stepps to address bpd part 2 - borderline personality disorder · the goal: replace negative...
TRANSCRIPT
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STEPPS to Address BPD
Part 2
Presented by
Nancee Blum, MSW
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Measures of Emotional Intensity Baseline (1)
warm relaxed happy calm positive attitude self-confident positive self-image
socializing reading listening to music making plans sign up for classes
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Measures of Emotional Intensity Blow-Up (5)
rage hopeless abandoned helpless racing thoughts
screaming throwing hitting self-harm suicidal behavior
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Measures of Emotional Intensity Pre-Blow-Up (4) anger despair depression extreme anxiety severe withdrawal suicidal thoughts
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Measures of Emotional Intensity Development (3) frustrated nervous fear of unknown tired/sleep all day miss appointments start isolating nit-picking
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Measures of Emotional Intensity Beginning of Intensity (2)
irritable restless insomnia nightmares decreased motivation fears beginning
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Cognitive Filters Important beliefs about oneself/world Accepted without question Self-perpetuating Very resistant to change Usually outside of awareness Operate in subtle ways Activated by events
© Bradley Trevor Greive, 2002
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Common Maladaptive Filters
Abandonment Emotional deprivation Defectiveness/Shame Vulnerability to harm & illness Unrelenting/unbalanced standards Entitlement/insufficient limits Trust/mistrust
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The Goal: Replace Negative Filters with Positive Ones!
Play is healthy Feeling good is an
acceptable goal Altruism Caring Relationship stability Trust Socialization Self-acceptance
Achievement Competence Self-help Efficacy Boundaries Self-control Emotion
management
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Why Are Filters Important?
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anxious irritable
muscles tense
He’s late again!
abandonment
Call his office.
Pacing - Call his cell phone.
content, happy
muscles relaxed
things are good.
self control
Something enjoyable
listening to music, reading
boyfriend late!
boiling abandoned
heart pounding shaking
I’ll never have another boyfriend.
abandonment, social undesirability
self harm - cut
screaming, throwing things cutting
fuming suicidal
sweating nausea
He’s found someone else.
abandonment
self harm
Cry- look for a razor.
frustrated angry
butterflies in stomach
He’s never coming back.
abandonment
Go to his office.
Call his office, friends, family.
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Essential STEPPS Elements
BEST (or QuEST) self-rating scale Criteria for BPD
- reframe as emotional intensity disorder (EID) Emotional Intensity Continuum Cognitive (Thought) Filters Emotion Management Skills
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A Typical Session Fill out BEST form Relaxation exercise Review Emotional Intensity Continuum Review Skill Monitoring Card Review homework assignment Introduce and read through new lesson Assign homework
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Purpose of Family/Staff (Reinforcement Team) Education
Provide information Empowerment Consistent responses Provide guidelines for coping Develop working alliance
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Educating Reinforcement Team
Includes family members, therapists, health care providers, significant others
One two-hour evening session May attend any two regular sessions after
evening session (with permission) Patients report increased support
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Responding to Person with BPD
Where are you on emotional intensity continuum (1-5)?
Have you used your notebook? What skill can you use in this situation? How will you use it? If person cannot think of skill, ask about
each one on the list 43
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STAIRWAYS™: The Next Step in BPD Skills Training
Setting Goals Trying New Things
Anger Management Impulsivity Control
Relationship Behaviors Writing a Script
Assertiveness Training Your Choices Staying on Track 45
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STAIRWAYS: The Next Step in Borderline Skills Training
Reduces abandonment fears Decreases intensity of service Meets two times per month - 2 hours
per meeting Work on additional skills that affect
their lives Reinforces previously learned skills
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Facilitator Training
Master’s level with experience 2-day intensive workshop Ongoing follow-up and
consultation by internet (SKYPE), email, phone
Ratings of videotaped sessions for therapist fidelity to model
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Research Studies RCTs completed in Iowa* and The
Netherlands** (references below) Multiple non-RCTs from US, England, Italy,
Scotland, Netherlands published STEPPS reduces global severity, BPD
symptoms, and depression Prison studies (non-RCT) show ↓ self-harm,
suicide attempts, disciplinary infractions
*Blum, et al. Am J Psy April, 2008 **van Wel, et al. Dutch J Psy 2009
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STEPPS on the Web
www.steppsforbpd.com
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The End
Nancee Blum, MSW, LISW Department of Psychiatry
Roy J. and Lucille A. Carver College of Medicine The University of Iowa
Thank You!