” Blum said.
She has traveled the world training mental health providers, but her first trip to the Netherlands in 1998 left a big impression on her. Two psychiatrists who directed the provision of mental health services for a million people in the country invited Blum to train their teams of therapists. Luckily, there were no language barriers as the Dutch typically learn to speak English at a young age.During that time Blum used weather symbols as a metaphor for different levels of emotional intensity, with a tornado representing the highest level. But she quickly learned that there is no Dutch word for ‘tornado’. The group came up with a quick solution: there would now be a new Dutch word!
Although humorous, the language mix up was a good learning experience for Blum and prompted her to create a more universal metaphor. Emotional intensity is now also represented by pots on a burner in STEPPS, going from cool water to boiling over.
Blum and Black have worked together for over three decades and have written many articles, book chapters, and done numerous presentations together both in the US and abroad.
Black is an award-winning clinician and teacher at the University of Iowa, who has written major educational publications including Introductory Textbook of Psychiatry and DSM-5 Guidebook. He is a Distinguished Fellow of the American Psychiatric Association and the president of the American Academy of Clinical Psychiatrists. Blum also provides consultation and training for the STEPPS program in the Iowa Department of Corrections.
The book, published by Oxford University Press and on sale now, describes the various treatment settings and countries in which STEPPS has been implemented and compiles the body of evidence that supports the program as an effective clinical treatment.
BPD may affect up to two percent of the general population and can be very debilitating, with symptoms that include impulsivity, emotional instability and increased risk of suicide.
The five-month program is led by two facilitators who teach patients about emotion regulation and behavioral skills to better handle their BPD symptoms. It incorporates Cognitive Behavioral Therapy along with educating patients and their support system (i.e., family members, friends, or mental health professionals) about BPD symptoms.
STEPPS was designed to be easily learned by therapists of varying backgrounds and is intended to supplement a patient’s ongoing treatment, instead of replacing it.
The new book serves as a guide for psychiatrists, psychologists, social workers, nurses and counselors who treat patients with BPD.
“We do hope that the book will stimulate interest on the part of therapists to learn more about the program and be encouraged to start the program,” Blum said.
The STEPPS program is already widely used in the Netherlands, Blum said, where roughly 900 therapists have been trained and over 25,000 patients have completed the treatment.
The program has also been translated into German and Italian. Providers in the United Kingdom even adapted the program for adolescent patients.
With eight chart review-based studies and three randomized controlled studies, STEPPS has one of the largest bodies of empirical support for any group treatments for BPD, behind only Dialectical Behavior Therapy. The data generally reflect that patients show improvement in mood regulation and behavior after completing the program.