Insights into Psychology Series, Therapy

What Is… STAIR Narrative Therapy for PTSD

Insights into psychology: STAIR narrative therapy for PTSD

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is STAIR narrative therapy.

I recently stumbled across STAIR narrative therapy for PTSD, so I thought I’d do a post about it. STAIR stands for Skills Training in Affective and Interpersonal Regulation. STAIR narrative therapy, which was developed by Marylene Cloitre, consists of two different modules: first the STAIR, then the narrative therapy.

STAIR

STAIR teaches present-focused skills for managing emotions. It’s delivered over 8 sessions, either in a group or individual format. It covers:

  • Session 1: Introducing the Client to Treatment: includes teaching of focused breathing technique
  • Session 2: Emotional Awareness: includes naming and describing emotions, using a feelings list and feelings wheel, and a feelings monitoring form (situation, feeling, intensity, thoughts, actions)
  • Session 3: Emotion Regulation: uses a 3 channels of emotion approach—body, thought, and behaviour, and covers coping skills
  • Session 4: Emotionally Engaged Living: includes pleasurable activities
  • Session 5: Understanding Relationship Patterns: looks at interpersonal schemas
  • Session 6: Changing Relationship Patterns: involves role-playing
  • Session 7: Agency in Relationships: covers boundaries, assertiveness, “I messages,” and making requests effectively
  • Session 8: Flexibility in Relationships: includes effectively saying no and looking at power balances in relationships

STAIR resources

The US Department of Veterans Affairs has a STAIR Coach app. It includes a mood journal and a self-care section, which includes planning the use of STAIR tools. Because it’s meant to be used in conjunction with STAIR therapy, it doesn’t really get into explanations of the tools, but they include things like:

  • act the opposite
  • ask for support
  • compassion for others
  • focused breathing with music
  • muscle relaxation
  • pleasurable activities
  • positive imagery
  • practice assertiveness
  • soothe the senses

Kaiser Permanente has posted a set of STAIR group handouts on their website, which can give you a better idea of what’s involved.

Narrative therapy

The narrative therapy component then moves to the past to create a sequential narrative of the traumatic events in order to create meaning. The story has a beginning, middle, and end, like an autobiography. The trauma is framed as making up only certain chapters in the larger autobiography of life. The client is empowered as the author of their own story, able to create future chapters for themselves.

This component also looks at how the trauma has affected relationship schemas, and how strategies that were adaptive in the context of trauma may no longer be helpful.

The rationale

The therapy takes the approach that recovery involves making meaning of the past as well as building skills for living in the present. It recognizes that sustained traumas can lead to internal resource depletion and interrupt the development of personal skills. STAIR is designed to boost those skills before delving into the trauma. The narrative component then allows people to rewrite their own story.

A major goal of therapy is to improve self-efficacy and self-acceptance, and also to allow people to approach the world with greater empathy and compassion.

STAIR training on its own has been shown to be beneficial for people with PTSD/C-PTSD, but the combined STAIR narrative therapy is more effective.

Dr. Cloitre did a talk on STAIR narrative therapy for the Harvard School of Public Health, which you can watch here if you’re interested.


It sounds like STAIR narrative therapy draws on bits and pieces from cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), and narrative exposure therapy. Have you ever come across or done this type of therapy?

Sources

The Psychology Corner: Insights into psychology and psychological tests

The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.

14 thoughts on “What Is… STAIR Narrative Therapy for PTSD”

  1. I’ve done the first three a lot, and am troubled by acting the opposite. But, that’s what society wants. They don’t want a mentally I’ll person acting mentally I’ll at appointments and in the general public. They want us to be pleasing and polite. Hmmm. Could that have anything to do with why we are so bothered at times? That we keep it all locked away at certain times?

    1. I don’t think that’s how it’s intended. At least in DBT, it’s more like if your illness is urging you to do something or react in a particular way, that’s often the opposite of what’s actually good for you, kind of like anxiety urges people to avoid but avoidance actually makes anxiety worse.

  2. I don’t have trauma, but eight sessions for all those things sounds pretty intense!

    I had thought about something similar to narrative therapy for my own issues. I think it can even apply to groups in society. I know the biggest thing for me in changing my life lately is being able to reframe my internal narrative that had been, “I’m a useless person who can’t function in the world” to “I’m an autistic person who struggles with some things.”

  3. I’m wondering how it actually works. For my PSTD I was just given strong anti anxiety tablets and with time, when I was well enough to ‘act normal’ it went away.

    My PTSD was caused by workplace issues and I think the fact that I was recently dismissed by a different employer but can function pretty much normal shows that I don’t have PTSD any more.

    But when I think how bad I felt at the time it seems impossible that any type of therapy would help without medication, I was frightened of absolutely everything. But then possibly it was because no one believed me.

  4. Never heard of it. Sounds interesting. As I might have mentioned, Keva’s mom is an EMDR therapist for PTSD. I might try that next.

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