Systems Training for Emotional Predictability and Problem Solving (STEPPS™): An Introduction for Psychologists

Problem: Borderline personality disorder (BPD) is highly prevalent in individuals treated in both psychiatric hospital units and outpatient clinics, and occurs even more frequently among those incarcerated in prisons. Black and colleagues (2007) assessed 220 offenders entering the Iowa prison system and found nearly 30% met criteria for BPD, including 55% of women and 27% of men.  Patients suffering from the disorder present a greater risk for serious behavioral problems at the institution without treatment (Warren et al., 2002). There are few effective, easily implemented, evidence-based treatment programs for BPD in correctional settings.

The STEPPS Program: The 20-week outpatient, cognitive-behavioral, skills-based program is delivered in a group setting with weekly two-hour sessions led by two facilitators who follow a detailed lesson plan. The program is fully manualized, and is designed to be easily delivered in a classroom or seminar setting. Each lesson focuses either on an emotion management or a behavioral skill, and is augmented with homework assignments. STEPPS does not include individual therapy, and is referred to as an “adjunctive” program because it is added to whatever treatment group members are currently receiving (e.g., medications). The program has three main components: (1) Awareness of Illness, (2) Emotion management skills, and (3) Behavior management skills. The term BPD is reframed as Emotional Intensity Disorder (EID) which seems to better reflect the experience of those with BPD. The systems component is implemented with a two-hour session that educates family members, friends, healthcare professionals, and correction workers, about the disorder and the program. The STEPPS program is described in more detail by Blum et al. (2008).

Conclusion: STEPPS was introduced in the Iowa Department of Corrections (IDOC) in 2005, and continues to be used in several prisons; the program has since been extended into community corrections. Secondary data analysis of results in both male and female offenders at eight facilities demonstrated “robust improvement in BPD symptoms, mood, and negative affectivity.” Further, the program significantly reduced both suicidal/self-harm behaviors and disciplinary infractions (Black et al., 2013).  Previous surveys of group participants and therapists showed high acceptance of, and satisfaction with, the program (Blum et al., 2002).

Future Research: There have been two RCTs and nine uncontrolled trials in non-forensic settings. A controlled trial to assess the impact of the STEPPS program in prison settings has not yet been conducted.  Presently, the program has only been studied in medium security prisons and a few community corrections settings. There is a need to broaden the implementation beyond the current settings and to include more male offenders. Finally, further studies are needed to test whether the benefits are maintained or extended beyond the 20-weeks, and even after leaving prison and/or community corrections.

About the Authors

Jerrod Brown, M.A., M.S., M.S., M.S., is the Treatment Director for Pathways Counseling Center, Inc. in St. Paul, MN.  Pathways’ focus is to provide programs and services that benefit individuals impacted by mental illness and addictions. Mr. Brown is also the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS).

Nancee Blum, MSW, LISW, is a Social Work Specialist and Adjunct Clinical Faculty in the Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, IA. She is also a consultant to the Iowa Department of Corrections. Her clinical and research interests include assessment, treatment, and development of training materials for personality disorders.

Disclosures: Ms. Blum receives grant support from the Nellie Ball Trust and royalties from Level One Publishing LLC, publisher of STEPPS, STEPPS UK, and STAIRWAYS, Psychiatrie Verlag, publisher of the German translation, Cristaldo for the Italian translation, and from the American Psychiatric Press, Inc., and Oxford University Press. She presents training workshops for the American Institute for the Advancement of Forensic Studies (AIAFS), for which she is compensated.


Black, D. W., Gunter, T., Allen, J., Blum, N., Arndt, S., Wenman, G., & Sieleni, B.  (2007). Borderline personality disorder in male and female offenders newly committed to prison. Comprehensive Psychiatry, 48, 400-405.

Black, D. W., Blum, N., McCormick, B., & Allen, J. (2013). Systems training for emotional predictability and problem solving (STEPPS) group treatment for offenders with borderline personality disorder. The Journal of Nervous and Mental Disease, 201, 124-129.

Blum, N., Pfohl, B., St. John, D., Monahan, P., & Black, D. W. (2002). STEPPS: A cognitive-behavioral, systems-based group treatment for outpatients with borderline personality disorder—a preliminary report. Comprehensive Psychiatry, 43, 301-310.

Blum, N., St. John, D., Pfohl, B., Stuart, S., McCormick, B., Allen., J., Arndt, S., Black, D. W. (2008). Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. American Journal of Psychiatry, 165, 468-478.

Warren, J., Bumette, M., South, S.C., Chauhan, R., Bale, R., & Friend, R., (2002). Personality disorders and violence among female prison inmates. Journal of the American Academy of Psychiatry Law, 30, 502-509.

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