Surviving is Not the Same as Living: Understanding Complex PTSD and STAIR Therapy

When people think of Post-Traumatic Stress Disorder (PTSD), they often picture a single, life-threatening event - like a car crash or a natural disaster. But when trauma is repetitive, prolonged, or occurs during childhood, it leaves a different kind of footprint.

Living for years under conditions of domestic violence, childhood abuse, or chronic instability changes how you see yourself and how you connect with the world.

In the clinical world, this is known as Complex PTSD (C-PTSD). At The Psychology Alley, we use a specialised, evidence-based approach called STAIR (Skills Training in Affective and Interpersonal Regulation) to help individuals move beyond mere survival and actually reclaim their lives.

The Hidden Impact of Complex Trauma

Standard PTSD primarily causes flashbacks, nightmares, and a constant sense of threat. While C-PTSD includes these symptoms, it also deeply impacts three core areas of everyday life.

1. Emotional storms

Your emotional volume dial might feel broken. You might swing between intense, rapid spikes of anger or irritability, and moments of complete emotional numbing, emptiness, or dissociation. Calming down after being triggered feels almost impossible.

2. A negative self-concept

Complex trauma leaves behind a persistent whisper that you are permanently damaged, worthless, or a failure. This is often accompanied by deep, heavy feelings of chronic shame and guilt, even though you were the victim.

3. Fractured relationships

When the people who were supposed to look after you caused you harm, your brain learns that closeness equals danger. As an adult, this can manifest as keeping people at a distance, completely avoiding intimacy, or finding it incredibly daunting to trust anyone.

You are not broken. If you struggle with these areas, it is not a character flaw. It simply means your energy was entirely consumed by surviving your environment. The skills needed to manage emotions and build safe relationships simply had to take a back seat.

What is STAIR?

Because complex trauma impacts your day-to-day coping mechanisms, traditional trauma therapies that force you to recount your past immediately can sometimes feel overwhelming.

Skills Training in Affective and Interpersonal Regulation (STAIR) is a flexible, buoyant, and resource-building approach. It acts as a phase-based treatment, meaning it helps you build internal strength before you ever choose to look at past memories.

Treatment is typically divided into two clear, manageable parts.

Part 1: Your Emotional Toolkit

The first half of therapy focuses entirely on the present day. You will learn practical, body-based strategies for self-soothing when your nervous system is overwhelmed. We work on cognitive tools to quieten self-hatred, build self-compassion, and help you regain a sense of mastery over your daily life.

Part 2: Navigating the Social World

Once you can steady your emotional storms, the focus shifts to relationships. You will practice skills for assertive communication, learning how to express negative emotions like disappointment safely, and how to tolerate the vulnerability that comes with closeness and intimacy.

Moving the Past into the Past

STAIR can be delivered in individual weekly sessions or in a supportive group format. It can be used as a standalone therapy to improve your quality of life, or as a stabilising first step before doing deeper narrative trauma work.

The ultimate goal of STAIR is not just to reduce your psychiatric symptoms. It is designed to rebuild the environmental, social, and personal resources that complex trauma stripped away, allowing you to finally feel grounded in the present.

Next Steps

If you are ready to stop just surviving and start building a life focused on genuine connection and emotional safety, we are here to assist.

References:

Amilhau, A., Soubelet, A., Crozier, L., & Colamarino, L. (2025). Skills training in affective and interpersonal regulation (STAIR) for treating complex trauma: A systematic review. European Journal of Trauma & Dissociation, 9(1), 100493.

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.

MacIntosh, H. B., Cloitre, M., Kortis, K., Peck, A., & Weiss, B. J. (2018). Implementation and evaluation of the skills training in affective and interpersonal regulation (STAIR) in a community setting in the context of childhood sexual abuse. Research on Social Work Practice, 28(5), 595-602.

Nickerson, A., Cloitre, M., Neuner, F., O'Donnell, M., Bryant, R. A., Liddell, B. J., ... & Specker, P. (2026). Emotion regulation skills training as an adjunctive treatment to narrative exposure therapy for posttraumatic stress disorder (PTSD) in refugees: a pilot randomized controlled trial. European Journal of Psychotraumatology, 17(1), 2648941.

Ortigo, K. M., Bauer, A., & Cloitre, M. (2020). Skills training in affective and interpersonal regulation (stair) narrative therapy: Making meaning while learning skills. In Emotion in posttraumatic stress disorder (pp. 513-543). Academic Press.