Modalities / Cognitive-Behavioral

STAIR

Marylene Cloitre · 2002
Key text: Cloitre et al. (2010)
Cognitive-Behavioral Focus: Skill + Processing Short (16) Individual

Core Mechanism

Phase 1 builds emotion regulation and interpersonal skills; Phase 2 uses modified narrative exposure with these new capacities

Ontology

Complex trauma disrupts both affect regulation and interpersonal functioning; skills needed before narrative processing

Therapeutic Voice

"Let's practice naming what you're feeling with more precision — not just 'bad,' but specifically what kind of bad."

View of the Person

A complex trauma survivor whose emotion regulation and interpersonal capacities must be built before narrative processing


Evidence

Referenced in complex PTSD treatment guidelines

5+ RCTs

Included in PTSD meta-analyses

Strong evidence for complex PTSD. Phase-based approach influential.

PTSD & Acute Trauma
Effect: d = 0.76 vs active control
~55-65% improvement in cPTSD
Cloitre et al., 2010 (2010)

Conditions

Epistemology

Empiricist

Blind Spots

Two-phase structure lengthens treatment; Phase 1 skills focus may feel slow for clients ready to process

Contraindications

Active psychosis, severe cognitive impairment, clients in acute crisis requiring immediate stabilization, clients who have adequate emotion regulation and are ready for direct trauma processing without skills-building phase


Training

STAIR/NST training workshop. Phase-based trauma treatment

No formal certification

16-24 hrs + supervised cases

$1K-2K

Equity & Cultural Adaptations

LGBTQ+ affirming adaptationsCross-cultural adaptationsMilitary/veteran-specific adaptations

Philosophical Roots

Herman (phase-oriented treatment); Cloitre (skills before exposure); developmental psychopathology; attachment theory

Related Modalities


Clinical Vignettes

See how STAIR formulates these cases:

Test Yourself

STAIR's two-phase structure?

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Phase 1: emotion regulation + interpersonal skills. Phase 2: narrative processing.


Sources

Cloitre, M., et al. (2010). Treatment for PTSD related to childhood abuse: An RCT (STAIR/NST). AJP, 167(8), 915-924.