Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE)

Note: The STAIR/MPE program was not responsive to the CEBC's inquiry. The following information was obtained from publicly available sources.

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) has been rated by the CEBC in the area of: Trauma Treatment (Adult).

Target Population: Adult survivors of childhood or chronic interpersonal violence

Brief Description

STAIR/MPE is a sequential, two-phase treatment based in a developmental model which is designed to be sensitive to the disturbances in attachment, emotion regulation, and interpersonal functioning that survivors of childhood or chronic interpersonal violence often bring to treatment. Phase 1: Skills Training in Affective and Interpersonal Regulation (STAIR) is designed to enhance day-to-day functioning by building emotion regulation capacities and interpersonal skills and provides a window of opportunity for client and therapist to develop a strong therapeutic alliance. Phase 2 of treatment is a modified version of prolonged exposure (MPE). After the exposure work is completed, emotions arising from the narrative should be able to be identified and modulated through grounding techniques. In addition, client and therapist review the taped narratives for interpersonal schemas about self-and-others regarding themes of rejection, betrayal, shame, failure and loss. STAIR/MPE has been shown to provide improvement in emotion regulation, self-efficacy, anger expression, interpersonal problems, and perceptions of social support.

Education and Training Resources

Publicly available information indicates there is a manual that describes how to implement this program, and there is some training available for this program.
See contact info below.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills Training in Affective and Interpersonal Regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067-1074.

Type of Study: Randomized controlled trial
Number of Participants: 58

Population:

  • Age — Mean=34 years
  • Race/Ethnicity — 46% Caucasian, 20% African American, 15% Hispanic, and 19% Other including Asian, Caribbean, and American Indian
  • Gender — 100% Female
  • Status — Participants were adult women survivors of child abuse self-referred by means of advertisements in the community or word of mouth.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article reports on women with posttraumatic stress disorder (PTSD) related to childhood abuse who were randomly assigned to Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) or a minimal attention wait-list control. Phase 1 of STAIR/MPE included 8 weekly sessions of Skills Training in Affect and Interpersonal Regulation (STAIR); Phase 2 included 8 sessions of modified prolonged exposure (MPE). Measures utilized include the Childhood Maltreatment Interview Schedule, the Sexual Assault and Additional Interpersonal Violence Schedule, the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for the DSM–IV (SCID-I and SCID-II), the Modified Posttraumatic Stress Disorder Symptom Scale (MPSS-SR), the General Expectancy for Negative Mood Regulation Scale (NMR), the Anger Expression subscale (Ax/Ex) from the State–Trait Anger Expression Inventory, the Beck Depression Inventory (BDI), the State subscale of the State–Trait Anxiety Inventory (STAI–S), the Inventory of Interpersonal Problems (IIP), the Social Adjustment Scale–Self Report (SAS-SR), and the Working Alliance Inventory (WAI). Results indicate that compared with those on the wait list, participants in STAIR/MPE showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations. Limitations include small sample size, concerns about generalizability due to the exclusion criteria for the study, and the lack of follow-up data on the wait-list group.

Length of postintervention follow-up: 3 and 9 months with the intervention group only.

Cloitre, M., Chase Stovall-McClough, K., Miranda, R., & Chemtob, C. M. (2004). Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 72(3), 411-416.

Type of Study: Secondary analysis of two randomized controlled trials
Number of Participants: 49 (only 34 completed intervention)

Population:

  • Age — 18-40 years
  • Race/Ethnicity — Those that completed intervention: 56% Caucasian, 21% African American, 12% Hispanic, and 11% Other
  • Gender — 100% Female
  • Status — Participants were adult women survivors of child abuse.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcomes of Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) for childhood abuse-related posttraumatic stress disorder (PTSD). Subjects were taken from the STAIR-MPE groups in two randomized controlled trials. Measures utilized include the Clinician-Administered PTSD Scale, the Working Alliance Inventory (WAI), the General Expectancy for Negative Mood Regulation Scale (NMR), and the Modified Posttraumatic Stress Disorder Symptom Scale (MPSS-SR). Results indicate that the strength of the therapeutic alliance established early in treatment reliably predicted improvement in PTSD symptoms at posttreatment. Furthermore, this relationship was mediated by participants’ improved capacity to regulate negative mood states in the context of Phase 2 exposure therapy. In the treatment of childhood abuse-related PTSD, the therapeutic alliance and the mediating influence of emotion regulation capacity appear to have significant roles in successful outcome. Limitations include small sample size, concerns about generalizability, and reliability on self-reported measures.

Length of postintervention follow-up: Not specified.

Levitt, J. T., Malta, L. S., Martin, A., Davis, L., & Cloitre, M. (2007). The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack. Behaviour Research and Therapy, 45(7), 1419-1433.

Type of Study: One group pretest-posttest design
Number of Participants: 59

Population:

  • Age — Mean=45 years
  • Race/Ethnicity — 79% Caucasian, 7% Hispanic, 4% African American, and 10% Other
  • Gender — 68% Female
  • Status — Participants were survivors of the World Trade Center attack on 9/11/2001.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this treatment effectiveness study was to evaluate the flexible application of a Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) for posttraumatic stress disorder (PTSD) and related symptoms in survivors of the 9/11 terrorist attack on the World Trade Center. Measures utilized include the Modified PTSD Symptom Scale Self-Report (MPSS-SR), the Beck Depression Inventory (BDI), the General Expectancy for Negative Mood Regulation Scale (NMR), the Social Adjustment Scale Self-Report (SAS-SR), the Coping Orientation to Problems Experienced Inventory (COPE), and the Interpersonal Sensitivity and Hostility subscales from the Brief Symptom Inventory (BSI). Results demonstrated significant pre–post reductions in symptoms of PTSD and depression for the flexible application of STAIR/MPE. Limitations include lack of control group and small sample size.

Length of postintervention follow-up: None.

References

Ford, J. D., Courtois, C. A., Steele, K., Hart, O. V. D., & Nijenhuis, E. R. (2005). Treatment of complex posttraumatic self‐dysregulation. Journal of Traumatic Stress, 18(5), 437-447.

Levitt, J. T., & Cloitre, M. (2006). A clinician's guide to STAIR/MPE: Treatment for PTSD related to childhood abuse. Cognitive and Behavioral Practice, 12(1), 40-52.

Ponniah, K., & Hollon, S. D. (2009). Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: A review. Depression and Anxiety, 26(12), 1086-1109.

Contact Information

Name: Marylene Cloitre, PhD
Agency/Affiliation: Institute for Trauma and Stress at the NYU Child Study Center
Email:
Phone: (212) 263-7300

Date Research Evidence Last Reviewed by CEBC: July 2017

Date Program Content Last Reviewed by Program Staff: July 2015

Date Program Originally Loaded onto CEBC: October 2013