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

Adult survivors of childhood or chronic interpersonal violence

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.

Marylene Cloitre
Institute for Trauma and Stress at the NYU Child Study Center

• Email: marylene.cloitre@nyumc.org
• Phone: (212) 263-7300

Homework

This program does not include a homework component.

Languages

Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) has materials available in the following languages other than English:

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is no training information available for this program.

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Formal Support for Implementation

There is no formal support available for implementation of Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Fidelity Measures

There are no fidelity measures for Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Established Psychometrics

There are no established psychometrics for Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Fidelity Measures Required

No fidelity measures are required for Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Implementation Guides or Manuals

There are no implementation guides or manuals for Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Implementation Cost

There are no studies of the costs of Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Research on How to Implement the Program

Research has not been conducted on how to implement Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure.

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• 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. https://doi.org/10.1037/0022-006X.70.5.1067

  Type of Study: Randomized controlled trial

  Number of participants: 58

  Population:

  • Age — Mean=34 years
  • Race/Ethnicity — 46% Caucasian, 20% African American, 19% Other - including Asian, Caribbean, and American Indian, and 15% Hispanic
  • 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:

  The purpose of the study was to examine the effectiveness of Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) on women with posttraumatic stress disorder (PTSD) related to child abuse. Participants were randomly assigned to 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 in the minimal attention wait-list control, 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 the small sample size, concerns about generalizability due to the exclusion criteria for the study, and the lack of follow-up data on the minimal attention wait-list control group.

  Length of controlled postintervention follow-up: None.

• 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. https://doi.org/10.1037/0022-006X.72.3.411

  Type of Study: Randomized controlled trial

  Number of participants: 49

  Population:

  • Age — 18–40 years
  • Race/Ethnicity — Intervention Group: 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:

  The purpose of the study was to examine 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. Participants were assigned to STAIR/MPE. Participants were compared between completer group versus non-completer group of STAIR/MPE. 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 the small sample size, concerns about generalizability, concerns about the reliability on self-reported measures, every participant being assigned to treatment before comparison, and the lack of follow-up.

  Length of controlled postintervention follow-up: None.

• 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.