TABLE 1.

Session-by-Session Description of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder

Session	Description
Session 1	Introduction of participants and co-facilitators.
	Completion, scoring, and recording of the Borderline Evaluation of Severity Over Time (BEST) scale.
	Review guidelines for participating in STEPPS program.
	Review concept of borderline personality disorder, including diagnostic criteria and introduction of Emotional Intensity Disorder as an alternate “diagnostic” label.
	Identification of reinforcement team (members of support system with whom they choose to share information about borderline personality disorder, the skills they are learning, and how the team can reinforce what they’ve learned).
	Each group member identifies his or her specific goals (e.g., personal, social, educational/vocational).
Session 2	Completion of the BEST. (From this point forward, participants complete the BEST prior to each subsequent session.)
	Completion of schema questionnaire and education about schemas (cognitive filters) in borderline personality disorder.
Session 3	Description of distancing from emotional intensity, and relaxation breathing; each subsequent session begins with a different relaxation exercise.
Sessions 4 and 5	Introduction to the Emotional Intensity Continuum. These two sessions also teach the communicating of feelings, physical sensations, thoughts, filters, behaviors, and action urges more accurately.
	Beginning with session 5, the relaxation exercise is followed by a review of each participant’s use of the Emotional Intensity Continuum and specific STEPPS skills.
Sessions 6–8	Teach the challenging of maladaptive filters by identifying common cognitive distortions and replacing them with more accurate and functional alternative thoughts.
Sessions 9 and 10	Teach distracting behaviors and positive affirmations to reduce emotional intensity.
Sessions 11 and 12	Teach the management of problems using specific problem solving paradigms.
Session 13	Identify problematic lifestyle behaviors (eating, sleeping, exercise, etc.) and discuss the need for balance. Participants complete a questionnaire to identify areas of difficulty. Each participant identifies a problem area on which to work.
Session 14	Specific goals are set for one previously identified problematic behavior, which are worked on in the remaining weeks.
Session 15	Healthy eating and sleep behaviors are reviewed.
Session 16	Healthy exercise, leisure, and physical health behaviors are reviewed.
Session 17	Skills to reduce self-harm behaviors are taught. Participants use the Emotional Intensity Continuum to identify antecedents to self-harm and other abusive behaviors.
Sessions 18 and 19	Discussion of interpersonal boundaries and solicitation of relationships.
Session 20	Comparison of initial and termination schema (i.e., cognitive filters) questionnaire.
	Evaluation of the group’s progress and use of skills. Celebration of completion.