STAIR Therapy

What is STAIR therapy?

After certain traumatic events, individuals with posttraumatic stress disorder (PTSD) might grapple with agitation, anxiety, recklessness, and trouble concentrating, among many others. Standard methods for treating and managing PTSD include exposure therapy, where the individual is gradually exposed to the source of their trauma, and cognitive behavioural therapy (CBT), where their behavior and thoughts are reframed through talk therapy. 

While the formerly mentioned treatments are widely used, another approach to treating PTSD is called Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy is used. STAIR Therapy is a narrative therapy that focuses on skills training to help individuals with PTSD develop and strengthen interpersonal skills and emotion regulation (Hassija & Cloitre, 2015). 

What is the goal of STAIR therapy?

STAIR Narrative Therapy was initially designed to help alleviate trauma-related problems in child abuse populations. A 2005 study conducted among women who suffered from childhood abuse revealed issues in how they handle emotions and relate to others, which affects their ability to function well (Cloitre et al., 2005). 

So, STAIR Therapy stems from the idea that along with treating PTSD symptoms, it's essential to learn to manage emotions and improve relationships for better recovery, making these the main goals of said therapy. 

Overview of the STAIR therapy process

STAIR therapy is a multi-component therapy phase-based treatment. It begins with Skills Training in Affective and Interpersonal Regulation (STAIR), lasting up to ten sessions. During this phase, social and emotional competencies are rehabilitated or strengthened. The ten sessions are divided into two, with five sessions allocated each to emotion regulation and enhancing social and relational capacities.

Following this is the Narrative therapy phase, a modified version of Exposure Therapy that concentrates on making meaning from the client's trauma stories. This phase spans eight weekly sessions. In total, STAIR Narrative Therapy consists of 18 sessions.

Interventions of STAIR therapy

STAIR Therapy involves various interventions for its components. To explore these interventions, we'll examine those outlined by Cloitre during a Mental Health Forum hosted by the Harvard T.H. Chan School of Public Health in 2021. Beginning with interventions for emotion regulation, they encompass the following:

1. Tracking emotions daily: The intervention involves monitoring the patient's daily emotional experiences.
2. Practicing emotion regulation strategies: This involves employing strategies like soothing senses, thought shifting, and positive activities.
3. Developing distress tolerance for valued goals. This includes building resilience and perseverance in the face of emotional challenges to continue pursuing essential objectives (finishing therapy).

Meanwhile, for the relational capacities part, interventions include:

1. Practicing interpersonal skills: This intervention includes engaging with others and standing on one's ground with compassion.
2. Cognitive re-appraisal about oneself and others: The focus is on reframing thoughts and perceptions related to oneself and others more positively or constructively.
3. Cognitive re-appraisal (not confrontational, but aspirational): When approached aspirationally, it involves reinterpreting situations and beliefs to pursue personal growth and desired outcomes while acknowledging and validating old beliefs based on past experiences or trauma.

Who can benefit from STAIR therapy?

We have learned earlier that STAIR Therapy's goal is to help individuals with PTSD. Specifically, here are the different groups that can benefit (Harvard T.H. Chan School of Public Health, 2021; National Center for PTSD, n.d.):

1. Childhood abuse survivors: They can be assisted in recovering from prior traumas, developing coping techniques, and re-establishing a sense of safety and confidence in themselves and others.
2. Refugees: Refugees are given tools to help them deal with the emotional discomfort and cultural adjustment issues connected with forced migration, enabling them to settle into new contexts.
3. Survivors of domestic violence: They can rebuild self-esteem, set boundaries, and process trauma to break free from cycles of abuse and rebuild their lives.
4. Adverse childhood experiences (ACE) plus adult traumas: For people who had tough times growing up and faced more challenges later in life, the therapy makes them stronger. Furthermore, it helps them feel better emotionally and aids in their growth.
5. Combat survivors: Through coping strategies, the therapy can help with the aftermath of combat trauma by managing symptoms and improving daily functioning for veterans and active-duty service members.
6. Accident survivors: Those who have experienced accidents can benefit from STAIR therapy by learning techniques to regulate emotions and navigate interpersonal challenges resulting from the trauma.
7. Sexual assault survivors: Survivors of sexual assault are empowered to heal and move forward with tools to help them address emotional distress and rebuild interpersonal connections.

Research and evidence

The efficacy of Skills Training in Affective and Interpersonal Regulation (STAIR) therapy has been demonstrated across various contexts, showcasing its versatility in addressing diverse traumatic experiences and populations.

Zaccari et al. (2023) exemplified its effectiveness through synchronous telehealth delivery to a rural woman veteran with complex posttraumatic stress disorder (CPTSD), resulting in notable improvements in trauma and eating disorder symptoms. This highlights the significance of evidence-based, phased therapy approaches like STAIR in addressing complex trauma, especially amidst the increasing utilization of telehealth, particularly during the COVID-19 pandemic.

Moreover, Cloitre et al. (2023) showcased the potential of STAIR Narrative Therapy in assisting a 55-year-old gay man in managing stressors related to his identity and processing traumatic memories, suggesting its applicability for sexual and gender minority individuals navigating trauma-related challenges.

Additionally, Khosravi and Adibi (2022) demonstrated the effectiveness of an intervention combining STAIR with Narrative Therapy-Adolescent Version (SNT-A) in reducing suicidal ideation among an adolescent survivor of rape or sexual assault, indicating the promise of integrated approaches for addressing complex trauma in youth populations.

Overall, the literature highlights the versatility and efficacy of STAIR therapy in addressing trauma-related symptoms across various populations and settings.

Why use Carepatron as your therapy software?

As a mental health professional, helping your patients overcome posttraumatic stress disorder is a priority. Reducing PTSD symptoms, which may have resulted from traumatic memories and childhood abuse through STAIR therapy, is a step toward a life of recovery. And we at Carepatron know just how important that is. That's why we offer an all-in-one therapy software to help you in your private practice. 

Carepatron offers a telehealth feature that helps you set up treatment sessions with your clients in the comfort of their homes. Clients also receive appointment reminders, which helps reduce the risk of no-shows. Furthermore, monitoring client progress has been made convenient to help through progress notes. 

Enhance your client care with the help of our library resources to transform your therapy practice. Try Carepatron today! 

References

Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36(2), 119–124. https://doi.org/10.1016/s0005-7894(05)80060-7

Harvard T.H. Chan School of Public Health. (2021). Mental Health Forum: STAIR Narrative Therapy. In YouTube. https://www.youtube.com/watch?v=WCO9KoU4vvA

Hassija, C., & Cloitre, M. (2015). STAIR Narrative Therapy: A skills focused approach to trauma-related distress. Current Psychiatry Reviews, 11(3), 172–179. https://doi.org/10.2174/1573400511666150629105544

Khosravi, M., & Adibi, A. (2022). STAIR plus Narrative Therapy-Adolescent Version (SNT-A) in an 11-year-old girl with PTSD and suicidal behaviors following rape/sexual assault: A case report. Journal of Child & Adolescent Trauma. https://doi.org/10.1007/s40653-021-00430-5

Marylene Cloitre, Lovelund, A. A., Jackson, C., Edward, D., & Baker, M. (2023). STAIR Narrative Therapy for complex posttraumatic stress disorder: Treating sexual and gender minority trauma. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23572

National Center for PTSD. (n.d.). STAIR Basics - What is STAIR? Www.ptsd.va.gov. https://www.ptsd.va.gov/apps/STAIR/STAIROverview/010201----.htm#

Zaccari, B., Lovejoy, T. I., & O'Neil, M. E. (2023). Skills Training in Affective and Interpersonal Regulation Narrative Therapy delivered via synchronous telehealth: A case study of a rural woman veteran with complex posttraumatic stress disorder. Clinical Case Studies, 22(4), 153465012311584. https://doi.org/10.1177/15346501231158400