Skills Training in Affective and Interpersonal Regulation (STAIR)
Skills Training in Affective and Interpersonal Regulation (STAIR) is a cognitive-behavioral psychotherapy developed by Marylene Cloitre in 2002. Its core mechanism: phase 1 builds emotion regulation and interpersonal skills; Phase 2 uses modified narrative exposure with these new capacities. This catalogue links it to complex trauma and PTSD, typically in individual format, short (16).
Related condition topics
These links support exploration. They do not establish that STAIR is effective or recommended for each condition.
How Skills Training in Affective and Interpersonal Regulation works
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
Epistemology
Evidence
1 condition assessment available
An overall effectiveness assessment has not been completed. Completed assessments for specific populations appear below.
Condition-specific assessments
Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.
Complex Trauma / Developmental Trauma
Population and scope: Adults aged 18–65 with CAPS-5 PTSD after repeated childhood sexual or physical abuse; eight STAIR sessions followed by 16 EMDR sessions, compared with 16 immediate EMDR sessions. Entry did not require a complex-PTSD diagnosis.
Randomized studies
Van Vliet et al. (2021) reports 135 randomized adults; analyses used 121 after 11 withdrawals before treatment and three delayed eligibility exclusions. Only 28.9% met SIDES complex-PTSD criteria at baseline; this was not an ICD-11 diagnostic interview. Both groups improved, with no statistically significant endpoint advantages for adding STAIR through six months or in treatment dropout. Immediate EMDR showed faster early improvement in self-reported PTSD symptoms, interpersonal problems and post-traumatic cognitions. The authors found no need for a preparatory phase in this sample. The study was not an equivalence trial, did not test standalone STAIR and had no inactive control. Twice-weekly STAIR may have limited time to practise skills between sessions. Exclusions included ongoing abuse, acute suicidality requiring crisis intervention and screened substance misuse/dependence. These findings do not establish that every person with complex PTSD needs, or should avoid, preparation.
Source assessment dated
- Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 3
- Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 4
- Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 5
- Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 6
- Van Vliet et al. 2021, STAIR–EMDR versus immediate EMDR, PDF p. 7
Guidelines and official sources (1)
1 clinical guideline check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds the evidence insufficient for a recommendation for or against STAIR. This is not a positive recommendation for complex PTSD.
Scope: STAIR for adult PTSD treatment.
Recorded material under review
The existing notes below are retained separately from assessment records. These recorded claims await source checking, including study design, recommendations and numerical estimates.
5+ RCTs
Included in PTSD meta-analyses
The checked STAIR–EMDR study found improvement in both groups and no significant endpoint advantage over immediate EMDR through six months. Immediate EMDR showed faster early improvement in self-reported PTSD symptoms, interpersonal problems and post-traumatic cognitions. The authors concluded preparation was not necessary in this sample, which did not require a complex-PTSD diagnosis. This was not a standalone STAIR test or a rule for every patient; other protocols and studies require separate review.
Training and certification
STAIR/NST training workshop. Phase-based trauma treatment
No formal certification
16-24 hrs + supervised cases
$1K-2K
Equity & Cultural Adaptations
Clinical cautions and blind spots
Assessment and precautions
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
Blind spots
Two-phase structure lengthens treatment, and Phase 1 can feel slow to clients who are ready to process; the premise itself is contested, since a number of trauma researchers argue that phase-based sequencing delays effective treatment without clear evidence that a skills phase is necessary
Philosophical roots
Herman (phase-oriented treatment); Cloitre (skills before exposure); developmental psychopathology; attachment theory
Compared with other approaches
STAIR in 1 Comparative Clinical Vignette
Each vignette presents the same client through multiple theoretical lenses side by side — showing how STAIR formulates presenting problems, sets treatment focus, and sounds in the consulting room compared with other approaches. This comparative pedagogy is unique to Epoché Clinical; no other clinical reference systematically formulates the same case across traditions.
Test Yourself
STAIR's two-phase structure?
Show answer
Phase 1: emotion regulation + interpersonal skills. Phase 2: narrative processing.