Trade between countries usually involves products. However, one successful export from the United States to the Netherlands, Norway and several other countries is a cognitive therapy treatment program created by University of Iowa experts to help people with borderline personality disorder.
The treatment program, called Systems Training for Emotional Predictability and Problem-Solving (STEPPS), augments standard treatment -- medication and individualized psychotherapy -- in order to give people with borderline personality disorder techniques to raise self-awareness and self-management.
People with the disorder struggle to manage intense emotions, experience frequent suicidal thoughts and can engage in self-damaging, impulsive behaviors. Their relationships with others are often unstable because of inconsistent or intense moods.
Borderline personality disorder, characterized in the STEPPS program as emotional intensity disorder, is found all over the world at about the same prevalence rate, said Nancee Blum, social work specialist in psychiatry in the UI Roy J. and Lucille A. Carver College of Medicine. Blum pioneered the treatment program along with colleagues Don St. John, UI physician assistant in psychiatry; Norm Bartels, a clinician in Wheaton, Ill.; and Bruce Pfohl, M.D., UI professor of psychiatry.
"Borderline personality disorder crosses many cultural lines. Sharing a treatment approach to benefit patients and experts in other countries has been exciting and gratifying," said Blum, who also is an adjunct faculty member in the UI College of Nursing and the School of Social Work in the UI College of Liberal Arts and Sciences.
Recently, experts in the Netherlands reported that 80 percent of their mental health facilities now have STEPPS-trained therapists using the Dutch version of STEPPS. In April, Blum will go to London to introduce the program to clinicians there. Meanwhile, the STEPPS manual is being translated for use in Norway, where therapy groups are starting. In addition, the group treatment approach has spread to Argentina, Australia, Canada, New Zealand and Spain.
STEPPS involves 20 weekly group meetings where patients learn to change some of the ways they think about themselves and others, and adopt specific skills for managing their intense emotions. Patients learn new behaviors related to eating, sleeping, exercise, physical health and relationships. Patients also learn new ways to communicate about the disorder with others in their "system," which includes health care professionals, relatives and significant others, and close friends. As part of STEPPS, patients invite these individuals to attend an educational session.
"The STEPPS emphasis is on learning emotional management and behavioral skills so that the symptoms are less bothersome and people can instead move on to more satisfying activities in their lives," Blum said.