STAIR Narrative Therapy
Research Findings on STAIR Narrative Therapy

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STAIR Narrative Therapy (SNT) was developed to target and resolve three symptom clusters: PTSD symptoms, emotion regulation difficulties and interpersonal problems

Four studies have demonstrated the effectiveness of STAIR Narrative Therapy.

Two randomized control trials (RCTs) were completed with women who had PTSD related to childhood abuse. The first study indicated that the SNT treatment is superior to the waitlist condition in regard to reducing PTSD symptoms, emotion regulation problems and interpersonal difficulties (Cloitre, Koenen, Cohen, & Han, 2002). The second study found that the sequential therapy (STAIR plus Narrative ) was superior to treatment conditions in which only one or the other of the component parts was provided (Cloitre et al., 2010). Follow-up assessment  in both studies revealed continuing improvement in the three symptom domains of PTSD, emotion regulation problems and interpersonal difficulties over a 6 (Cloitre et al, 2010) and  9 month period (Cloitre et al, 2002).

A third study, with a benchmark design (Levitt et al, 2007), evaluated the flexible application of STAIR Narrative Therapy. Therapists were encouraged to repeat or skip sessions related to the needs of their patients regarding emotion regulation problems, interpersonal problems and PTSD symptoms.  . The results of the flexible treatment were equivalent to a 2002 study, where strict adherence to the standard protocol was required. These findings suggest that STAIR is robust, producing improvement in PTSD symptoms, emotion regulation and interpersonal difficulties while allowing for clinician-based decisions regarding number of sessions and types of interventions for each individual patient. .

STAIR has also been investigated in the context of group work. Specifically STAIR provided in a group format (without narrative work) was compared to  “treatment as usual” psychotherapy groups in an inpatient unit of individuals with PTSD and schizo-affective disorders. Patients in the STAIR condition experienced significant reductions in PTSD, physical agitation, emotional blunting and social withdrawal while the Treatment AS Usual (TAU) condition showed little or no changes in these symptoms.

Secondary analyses of these studies have indicated that the strength of the therapeutic alliance as well as increases in emotion regulation capacity established during the first phase of treatment was associated with increased effectiveness of the narrative work as measured by greater PTSD symptom reduction (Cloitre et al, 2002; Cloitre et al, 2004). These results indicate the benefits of providing an initial phase of treatment that allows for the development of a good working alliance and emotion regulation skills before turning focused attention to the trauma memories. Lastly, the use of the combination of skills training plus narrative work has been shown to produce significantly greater benefits than narrative work alone among those with salient dissociative symptoms (Cloitre et al, 2011).

References

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 child abuse. Journal of Consulting and Clinical Psychology, 70, 1067-1074.

Cloitre, M., Stovall-McClough, C., 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, 411—416.

Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., et al. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. American Journal of Psychiatry, 167, 915-924.

Cloitre, M. Petkova, E, Wang, J. Lu (Lassell)F. (2012). An examination of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse. Depression and Anxiety, 29(8), 709-717.

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, 1419-1433.

Trappler, B., & Newville, H. (2007). Trauma healing via cognitive behavior therapy in chronically hospitalized patients. Psychiatric Quarterly, 78, 317-325.