This page explains all about our Emotion Regulation Pathway (ERP) service:
- What the ERP is
- The support the service offers
- How to access the service
- Further information and reading
- More information on Dialetical Behaviour Therapy
- More information on Structured Clinical Management
- Additional support available if you are struggling right now
- Contacting the team.
The Emotion Regulation Pathway (ERP) is a service for people with Complex Emotional Needs associated with personality difficulties. The ERP team works very closely alongside colleagues in the Living Well community teams, who also provide many other services to people with Complex Emotional Needs. The ERP team are committed to improving care and providing evidence-based treatments for people with personality difficulties. This may be by supporting people directly or by recommending other Derbyshire services that can help.
'Personality' refers to the way we think, feel and behave. Due to our genetic makeup and life experiences, difficulties can arise in these areas. If the difficulties are causing you great distress, are long-lasting and impact on many aspects of your life, then help may be needed from mental health services.
About the ERP team
The Emotion Regulation Pathway (ERP) is staffed by practitioners who have all chosen and been selected to work in this area. The team all receive an enhanced level of training and supervision to provide the best quality care. It is a multi-disciplinary team of Community Psychiatric Nurses, Clinical Psychologists, Occupational Therapists, DBT Therapists and Social Workers, who are able to take a variety of approaches to best understand and help the people they work with.
Throughout all the team's interventions, there is a focus on developing a safe and trusting therapeutic relationship, based on being curious about and understanding a person’s thoughts, feelings, urges and behaviours. There is also a clear therapeutic direction with expectations about the different roles of staff and service users.
The team are committed to improving the experience and outcomes of all people with Complex Emotional Needs and so support other Trust services and partner organisations with consultation, supervision and training. The team also support other groupwork programmes delivered in the Living Well teams, including the Managing Emotions Programme and Coping with Emotions groups where available.
The team's support may be helpful if you have difficulties in the following areas:
- Managing your emotions, particularly strong and rapidly changing emotions
- Managing urges to act quickly and impulsively, including self-harm and suicidal thoughts
- Managing relationships.
There are two main treatment offers within ERP: Structured Clinical Management (SCM) and Dialectical Behaviour Therapy (DBT). We also have a developing Mentalisation Based Treatment (MBT) offer in some areas. All these are psychologically informed, evidence-based, systematic approaches to help people address their personality difficulties.
Research has demonstrated these approaches to be effective in addressing problems associated with what is sometimes called ‘personality disorder’. They are consistent with, and specifically recommended within, latest practice guidance including NICE Guidance and the Royal College of Psychiatrists’ 2020 Position Statement.
Different stages of support
All ERP offers include four main stages: assessment, socialisation, treatment and transitions.
You will first be offered an assessment with an ERP worker. The assessment will usually take place over 4 to 6 sessions and will work on understanding your difficulties and agreeing short and long term goals.
Following this assessment, the findings will be discussed with you and a programme of treatment will be discussed with you.
Some people may feel ready to engage with our treatment programmes, or an alternative option, immediately after completing their assessment.
However, some people may benefit from up to 12 weeks of socialisation. This time will be used to problem solve any difficulties about coming to group sessions or committing to change.
Your ERP worker will work with you to set short- and long-term goals, agree a treatment contract about what to expect and what is expected of you, and develop a more in-depth safety plan to help you during difficult times.
In this stage, you will be offered weekly individual sessions as well as weekly group sessions. All our treatments require attendance at both group and individual sessions: both the individual and group aspects of treatment are crucial to change. The treatment stage usually lasts 6 to 12 months.
For more information about the different treatments, see the sections about Structured Clinical Management and Dialectical Behaviour Therapy below.
In the ending or transitions stage, you will continue to have access to support from your worker over a six-month period but contacts will be less frequent.
You and your worker will review the skills you have developed, plan how you can maintain these in the future and explore the resources you will need.
What if I am not ready for treatment?
There are no significant risks associated with our interventions, however, as with all therapies, it requires people to think and talk about their difficulties and work towards change. This can be challenging.
Sometimes people don’t feel ready to start treatment. If you feel you are not able to start then you may be offered further contact with the ERP worker to understand and overcome the barriers to you starting treatment.
The Emotion Regulation Pathway (ERP) team work with adults of working age and accept referrals from community mental health Living Well teams, crisis and inpatient services. The team do not accept self-referrals. A professional worker you have regular contact with, such as a key-worker, care co-ordinator, psychiatrist or psychologist, should speak to you about the referral first and involve you in the decision. If you agree to be referred, this person will then contact the team.
The ERP team focus on the following three problem areas in treatment; therefore, to benefit from the service, people will need to have significant and long-standing difficulties in at least two of these areas:
- Emotional instability: intense, unstable and reactive emotions (typically lasting from hours up to a few days)
- Impulsivity problems: eg. self-harm or suicidal behaviour, drugs, alcohol etc. These will be self-damaging and usually in response to difficult emotions
- Relationship problems: often unstable and intense relationships, though people may also be isolated.
In addition, people must have enough stability in their social situation and physical health to engage in the regular sessions offered by the ERP team. Once a referral has been made, the team will review this and may speak with the referrer for further discussion. You will kept informed about the outcome of your referral either by letter from the ERP team or through your referrer.
What are the timescales?
There are usually waits before assessment starts. We do everything we can to make these waits as short as possible.
The three stages of treatment then typically last between 12 and 24 months, depending on your needs.
The length of time and commitment needed will be discussed with you individually as part of your goal setting and treatment contract.
Where does treatment take place?
The ERP team's treatments are delivered within community settings, as this is where you will be using skills and strategies for solving life problems. Recovery happens best at home.
Individual contact is usually provided face-to-face or by online video call. The team provide both face-to-face and online group sessions, though availability of these is dependent on geographical area. Different options will be discussed with you by your worker during assessment.
If hospital admission is necessary at any point, it is recommended that this is relatively brief and with a clear goal and timescale in mind. Contact with your worker will continue during the admission wherever possible.
This section includes more information on two of the most common forms of treatment used by the Emotion Regulation Pathway (ERP) service. It also includes information about further reading and links to other websites.
Dialectical Behaviour Therapy (DBT) is one of the main treatments available within the Emotion Regulation Pathway.
DBT is a structured, evidence-based, treatment for people with Borderline Personality Disorder (BPD) or Emotionally Unstable Personality Disorder. It was developed by Marsha Linehan, informed by her own experiences of these problems. It has been developed and researched over the last 30 years.
The main goals of DBT are:
- To stop self-harming behaviours and suicidal behaviours
- To remove any blocks to therapy
- To change behaviours that stop the person achieving a reasonable quality of life.
DBT therapists set treatment goals in a certain order. The therapy teaches coping skills to use at times of stress and distress. It teaches you more successful ways of reacting when you feel strong emotions.
In line with all Emotion Regulation Pathway interventions, there are four main stages: assessment, socialisation, treatment and transitions.
In the DBT treatment stage you will be offered attendance at a two-hour skills training group once a week. In the group you will learn skills that can help you deal more successfully with upsetting events. These skills include:
- Ways of increasing your awareness of what you are feeling and doing
- Ways of stopping yourself from acting in a harmful way when you have painful emotions and thoughts
- Ways of helping yourself to manage strong emotions
- Ways of improving your relationship with other people.
In DBT there is an expectation that you will practise skills between sessions, feeding back on your skills practice in group.
You will also be offered one-to-one sessions, and contact can be made between sessions if necessary. A genuine, accepting relationship between you and your therapist is essential. Your therapist will work to make a strong and positive relationship with you from the start.
The main purpose of individual sessions will be to examine any upsetting events that have occurred in the past week and help you to find different ways of reacting to them. You will be asked to complete diary cards to monitor your progress.
Researchers have compared DBT with other psychological therapies. The results are better for those who have completed a DBT programme.
Many people say they have found the different parts of the programme very useful. They say:
- They have felt a lot of help and support from other members of the group
- The programme has helped them to deal better with many parts of their lives
- The programme has helped them to stop harming themselves.
Most people who complete the programme say that they feel stronger, more confident and have better control over their lives. They usually say they are having a better quality of life.
What is it actually like to be in therapy?
Here is a client’s description:“I never thought I’d stick it at first – it all seemed so structured, but I was desperate and it seemed my last hope. I was terrified of the group. I thought I’d have to tell everyone about myself but it wasn’t like that. People in the group understood what I felt as they had been through it too…..it was not easy but it was worth it. I use the skills in some way almost every day. In the last year I have only self-harmed twice.”
Structured Clinical Management (SCM) is one of the main treatments available within the Emotion Regulation Pathway.
SCM is a psychologically informed, evidence-based, systematic approach to help people address their personality and relational difficulties. It was developed by Professor Anthony Bateman and Professor Peter Fonagy at St Ann’s Hospital in London using the principles outlined within the 2009 NICE guidelines for recognition and management of borderline personality disorder.
SCM may be helpful if you have difficulties in the following areas:
- Managing your emotions
- Managing urges to act quickly (acting without thinking)
- Self-harm and suicidal thoughts
- Making and keeping healthy relationships.
SCM has a clear, reliable and consistent structure, to help you feel safe. SCM aims to develop a secure therapeutic relationship by the use of a curious, responsive, and optimistic therapeutic stance, and giving validation of mental states. Together you will then develop a shared understanding of your difficulties, establish a collaborative detailed crisis plan, set clearly focussed goals, and then use problem-solving practices to work towards these goals.
Despite its name, Structured Clinical Management is actually a more flexible approach than many other formal therapies, such as DBT. SCM can work better for people who find the highly structured nature of DBT with its expectations of intensive skills practice difficult.
In line with all Emotion Regulation Pathway interventions, there are four main stages: assessment, socialisation, treatment and transitions.
In the SCM treatment stage your SCM practitioner will also act as your care coordinator. Any contact you have with a psychiatrist will usually remain unchanged.
Your SCM practitioner will help you to develop further understanding of your difficulties and develop specific skills to solve problems and meet your goals. You will learn and practice skills in four key areas:
- Problem solving
- Tolerating and managing emotions
- Impulsivity, self-harm and suicidality
- Improving relationships.
At this stage, you will be offered weekly individual sessions as well as weekly group sessions.
Your practitioner will work with you to develop individualised understandings and solve any problems that come up. Through groups sessions you will learn new skills, learn solutions from others with similar problems, and practice problem-solving together.
SCM has been found to be as effective as other specialist treatments such as Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Treatment (MBT) in helping people address their personality and relational difficulties. Emotion and mood regulation, managing urges and interpersonal problems and quality of life all improve with SCM treatment, and are usually maintained over time. There is evidence for SCM being particularly effective within the initial 6 months of treatment, and compared to more specialist treatments, it can be faster at reducing self-harm
Within Derbyshire our SCM service has been shown to lead to significant improvements in people’s quality of life, emotion dysregulation, and symptoms of borderline personality. People also had significantly fewer hospital admissions, spent less time in hospital and had fewer contacts with crisis teams following starting SCM.
The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance (2019) by Matthew McKay, Jeffrey C. Wood.
For further information about the Derbyshire Emotion Regulation Pathway or Structured Clinical Management and Dialectical Behaviour Therapy, please discuss with your mental health worker. You may also find the following websites helpful:
- Personality disorders page on the NHS website
- National Institute for Health and Care Excellence guidance on borderline personality disorder: recognition and management
- Personality disorders section on the Mind website
- Personality disorders section on the Rethink website
- Royal College of Psychiatrists 2020 Position Statement: ‘Services for people diagnosable with personality disorder’
If you feel you need additional support, please view our help in a mental health crisis page.
Information for carers can be found on the Derbyshire County Council website.
You can write to the ERP team at:
Emotion Regulation Pathway
Derbyshire Healthcare NHS Foundation Trust
Clinical Psychology Services
3rd Floor, St. Andrews House
201 London Road