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STAIR: A Treament for PTSD from Childhood Abuse


Updated May 22, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.


The experience of childhood sexual and/or physical abuse has the high potential to lead to the development of posttraumatic stress disorder (PTSD). In addition, people who have experienced childhood abuse experience difficulties in other areas of their life, such as interpersonal problems and anger and shame).

Given the wide range of difficulties experienced among people with PTSD from childhood abuse, some mental health professionals have suggested that current treatments for PTSD, such as exposure therapy, might not be adequate for victims of childhood abuse. Exposure therapy works incredibly well in reducing the symptoms of PTSD, but it may not address difficulties regulating emotion or interpersonal problems.

Therefore, to address this limitation of exposure therapy, Dr. Marylene Cloitre modified exposure therapy for PTSD by first teaching patients healthy ways of managing their emotions and interpersonal relationships. She calls this two-stage treatment, Skills Training in Affect and Interpersonal Regulation (STAIR) with Exposure Therapy.

Components of STAIR With Exposure Therapy

In STAIR, patients are first provided with information on the symptoms of PTSD and the myriad of difficulties that can arise when someone experiences childhood abuse. Next, patients are taught skills focused on triggers, and thoughts. In addition, patients are taught healthy ways of managing their emotions. Patients are also assisted in identifying why some of their difficulties may have developed. For example, patients may explore how their family dealt with emotions.

In addition, patients are assisted in learning how to accept and tolerate their negative emotions. The goal of this is to break down cognitive-behavioral treatment of PTSD can offer this treatment. You can find cognitive-behavioral therapists in your area through provider search engines at the Association for Cognitive and Behavioral Therapies and Anxiety and Depression Association of America. You can also learn more about STAIR at this website.


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 Child Psychology, 70, 1067-1074.

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

Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press.

Levitt, J.T., & Cloitre, M. (2005). A clinician's guide to STAIR/MPE: Treatment for PTSD related to childhood abuse. Cognitive and Behavioral Practice, 12, 40-52.

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F.S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for posttraumatic stress disorder. Journal of Traumatic Stress, 10, 529-555.

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