S12G V2.

4 01-19

Skills Training in Affective & Interpersonal Regulation

STAIR
Essentials
Marylene Cloitre1, Madhur Kulkarni2, Christie Jackson3, Brandon Weiss1,
Chetali Gupta1

1
National Center for PTSD, VA Palo Alto Health Care System
2
VA Palo Alto Health Care System
3
VA New York Harbor Healthcare System
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12 Session STAIR
Session Topic
1 Introduction to Treatment
2 Emotional Awareness
3 Emotion Regulation - Focus on the Body
4 Emotion Regulation - Focus on Thoughts and
Behaviors
5 Emotionally Engaged Living - Distress Tolerance
6 Understanding Relationship Pattern
7 Changing Relationship Patterns - Increasing
Assertiveness
8 Changing Relationship Patterns - Practicing
Assertiveness
9 Changing Relationship Patterns - Managing Power
10 Changing Relationship Patterns - Increasing
Respect for Self and Others
11 Changing Relationship Patterns - Increasing
Closeness
12 Summary of Work and Self-Compassion
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Skills Training in Affective & Interpersonal Regulation

STAIR
SESSION # 1 Introduction

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SESSION AGENDA
Identify goals
Review challenges
Discuss impact of trauma on emotions and relationships
Overview of treatment approach (3 channels)
New Tool: Focused Breathing exercise
Commit to skills practice

PURPOSE
o This treatment was specifically designed for individuals who have had traumatic
experiences.

o Some symptoms relate directly to the trauma such as nightmares, intrusive thoughts
or memories of trauma, and feeling jumpy or easily startled. One of the goals of this
treatment is to develop coping strategies to manage and resolve these symptoms.

o Emotions can be hard to manage. People can feel overwhelmed and thus avoid
feelings as much as possible or just shut down completely. This treatment will help
make it easier to be aware of what you feel and use your feelings as a healthy guide
for making decisions and taking action.

o Trauma also can have a negative impact on relationships. This includes feeling
disconnected from others or not understood, loss of trust in others, and difficulty
managing conflict. This treatment will help restore (or help develop!) confidence in
yourself, appropriate assertiveness, and help manage or improve relationships.

o Self-identify can suffer, as trauma can lead to feeling a loss of mastery and control,
even a loss of self-worth. Feelings of shame and guilt can occur.

Goals of this treatment are to help you learn:

o How to become more aware and comfortable with all your emotions
o Positive, healthy coping skills for managing distressing feelings
o How to identify unhealthy relationship patterns
o Skills to improve your relationships
o How to increase your sense of mastery and self-worth

HOW TRAUMA IMPACTS INDIVIDUALS

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What is Trauma?
A traumatic event is an overwhelming or uncontrollable experience that can happen to
anyone at any age.
It may be a personally life-threatening experience or may involve witnessing something
that causes you to feel horrified, helpless, or intensely fearful for your life or the lives of
others.
Traumatic events can include child abuse, domestic violence/partner violence, combat
violence, sudden/unexpected loss of a loved one, car accidents, sexual abuse/violence, and
natural disasters (e.g., a hurricane).

How Might Trauma Negatively Impact You?

Disturbing memories of events: nightmares, flashbacks, feeling like the experience is
happening all over again, discomfort with or avoidant of reminders of the experience.

Emotions: difficulty tolerating and expressing negative emotions including anxiety,

sadness, and anger; alternating between numbness (no feelings) and feeling out of control
(too much feeling).

Relationships: isolation; difficulty having close relationships due to distrust, difficulties

with resolving conflicts, and secrets; tendency to view others as
rescuers/victims/aggressors; repeating problematic relationship patterns.

Sense of Self: feelings of helplessness, loss of confidence, feeling worthless, feeling

ashamed and guilty. Feeling loss of identify (e.g., you are not the same person you were).

Physical Health: trouble with emotions can lead to sleep problems, headaches, pains in
stomach, tense muscles, problems with drinking or smoking too much, or not eating well.

Emotional Disorders: Posttraumatic Stress Disorder (PTSD), Depression,

Anxiety/Anxiety Disorders, Panic Disorder, Eating Disorders, Substance Use Disorders.

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STAIR focuses particularly on problems with emotion management and

relationships, both of which are common difficulties following traumatic
events.

Difficulty understanding and labeling feelings

Difficulty identifying your own emotions accurately
Feeling overwhelmed by emotions (positive or negative)
Fear of emotions/feeling emotions; see emotions as unsafe

actually experiencing
Wanting to avoid or escape emotions
Feeling that emotions control you

________________________________________________________

________________________________________________________

Feel distant or cut-off from others

Feel different from other people
Easily irritated by others
Feel others would not respect me if they knew what happened to me/what I did

Believe most people will disappoint me

Not assertive enough with others
Too aggressive with others

Avoid relationships
________________________________________________________

________________________________________________________

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How Have You Coped with These Problems?

How healthy are these strategies?

Do these behaviors work long-term?

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FOCUSED BREATHING EXERCISE:

Rationale:
One technique for dealing with distressing feeling states involves decreasing your physiological
arousal using breathing retraining.
When people are in an aroused state they tend to breathe from their chest and also breathe quicker
and more shallow. This can actually increase symptoms of anxiety including dizziness,
breathlessness, and even disorientation.
The aim of this exercise is to slow down your breathing which will in turn lead to a decrease in
anxiety.
It can also be used to manage states of irritation or anger and as a meditative tool for feeling calm
and grounded.

Getting started:
Make yourself comfortable (seated or lying down). Close your eyes or select one point in the room
to focus on and soften your gaze. Place one hand on your chest and the other on your stomach.
Take a slow, deep breath, and pay attention to which hand moves.
When breathing from the diaphragm, only the stomach hand should move up and down (or
mostly). It can help to think of how babies sleep, how their tummy moves up and down. Or you
might imagine your stomach as a balloon, filling with air and expanding as you inhale, then letting
out the air and shrinking as you exhale.

Slow down your rate of breathing:

Take in enough air to fill the space, then let it out slowly. Sometimes breathing out through the
nose is easier because it is a smaller opening which will help to control the rate of exhalation.
Pause briefly after exhaling before inhaling again. Some people tend to hold their breath too long at
first; the pause should come after exhaling.
Imagery can be helpful in maintaining a slow and steady rhythm. For example, a wave is a helpful
image for some. The image of climbing up a slide (inhaling) then sliding down (exhaling) and briefly
pausing at the bottom before climbing up again has been helpful for some people.

Meditational component:
In order to help slow your thoughts and focus attention on breathing, count your breaths as you
inhale, and think "relax," "calm," or some similar thought as you exhale.
Continue counting your breaths until you get to "10" and then start over at "1."
It is perfectly natural for other thoughts to come into your mind. Try not to get angry or frustrated,
just allow the thoughts to pass through your mind and bring your attention back to counting as
often as you need.
Some people find it helpful to concentrate mostly on the physical sensation of their breathing,
others on the counting or "relax" statement. Experiment with different methods, and do whatever
works best for you.

Practice: Practice is essential to develop this skill so it becomes something you can use to decrease distress
in stressful situations. You should practice the technique in a comfortable, quiet place where you will not be
disturbed. Take a few seconds to relax, then practice the breathing exercise for at least 5 minutes. This
should be practiced at least twice a day. Initially, it is best not to practice when you are already distressed.
The idea is that if you practice the breathing when you are in a calm state, it will become a habit that can
then be called upon when you are distressed.
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PRACTICE EXERCISES BEFORE SESSION 2

Practice the Focused Breathing exercise twice daily.

Complete ocial Influences on Our Emotional Experience.

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Skills Training in Affective & Interpersonal Regulation

STAIR
SESSION # 2 Emotional Awareness

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your
relationships

AGENDA:
o Review topic/tools from previous session
o New Topic: Emotional Awareness
o New Tools: Feelings Monitoring Form, Feelings List, Emotional Intensity Scale,
Feeling Wheel, Emotion Surfing
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Relationship between trauma and emotion/relationship problems
o Discussed how this treatment will offer more tools to add to your toolkit for
dealing with emotion difficulties and improving relationships

FOCUS ON EMOTIONAL AWARENESS

Being aware of what you are feeling, what other people are feeling, and how to express feelings
is something that is learned. What did you learn about how to express feelings in different
situations: growing up, in military, in your social situation now?

FUNCTION OF FEELINGS
Feelings are a resource for effective living. Following a trauma, feelings can become

can trust them to help you make decisions, take actions, and enjoy life.

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The STAIR Philosophy About

Emotions
Emotions serve a purpose. They:
Act as messengers (provide useful information)
Tell us who we are (our likes and dislikes)
Communicate with others

Trauma can overwhelm the emotional system,

creating both confusion and numbing.

Tools introduced in this session will help you:

Notice and name emotions
Identify their influence on your actions
Begin acting and relating to others in ways that
are consistent with your values

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Emotional Intensity Rating Scale
The Emotional Intensity Rating Scale is a convenient way of communicating to other people how much distress
you are experiencing at any given time. There are eleven points on the scale, ranging from 0 (absolute and complete
relaxation) up to 10 (extreme distress).

0 Total peace and serenity, such as when walking peacefully in the woods or reading a good book.
Your example:__________________________________________________________

1 Relaxed and not distressed. Stress is not experienced as unpleasant; it is

Your example:__________________________________________________________

2 A little bit upset but not a big deal (e.g., your shoes are uncomfortable). You have to pay special attention to
notice you are upset.
Your example:__________________________________________________________

3 Slightly upset/annoyed/bothered/worried. You notice it, and you have some unpleasant feelings/thoughts.
No bodily sensations.
Your example:__________________________________________________________

4 Mild distress, such as mild feelings of worry, apprehension, fear, or anxiety. The beginning of bodily tension
that is somewhat unpleasant.
Your example:__________________________________________________________

5 Mild to moderate distress. Some distinct, unpleasant bodily symptoms, but still tolerable.
Your example:__________________________________________________________

6 Moderate distress. Very unpleasant feelings of distress and/or substantial bodily tension such as a headache
or upset stomach.
Your example:__________________________________________________________

7 Moderately high distress that makes concentrating difficult. Fairly intense bodily distress. You can make
good choices about your behavior, but with some difficulty.
Your example:__________________________________________________________

8 High distress and/or bodily tension. These feelings cannot be tolerated very long. Thinking and problem-
solving are impaired and become difficult. Bodily distress is substantial.
Your example:__________________________________________________________

9 High to extreme distress. Bodily distress is substantial and the distress feels almost unbearable. Thinking is
significantly impaired. Feeling overwhelmed and out of control of your behavior.
Your example:__________________________________________________________

10 Extreme distress, panic- and/or terror-stricken, extreme bodily tension. The maximum amount of fear,
anxiety, and/or apprehension you can possibly imagine.
Your example:__________________________________________________________

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Feelings List

Affectionate Glad Relaxed

Afraid Gloomy Relieved
Amused Grateful Resentful
Angry Great Resigned
Annoyed Guilty Sad
Anxious Happy Safe
Apathetic Hateful Satisfied
Apprehensive Helpless Secure
Ashamed Hopeless Sexy
Bitter Horrified Shy
Bored Hostile Silly
Calm Impatient Strong
Capable Inadequate Stubborn
Cheerful Inhibited Stuck
Comfortable Irritated Supportive
Competent Isolated Sympathetic
Concerned Jealous Tearful
Confident Joyful Tender
Confused Lonely Terrified
Contemptuous Loved Threatened
Controlled Loving Thrilled
Curious Loyal Touchy
Defeated Manipulated Trapped
Dejected Manipulative Troubled
Delighted Melancholy Unappreciated
Depressed Miserable Uncertain
Desirable Misunderstood Understood
Despairing Muddled Uneasy
Desperate Needy Unfulfilled
Determined Nervous Unimportant
Devastated Numb Unloved
Disappointed Out of control Upset
Discouraged Outraged Uptight
Disgusted Overwhelmed Used
Disillusioned Panicky Useless
Distrustful Passionate Victimized
Embarrassed Peaceful Violated
Enraged Pessimistic Vulnerable
Excited Pleased Withdrawn
Frantic Powerful Wonderful
Frightened Prejudiced Worn out
Frustrated Pressured Worried
Fulfilled Proud Worthwhile
Furious Provoked Wronged
Generous Put down Yearning
Fanning, Patrick. The Addiction Workbook , p.88

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Increasing Your Emotional Awareness

Be more present with and mindful of your emotions.

Bring your complete attention to your experience in the present moment. Your three
channels (thought, behavior, and body) give you important clues to identify your
emotions.
having specific emotions or thoughts.
Accept yourself and your experiences in the present moment; allow yourself to be where
you already are, without attempting to change it or make it go away.
Seeing a thought or emotion for what it is--just a thought or emotion--rather than
buying into it and treating it as fact.
Tool: Emotion Surfing

Attempt to identify your emotions in the moment.

Tools: Use the Emotion List and Emotion Wheel if you need help identifying or labeling
your emotions.

Notice the intensity of your emotions.

Tools: Use the Emotional Intensity Rating S to determine

the intensity of the emotion you are experiencing.

Began to notice patterns in your emotions.

Tools: The Feeling Monitoring Form helps you learn about your emotions and the
situations that bring up specific feelings, as well as the coping strategies that you use that
do or do not work.

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PRACTICE EXERCISES BEFORE SESSION 3

Complete Feelings Monitoring Form (FMF) daily.

Continue to practice Focused Breathing at least twice a day/practice Emotion Surfing.
Use coping strategies to deal with difficult feelings and situations identified in FMF.

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Skills Training in Affective & Interpersonal Regulation

STAIR
SESSION # 3 Emotion Regulation
Focus on the Body

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

AGENDA:
o Review Feelings Monitoring Form and coping strategies
o New Topic: What is Healthy Emotion Regulation and Emotion Regulation on Body Channel
o New Tools: Self-Care Refueling Goals, Body Channel Tools for Emotion Regulation (Attention
to the Senses, Progressive Muscle Relaxation)
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

O
O How emotions can act as messengers
O How to increase your emotional awareness
O We introduced tools: Feelings Monitoring Form, Emotional Intensity Scale, Feelings List,
Feelings Wheel

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WHAT CAN SODA TEACH US ABOUT EMOTIONS?

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HEALTHY EMOTION REGULATION

What is Healthy Emotion Regulation?

Emotion Awareness: noticing and identifying the emotions you experience

Accepting all your emotions

Respond to negative and/or intense emotions in a way that is consistent with your values
(e.g., asserting yourself rather than acting aggressively)

Using multiple healthy strategies to cope with unpleasant emotions

What Healthy Emotion Regulation is NOT:

Believing you have no way to influence how you feel

Avoiding experiencing negative or strong emotions

Using unhealthy strategies to avoid or change your emotions (such as isolation, addiction, or
aggression)

Blaming others for your emotional experiences and your response to your emotions

Failing to protect yourself from harm

Failing to evaluate whether your actions

STAIR Ways to Respond to Emotions

Be aware of feelings
Use tools for body, thought, and behavior channels to regulate when upset

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Improving Your Emotional Health

Your emotional health is like your physical health: it needs nurturing.

When it does not get care, you begin to show more strain and it impacts
what triggers you, what you feel and think, and your resulting behavior.

Which of these can impact your mood/emotional health?

Lack of sleep
Hunger
Chronic stress (e.g., worries about finances/employment/housing)
Physical discomfort (e.g., being too hot or too cold)
Pain

What would it take to refuel your emotional tank?

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BODY CHANNEL

UNHEALTHY COPING IN THE BODY CHANNEL COMMON TO TRAUMA SURVIVORS:

Poor sleep habits
Poor diet
Use of harmful substances
Not enough exercise
Pushing your body too much/too much exercise
Ignoring your body (e.g., not treating illness, not visiting the doctor/dentist)
Self-injury to cope with negative feelings or to help with numbness
Poor hygiene

Others?
___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

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BODY CHANNEL TOOLS FOR EMOTION REGULATION

BASICS OF SELF-CARE

Meeting your basic needs

Stress and lack of attention to your body (e.g., hunger, thirst, rest, illness,
discomfort/pain, hygiene, and exercise) can influence your mood.

Routine refueling of your body. Treat your body well with a good diet, adequate sleep,
regular exercise, and other healthy behaviors.

Exercise. Take a walk, run, or stretch.

Improve your physical environment to make yourself feel comfortable.

When possible, notice your response to temperature, clothing, colors/textures,
sounds/noise, and clutter. Small changes in your surroundings can increase serenity
and positive emotions.

Create a Self-Care Health Plan.

Make ONE commitment to do something to improve your physical health starting

today. Use the Tracking Tool to schedule and track your activities.

Sleep ___________________________________________

Eating ___________________________________________

Exercise ___________________________________________

Your Environment _____________________________________

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EMOTION REGULATION STRATEGIES FOR THE BODY
CHANNEL
SOOTHING ACTIVITIES

In addition to basic refueling, you can learn techniques for reducing stress. You have already learned
the Focused Breathing exercise; keep using this one. Pick at least one other activity that feels good to
you. If you like the Progressive Muscle Relaxation (PMR), you can replace one of the two senses
work with PMR.

Get in touch with the environment using all 5 senses.

What can you carry with you to look at that is soothing?________________________

What can you listen to that is soothing or who can you call?_____________________

What can you smell that is soothing?______________________________________

What can you taste that is soothing?_______________________________________

What can you touch that is soothing?______________________________________

Try to target more than one sense at a time to help you relax more quickly and effectively.

Practice Muscle Relaxation. This is an optional exercise which may be especially

good for reducing dissociation. It is also recommended for managing chronic pain.

End session with identifying 2 body channel commitments. See tracking form.

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Progressive Muscle Relaxation (PMR)

Brief Description: You'll be alternately tensing and relaxing specific groups of muscles. After
tension, a muscle will be more relaxed than prior to the tensing. Concentrate on the feeling of the
muscles, specifically the contrast between tension and relaxation. In time, you will recognize
tension in any specific muscle and be able to reduce that tension.

How often do you practice it? Do the entire sequence once a day if you can, until you feel you
are able to control your muscle tensions.

Before the exercise: Sit in a comfortable chair or lie down on a bed. Get as comfortable as
possible--no tight clothes, no shoes, don't cross your legs.

Be careful: If you have problems with pulled muscles, broken bones, or any medical
contraindication for physical activities, consult
hurt. If you have pain in a specific area, skip that area.

Directions: Take a deep breath; let it out slowly. Again. Don't tense muscles other than the
specific group at each step. Don't hold your breath, grit your teeth, or squint! Breathe slowly and
evenly and think only about the tension-relaxation contrast.

Each tensing is for 10 seconds; each relaxing is for 10 or 15 seconds. Count "one-1,000
two-1,000..." until you have a feel for the time span.
Note that each step is really two steps--one cycle of tension-relaxation for each set of
opposing muscles.

1. Hands.
2. Biceps and triceps.
3. Shoulders.
4. Neck
5. Mouth.
6. Tongue.
7. Eyes.
8. Back.
9. Butt.
10. Thighs.
11. Stomach.
12. Calves and feet.
13. Toes.

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PRACTICE EXERCISES BEFORE SESSION 4

Complete Feelings Monitoring Form (FMF) daily (note positive and negative emotions).
Practice at least one body channel activity daily (soothing activities, Progressive Muscle
Relaxation, or self-care) in addition to Focused Breathing.
Continue Focused Breathing twice daily.
Using coping strategies to deal with difficult feelings or situations identified in your FMF.

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Skills Training in Affective & Interpersonal Regulation

STAIR
SESSION # 4 Emotion Regulation
Focus on Thoughts and Behaviors

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your
relationships

AGENDA:
o Review Feelings Monitoring Form and coping strategies
o New Topic: Emotion Regulation on the Thought and Behavior Channels
o New Tools: Emotion Regulation Tools on Thought Channel emotion surfing (again!),
evidence technique, thought shifting, positive images, reminders/reframes, positive
statements (affirmations) (Select two)
o New Tools: Emotion Regulation Tools on Behavior Channel take a break/Time Out,
slow down, alternative action, ask for help/seek support, pleasurable activities (Select
two)
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Discussed what soda can teach us about our emotions
to be processed and are allowed to lessen over time
o Defined
o Identified unhealthy coping strategies you have you used in the body channel
o Learned healthy tools for the body channel

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy strategies have
you used this week?

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UNHEALTHY COPING ON THOUGHT CHANNEL

COMMON TO TRAUMA SURVIVORS

THINKING PATTERNS

Assuming you are not safe

Fear of your own negative emotions

Not willing to trust others and/or yourself

Tuning into the negative and tuning out the positive

Black-and-White Thinking (there are no in-betweens)

use? Doomsday Thinking

The tyranny of t or

Avoiding thoughts/memories

Thinking non-stop about problems; trying to prolong negative feelings

Dissociation

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Emotion Surfing

Evidence Technique: Test your negative thought(s)

List the evidence for and against the accuracy of a negative
thought.
How strong is the proof? Compare the evidence for and against the accuracy of
the thought to determine how realistic or valid it is.
Let go. Be willing to let go of inaccurate automatic thoughts.
What else could it be? Consider alternatives; ask friends or people you trust.
Try it on for size. Live with it for a while, consider the benefits.

Thought shifting
Temporarily shift your attention rather than focusing on your worries until your
distress is at a reasonable level and you can think clearly and act appropriately.
Shift to another thought: Focus on something else in the room (e.g., colors, lights,
smells) or substitute your thought with another thought a positive
thought/statement, memory, or image.
Shift to a healthy activity: To help change your focus, engage in a healthy activity
go for a walk, listen to music, watch a video, clean/organize, call a friend,
complete some easy tasks that remain unfinished.

Positive imagery
Visualize a situation or setting (real or imagined) in which you feel calm and good.
Make that image as clear and vivid as possible by imagining how the place
looks, smells, sounds, etc.
Keep it handy. Keep pictures or symbols to remind you of the image/memory
(e.g., on your phone, in your wallet, or on a keychain) to help remind you of the
positive setting when you are distressed.

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Reminders/Reframes: Give yourself reminders to help you accept your
feelings
Feelings are just feelings, and thoughts are just thoughts. They are not facts, and
.
Feelings are short-term and will not be there forever.
Stuffing feelings inside only makes it harder to manage them long-term.

Positive statements (Affirmations)

Regularly repeat and make a commitment to a positive thought or a goal.

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Examples of Positive Statements (Affirmations)
o

o This too shall pass.

YOUR OWN PERSONAL MANTRA: ________________________________________________

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UNHEALTHY COPING ON BEHAVIOR CHANNEL COMMON TO TRAUMA SURVIVORS

Isolating

Avoiding necessary daily activities to avoid anxiety (e.g., not opening mail or
paying bills because it feels like "too much")

Addiction (e.g., alcohol, drugs, food, gambling, pornography, shopping,

video games)

Purposeful avoiding of taking care of yourself (e.g., restricting food intake,

stopping self-care)

Using anger to distance others

Avoiding family & friends

Taking care of other people to avoid your own problems

Avoiding having positive or negative emotions

Using controlling behavior to avoid feeling unsafe in situations and

relationships

Treating people badly when you are struggling with negative feelings

________________________________________

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Take a Break (Time-Out) (see worksheet):

Remove yourself from situation.
Identify a time you will return.

Slow Down:
Take a few deep breaths.
Do nothing.
Wait for response.
An opportunity to learn nothing bad happens.

Replace the problematic behavior with an alternative activity:

Replacement Behavior.
Opposite Actions (see worksheet).

Seek Support.
Call or text a friend/sponsor/provider and share your frustrations.
Attend a meeting or group.

Do something you enjoy (see Pleasurable Activities List)

Routinely engage in meaningful and pleasant activities to increase your
enjoyment.
When distressed, use pleasant activities to improve your mood.

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Take a Break: Formal Time-Out

Goal: Allowing yourself to take a break from a stressful situation until your
emotional level has decreased and you are less upset. This is not avoidance but
instead a deliberate choosing to take a break.

When to use it?

You are struggling with an automatic response that feels overwhelming.
You think you may make the situation worse.
You are so worked up that you cannot think clearly enough to be effective
in the situation.
Example: You become very angry while arguing with a family member and think you
may say hurtful things or become violent.

How to use it effectively:

o Simply stop the discussion that is provoking your increased distress and/or
leave the situation that is causing your escalation.
o Communicate to others what you are doing, why, and when you will be
back.
o Example: "I am feeling really angry, and I need a Time-Out before I say or do
something I will regret. I'm going to take 30 minutes to cool down. When I come back
and you are willing, I would like to continue this conversation."
o During the Time-Out:
Do not try to purposefully hold on to the negative emotion, increase the
emotion, or try to suppress/avoid it.
Notice the emotion, and watch it slowly ebb away.
Engage in an activity (like a walk) or other coping strategies that will help
you de-escalate your distress. The Time-Out can also be used with other
strategies, and you may want to think about activities that would best suite
you and your needs.

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Act Opposite of Your Emotional Urge

Your Emotion Your Urge Opposite Action

Anxiety Avoid Approach

Do it anyway (repeatedly)
Start small

Anger Attack/Punish Practice empathy and sympathy

Do something nice
Disengage from conflict or stressor

Sadness Isolate/Withdraw Be active

Do things that make you feel competent
Do things that you enjoy
Guilt Hide/Punish self Understand whether this feeling is justified or not
or others Identify and repair wrong as needed
Commit to doing things differently in future, accept
consequences, and let go

Shame Hide Understand whether this feeling is justified or not

Accept and have compassion for self
Commit to doing things differently in the future, accept
consequences, and let go

Overwhelmed Shut down/ Slow things down

Avoid Be present in the current moment
Make a list
Start with small steps
Do it anyway (repeatedly)

Hopeless Give up Do it anyway (repeatedly)

Start small

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Arts and crafts Painting

Bike riding People watching
Browsing in a book store Photography
Camping Playing music
Cooking Playing board games/cards with
Dancing friends or family
Drawing Playing with pets or kids
Exercising Reading a book
Fishing Relaxing in the park
Hanging out with a good friend Sexual Activities
Helping a friend Sitting in a coffee shop
Jogging Supporting a cause
Journal writing Swimming
Gardening Taking a long hot bath
Getting a massage Taking an interesting class
Pampering yourself: haircut, shave, Taking a walk
manicure/pedicure, facial, etc. Talking on the phone with a friend
Going for a drive Visiting friends
Going hiking Viewing beautiful scenery
Going on a picnic Volunteering
Going to church Watching a game in person or on TV
Going to a library Watching a favorite movie
Going to a play or concert
Going to a museum Your own suggestions:
Having lunch/dinner with a friend
Lifting weights ____________________________
Listening to music
Meditating

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PRACTICE EXERCISES BEFORE SESSION 5

Use Feelings Monitoring Form (FMF) once a day for 1 week (note positive and negative
emotions).
Practice two skills from the thought and behavior channels.
Continue Focused Breathing.
Use skills from all three channels as applicable to manage distressing feelings and situations
identified in the FMF.
Practice at least one strategy to increase positive experiences during the week.

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Skills Training in Affective & Interpersonal Regulation

STAIR
SESSION # 5 Emotionally Engaged Living
Distress Tolerance

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

AGENDA.
o Review Feelings Monitoring Form and coping strategies over the week
o New Topic: Distress Tolerance
o New Tool: Use FMF to identify situation that is worth coping with/apply skills
o Commit to skills practice

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy strategies have
you used this week?

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DISTRESS TOLERANCE IS
The ability to endure pain or hardship without resorting to actions that are
damaging to yourself or others.
Distress tolerance is a necessary life skill that most of us practice on a daily
basis.
Examples:
o Effectively controlling your anger when you feel a friend or family
member has wronged you.
o Managing anxiety when you are receiving a performance review from
your supervisor at work.
o What are other examples?
WHY TOLERATE UNPLEASANT EMOTIONS?
Allows us to act in a crisis
Frees up the energy we use for avoidance. Avoiding stress saps energy.
Enables us to make positive change. If you do not allow yourself to be in
touch with this distress, there will be no motivation to make important changes.
Distress can tell you that something is wrong, as well as tell you which areas in
your life you need to pay attention to and change.
Allows us to also experience positive emotions. Avoiding feelings means
that most or many feelings are cut off, not just negative ones. Tolerating more
negative, difficult feelings has the benefit of allowing a person to be more open
to experiencing positive feelings as well.
Allows us to achieve goals. It allows us to do difficult but worthwhile things
(e.g., interviewing for a job). Preparing to make any major change in life will
involve some anxiety and discomfort. By tolerating distress, you allow yourself
to achieve the goals that are important to you.

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PRACTICE EXERCISES BEFORE SESSION 6

Use Feelings Monitoring Form once a day for 1 week (note positive and negative emotions).
Use skills from all channels to tolerate distress to meet a goal.
Continue Focused Breathing.
Practice at least one strategy to increase positive experiences during the week.

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Skills Training in Affective and Interpersonal Regulation

STAIR
SESSION #6 Understanding Relationship Patterns

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

TODAY S AGENDA.
o Review Feelings Monitoring Forms and coping from previous session
o New Topic: Understanding relationship patterns and self-fulfilling prophecies
o New Tool: Relationship Patterns Worksheet 1
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Discussed value of tolerating unpleasant emotions
o Discussed how to decide which situation to practice distress tolerance

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy strategies have
you used this week?

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LINK BETWEEN EMOTION REGULATION AND HEALTHY RELATIONSHIP BEHAVIOR

Now that you have practiced some useful emotion regulation skills, you will use them to benefit
your relationships. Before getting started with that, consider what contributes to healthy and
unhealty relationships.

Good emotion regulation allows better communication and makes people more willing to
listen to you and open up.

Positive emotions elicit a postive response.

Negative emotions elicit a negative response.

Along with changing the emotions we bring to a situation, we can also change our
EXPECTATIONS about an interaction or a relationship.

Everyone has expectations about relationships and typical ways of approaching them. These
relationship patterns include beliefs, feelings, and actions, often based on past experiences.
Sometimes they help build and strengthen relationships, but sometimes ingrained expectations get
in the way of new and better ways of relating to others.

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What are your expectations about relationships now? Which do you view as
healthy

and which do you view as not so healthy?

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RELATIONSHIP PATTERNS: WHAT DOES YOUR RELATIONSHIP INSTRUCTION MANUAL LOOK LIKE?

What are relationship patterns? Patterns or blue-prints of thinking, behaving, and

feeling about yourself, others, and how relationships work.
How are they created? During our early relationships, often in our families, or during
significant adult experiences.
We learn to think, do, and feel what allowed us to be successful or safe in those
situations.
We do what rewarded us then. For example, being a nurturer led to love, or
being distrustful/keeping people at a distance led to safety.
. For
example, trusting others or relaxing your guard led to abuse, or asserting your
needs led to aggression, criticism, or danger.
How do they impact us now? for behavior in
relationships.
How are they impacted by trauma?
Sometimes the less healthy patterns are reinforced by traumatic events.
Example: ,
Sometimes our healthy patterns are changed by traumatic events.
Example:

These maps or instruction manuals can act as self-fulfilling prophecies because we

Sometimes we continue to use those same behaviors in other situations where those
behaviors are not always effective or helpful.

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Example: Shelby has a belief that no one will love him because he is unlovable. So he
keeps others at a distance and isolates. Therefore, he misses opportunities for others to get to
know him. He then uses the fact that he does not have close friends or a romantic partner as
evidence that he must be unlovable.

The Good News: These instructions can be changed! This therapy will help you explore,
identify, and change schemas to be more flexible and effective in your current and future
relationships.

You can write a new instruction manual or create a new map that identifies where you want to go
in relationships and how you are going to get there.

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THE FIRST STEP TO CHANGING YOUR RELATIONSHIP PATTERNS IS IDENTIFYING THEM.

CHECK THE BELIEFS THAT YOU RECOGNIZE IN YOUR LIFE.

Safety
If I let someone close to me, I may get hurt.
The only way to stay safe is to keep others at a distance.

Trust/Intimacy
I can t trust my own judgment to stay safe. I have bad judgment.
No one can be trusted.
mind.

o Others cannot handle hearing my experiences.

o They will judge/hate/disrespect me if they find out what has happened to me.

Power/Control
I cannot control anything in my life. I am powerless to solve problems in my life.
I cannot trust others to be in control.
People who have power abuse it.
Who has power is an either-or situation. Only one person can have power (either you have it
or I have it, but both of us cannot have power).

Self Esteem/Needs
If I share my problems or disclose my feelings, I will not be respected or will be seen as
weak.

Asserting my needs will cause problems in my relationships.

If I am not in a romantic relationship, something is wrong with me.

I am broken/crazy/unlovable.

AFTER COMPLETING THE CHECKLIST, ASK YOURSELF:

Do your responses surprise you?
How do these thoughts help or hinder your relationships? In what situations are these beliefs
helpful or not helpful?
How do the beliefs you checked influence your behavior with friends, family, romantic
partners, and acquaintances?

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REMEMBER THAT THESE PATTERNS CAN BE CHANGED!

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HOW TO COMPLETE THE RELATIONSHIP PATTERNS WORKSHEET 1

Take note when your interactions with others do not go well, feel
uncomfortable, or lead to conflicts.

Notice your thoughts and emotions in those problematic interactions.

Notice what your expectations of others are in those situations. Notice what
you believe is going on for them (their thoughts, emotions, and behaviors)
and the evidence for y -reading.

You will summarize what you notice using a new tool called the Relationship
Patterns Worksheet. Today we will introduce the first part of the sheet,
Relationship Patterns Worksheet 1.

You will note that the Relationship Patterns Worksheet will be just like the
Feelings Monitoring Form in that you will focus on situations, thoughts, and
feelings. The only difference is that now it involves two people, and you will
also focus on your beliefs about the other person s feelings and thoughts
about the situations.

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PRACTICE EXERCISES BEFORE SESSION 7

Complete Relationship Patterns Worksheet 1 2x before next session.

Use emotion regulation tools from all channels in the Relationship Patterns Worksheet 1.
Practice at least one strategy to increase positive emotions during the week.

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Skills Training in Affective and Interpersonal Regulation

STAIR
SESSION # 7 Changing Relationship Patterns
Focus on Assertiveness

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

AGENDA:
o Review Relationship Patterns Worksheet 1
o New Topic: Changing Relationship Patterns Focus on Assertiveness
o New Tool: Basic Personal Rights, Assertiveness Practice Situations, Relationship Patterns
Worksheet 2
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Discussed how trauma impacts relationship patterns
o What relationship patterns are, how they are developed, and how they can be changed

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy strategies have you
used this week?

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Basic Personal Rights

I have the right to ask for what I want.

I have the right to feel and express my feelings, both positive and negative.
I have the right to make mistakes.
I have the right to have my own opinions and convictions.
I have the right to be treated with dignity and respect.
I have the right to change my mind or decide on a different course of action.
I have the right to protest unfair treatment or criticism.
I have the right to expect honesty from others.
I have the right to my own values and standards.
I have the right to be angry at someone I love.
.
I have the right to negotiate for change.
I have the right to be in a non-abusive environment.
I have the right to ask for help or emotional support.
I have the right to my own needs for personal space and time, even if others would prefer
my company.
I have the right not to have to justify myself to others.
I have the right not to take responsibility for some

I have the right to not always worry about the goodwill of others.
I have the right to choose not to respond to a situation.

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Non-assertive behavior: you ignore or do not express your own rights, needs, and desires.
o Pros
o Cons
Aggressive behavior: you express your own rights at the expense of others through
inappropriate threats, outbursts, or hostility.
o Pros
o Cons
Assertive behavior: you express your own rights and needs/wants. You stand up for your
legitimate rights in a way that does not violate the rights of others.
o Pros
o Cons

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ASSERTIVENESS PRACTICE SITUATIONS

o Go to a library and ask the librarian for assistance in finding a book.
Alternatively, ask a salesperson to help you find something.

o In a drug store or convenience store, ask for change for a $1 bill without
buying anything.

o Call and make an appointment to have your hair cut. Call back later and cancel
the appointment. Alternatively, make and cancel dinner reservations or airline
reservations.

o Ask the pharmacist for information on an over-the-counter drug.

o Ask for a substitution on the menu when ordering a meal.

o Ask co-workers or classmates to do a favor for you (e.g., get you a cup of
coffee while they get their own, give their opinion on some aspect of your
work).

o Ask a friend for help fixing something.

o Ask a person who is making too much noise to be quieter.

o Ask your landlord to fix a problem in your apartment.

o Ask a person to stop doing something that bothers you.

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HOW TO CREATE ALTERNATIVES TO CURRENT RELATIONSHIP PATTERNS

COMPLETING RELATIONSHIP PATTERNS WORKSHEET 2

Identify a positive goal for the relationship.

Identify a belief and feeling that supports the relationship goal. Ask your therapist or a friend
for suggestions if you get stuck.
Imagine a response from the person that supports your goal. What could they be feeling and
thinking? Ask for help if you get stuck.
Imagine actions you can take to support the goal or maintain that goal if you reach it.

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PRACTICE EXERCISES BEFORE SESSION 8

Fill out Relationship Patterns Worksheet 2 twice during week.

Practice using an alternative approach in at least 1 interpersonal situation.
Use body, thought, and behavioral channel activities to manage interpersonal situations.
Practice at least one strategy to increase positive emotions daily.

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STAIR
SESSION # 8 Changing Relationship Patterns
Practicing Assertiveness

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

AGENDA:
o Review Relationship Patterns Worksheet 2
o New Topic: Changing Relationship Patterns Practicing Assertiveness
o New Tool: , Additional Skills to Practice
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Discussed different types of assertiveness
o Changing relationship patterns

PRACTICE EXERCISE REVIEW

Did you complete practice exercises? How did it go? If not, what other healthy strategies have you used
this week?

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goals and the nature of each relationship and vary your

approach accordingly.

Goal: Setting boundaries

sages
o Goal: To express hurt feelings or distress, or to give feedback about another's behavior.

rather than focusing on the person him/herself. By focusing on the consequences their
behavior causes us, the other person is less likely to feel attacked or criticized.

o Format: Behavior Feeling Consequence

o state behavior), I feel (state feeling)

because (state consequence for you

o Success in this exercise means stating your concerns clearly and respectfully, not
necessarily that the other person agrees with you.

What is happening around you? What is the other person doing?

What happens as a result?

Use this form sentence:
When you ____________(behavior), I feel _______________ (feeling)
because_______________(result).

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EXAMPLE 8.1 MESSAGE

What is happening around you? What is the other person doing?

What happens as a result?

Use this form sentence:

WHEN you asked me to work the extra shift

I FELT conflicted and concerned

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ADDITIONAL SKILLS TO PRACTICE:

HOW TO BE ASSERTIVE

Saying No
o Goal: To clearly communicate a boundary or your expectations about another's behavior or
request
o Format:
Approach 1: When you DO NOT want to promote a relationship
1.
2. If the other person persists, repeat yourself while looking the person directly in the
eyes and raising the level of your voice slightly.
Approach 2: When you DO want to maintain a relationship
1.
2. Without apologizing, give a brief explanation of your reason for declining.
3. , if appropriate, you can end by suggesting an alternative plan in

4. I understand that you would like me to help you with your move. Unfortunately, I

5. em for you, it can be useful to give

yourself some time before responding to a request (e.g ).
You will still want to respond within a reasonable amount of time.

Making Requests
o Goal: Asking for something that one desires or deserve
o Format:
1. Be specific about what you want and state it clearly and simply (e.g.,
).
2. versus ).
3. State the positive consequences of the
) and/or
-compliance (e.g.,
).
4. Avoid making excuses, downplaying or apologizing for your request, or blaming the
other person (e.g., versus
going to have to move all alone ).

Delaying or leaving volatile situations:

o Goal: To leave or delay the situation if the other person responds angrily or aggressively
o Format:
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1. Acknowledge what you observe.
2. Create a specific plan about when you will re-contact that person.
3. Example:

How do you respond when people do not respond positively to your assertiveness?
Empathize with the person making the request
o Goal: Maintain relationship even when asserting yourself by acknowledging that you
saying no is disappointing to them
o Format:
1.
2. Example: you move, but

Broken record:
o Goal: When dealing with someone who will not take no for an answer
o Format:
1. You simply repeat a concise sentence over and over without getting sidetracked by
other issues.
2. Example: if a salesperson keeps badgering you to buy something you do not want,
you can keep repeating,

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PRACTICE EXERCISES BEFORE SESSION 9

Fill out Relationship Patterns Worksheet 2 twice during week.

Practice using an alternative approach in at least 1 interpersonal situation.
Use body, thought, and behavioral channel activities to manage interpersonal situations.
Practice at least one strategy to increase positive emotions daily.

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Skills Training in Affective and Interpersonal Regulation

STAIR
SESSION #9 Changing Relationships
Managing Power

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

AGENDA:
o Review Relationship Patterns Worksheet 2
o New Topic: Changing Relationship Patterns Managing Power
o New Tool: Understanding different power balances, adding respect to the conversation,
Relationship Patterns Worksheets 2
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Your basic rights in relationships
o What is healthy assertiveness
o Using I messages
o Identifying alternative relationship patterns

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy strategies have you
used this week?

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Trauma-Generated Barriers in Each Type of Relationship

Type I: Equal power (e.g., friend, sibling, co-worker, partner, team member)
Barriers:
Although equal in power, there are problems.
Related thoughts:
Your work colleagues, peers/friends, or family members are threats or enemies.
They will be aggressive, competitive, or exploit you.
You need to be vigilant and aggressive.
You need to act like you have more power and authority than you actually have to protect yourself.
You need to keep a safe distance from others and not trust them.

Type II: you have less power (e.g., employee, supervisee, child, student, trainee)
Barriers:
You have less power than someone else.
Related thoughts:
The authority figure or boss is a threat or enemy.
You feel anxious and worried that something bad will happen to you if they are displeased with you or
they are in a bad mood.
You may be too eager to please, find it difficult to say no, or not ask for the authority or resources you
need or want because you are afraid they will PUNISH/hurt you.
You become angry and accuse them being exploitative when that might not be true but you were too
afraid to ask about things you saw going on and made your own interpretation.

Type III: you have more power than the other person
(e.g., parent, Employer, SUPERVISor, teacher, coach)
Barriers:
You have more power than others, and this makes you very uncomfortable.
Related thoughts:
You cannot execute your authority, so you do a bad job (as a boss, parent, or leader).

You feel taken advantage of by those under your authority.

Sometimes you do exert your power but
You feel mean/abusive so you are apologetic and sometimes take back what you say.
You actually act mean/abusive then you feel bad.

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POWER IN RELATIONSHIPS

3 Types of Power Balances in Relationships

Type I: You have equal power with a person (e.g., someone who is your friend, sibling, co-
worker, partner, team member)
Type II: You have less power than the other person (e.g., someone who is your employer,
supervisor, parent, teacher, coach)
Type III: You have more power than the other person (e.g., child, employee, supervisee,
student, trainee)

Name people you interact with where:

I have equal power: ___________________________________________________

I have less power: ____________________________________________________

I have more power: ____________________________________________________

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Those who have experienced violence, often at the hands of people who have more authority and
power, may equate power with abuse. In addition, v
worth, and those who are vulnerable to violence are often in circumstances of less or limited power.
This may lead an individual to equate having little power with being of little value, worth, and respect.

While differences in power balances are a fact of life, respect for oneself and others is a constant
regardless of the nature of a specific power balance. When you have equal power, express openness
and interest
When you have less power, remember that you have a right to act in ways that respect yourself and
your values (e.g., politely express your point of view but also remember to express respect for others
with more power (rather than mistrust or fear of abuse). When you interact with others with whom you
have more power, remember to show respect for the personhood of those with less power and express
your power in a positive way, with confidence and warmth.

Skill: Select the power balance that causes you the greatest difficulty. Select a situation that you can also
describe in the Relationship Patterns Worksheet. Formulate the point of view you want to express in a
way that is open, direct, Now, however, begin and end what you want
to say by acknowledging positive aspects of the person or relationship.

Begin with a statement that recognizes positive aspects or behaviors of the person.
State your request, concern, decision, or point of view.
End with a statement that again recognizes the positive aspects or behaviors of the person.

Try out this practice:

Communicate to your coach/therapist a request/concern/etc. using the Respect Bookends

Coach/Therapist repeats what you plan to say and imagine yourself as the other person.
How does it feel? What are your thoughts and reactions?
Practice again to maximize chances that you will get a good response, with adjustments as desired.

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SKILL: MANAGING POWER IN RELATIONSHIPS

Tool: Relationship Patterns Worksheet 2
This worksheet will help you identify relationship patterns and coach you in examining an alternative
explanation to your automatic thoughts about yourself and your expectations of others.

Practice exercises:

Identify a relationship with conflict.

Identify if negative feelings and beliefs arise from a power differential.
Evaluate accuracy of power differential. Ask for help if needed.
If power differential is accurate, complete Relationship Patterns Worksheet 2 by respecting the
power differential. Respect yourself and the other person in the process.
If power differential is inaccurate, identify what is more accurate. Complete Relationship Patterns
Worksheet 2, considering and respecting power balance. Respect yourself and the other person in
the process.

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EXAMPLE 9.2 RESPECT BOOKENDS

BEGIN AND END YOUR COMMUNICATION BY ACKNOWLEDGING THE NEEDS AND

POSITION OF THE OTHER PERSON.

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PRACTICE EXERCISES BEFORE SESSION 10

Fill out Relationship Patterns Worksheet 2 twice during the week with a focus on
managing power differences respectfully.
Practice interacting in a situation where there is a power differential and see if you
reach your goal.
Use body, thought, and behavioral channel activities to support interpersonal
situations.
Practice at least one strategy to increase positive emotions daily.

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Skills Training in Affective and Interpersonal Regulation

STAIR
SESSION #10 Changing Relationships:
Respect for Self and Others

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your relationships

AGENDA:
o Review Relationship Patterns Worksheet 2
o New Topic: Changing Relationship Patterns Respect for Self and Others
o New Tools: Alternative Approaches to Power Balances, RWP-2 with a focus on the impact of
trauma on respect for self and others
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Different kinds of power balances
o Using Respect Bookends
o Identifying alternative relationship patterns

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy strategies have you
used this week?

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Alternative Approaches to Each Type of Relationship

Type I: Equal power (e.g., friend, sibling, co-worker, partner, team member)
You have equal power:
Alternative thoughts (think of situations you have observed where equals worked well together):
Your work colleagues, peers/friends, or family members are interested in what you have to say.
They are open to hearing you out and coming to know you.
You may be able to share your thoughts and feelings with honesty.
You are collaborators and equals, respecting yourself and the other person.
You might be able to trust them, and you might be able to get close to them.

Type II: you have less power (e.g., employee, supervisee, child, student, trainee)
You have less power than someone else
Alternative thoughts (think of situations you have observed where a person with less power managed a tough
situation):
The authority figure may be fair and interested in your point of view.
You own up and apologize if you have made an error or hurt them and plan to do things differently next
time (with respect for yourself).
Y negative someone else says about you. You can communicate with
others about your point of view.
You feel angry and believe the authority figure is exploiting you. You take a time-out and check in on
your feelings, maybe talking with others to reassess before you act.

Type III: you have more power than the other person
(e.g., parent, Employer, SUPERVISor, teacher, coach)
You have more power than others
Alternative thought (think of leaders who are role models to you):
You have confidence in your authority. You earned it and can share your skills and knowledge.
You can use your authority with kindness and warmth, respecting those with less power.
When you feel taken advantage of by those under your authority, take a time-out and check in on your
feelings and those of others.
When you feel like you are or are going to be mean and abusive, review the situation with respect for the
other person. Revise as needed what you plan to say. Do the words and tone reflect respect for the other
person?
When you have a bad day and actually act mean, apologize with respect for yourself and the other person.

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Managing power dynamics in relationships can be difficult. If you remember to treat yourself and the
other person respectfully, the interaction will go better. Below are descriptions of how to proceed in
each power balance in ways that express respect for yourself and the other person.
When you have equal power, express openness and interest
Expect they will want to hear your opinion as well.

When you have less power, remember that you have a right to act in ways that respect yourself and
your values (e.g., politely express your point of view but also remember to express respect for others
with more power (rather than with mistrust or fear of abuse)).
When you have more power, remember to show respect for the personhood of those with less power
and express your power in a positive way, with confidence and warmth.

Skill: Select the power balance that causes you the greatest difficulty. Select a situation that you can also
describe in the Relationship Patterns Worksheet. Formulate the point of view you want to express in a
way that is open, direct, Now, however, begin and end what you want
to say by acknowledging positive aspects of the other person or relationship.

Begin with a statement that recognizes positive aspects or behaviors of the other person.
State your request, concern, decision, or point of view.
End with a statement that again recognizes the positive aspects or behaviors of the other person.

Try out this practice:

Communicate to your coach/therapist a request/concern/etc. using the Respect Bookends

Coach/Therapist repeats what you plan to say, and you imagine yourself as the other person.
How does it feel? What are your thoughts and reactions?
Practice again to maximize chances that you will get a good response, with adjustments as desired.

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Impact of Trauma on Self-Respect

In this exercise, think about ways in which your trauma has negatively impacted your ability to respect
yourself in interpersonal situations. Thinking negatively about yourself leads to engaging negatively with
others. See if any of these examples are relevant to you.

Problems include:
- Assuming people are thinking negatively about you or being critical when they are not.
- Wasting energy being defensive about criticism you think is coming your way.
- Not being able to enjoy being with people because you are worried about how you seem to them.
-
- Staying in a bad relationship because you think you deserve what you have.
- Being overly critical of others, just as you are overly critical of yourself.
- Being mean and critical to people when you are angry at yourself.

Alternative Perspective: Experiencing Self-Respect by Considering Your Trauma

Many people have difficulty respecting themselves due to the trauma they have experienced. A radical
alternative is to respect your traumatic experience and respect yourself for what you have been through.
What can you do to learn and grow from it? Things to consider are listed below. Use these ideas to help
fill out the alternative relationship model on the RPW-2.

Alternative attitudes include:

- Respecting yourself for living through your trauma and being here today.
- Knowing you have seen the best and worst of people and you can learn from that.
- Knowing you have seen the best and worst of yourself and you can learn from that.
- Sharing your experience and knowledge with others (eventually).
- Being compassionate towards others who have gone through hard times just like you.
- Being compassionate to th

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PRACTICE EXERCISES BEFORE SESSION 11

Fill out Relationship Patterns Worksheet 2 twice during the week with a focus on
managing power differences respectfully.
Practice interacting in a situation where there is a power differential and see if you
reach your goal.
Use body, thought, and behavioral channel activities to support interpersonal
situations.
Practice at least one strategy to increase positive emotions daily.

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Skills Training in Affective and Interpersonal Regulation

STAIR
SESSION # 11: Increasing Closeness and Intimacy

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PURPOSE: Learn skills to cope with distressing feelings and learn how to improve your
relationships

AGENDA:
o Review Relationship Patterns Worksheets from previous session
o New Topic: Emotional Distance
o New Tool: Ways to improve intimacy in relationships
o Commit to skills practice

SUMMARY OF PREVIOUS SESSION:

o Power balances differ in different relationships.
o Different actions and reactions are expected in different relationships and
power balances, but respect for oneself and the other person is a constant.

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy
strategies have you used this week?

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What are Boundaries?

COMMON BOUNDARIES IN RELATIONSHIPS:

NOT CLOSE ENOUGH
Holding Others at a Distance
Pros:
Me You Feel protected and safe
Less or no conflict
Cons:
Not connected
Lonely
Lack of support
Too much self-reliance

TOO CLOSE
Being Co-Dependent
Me You Pros:
Feel connected and "in-sync"
May feel support sometimes
Cons:
Lack of support around your priorities
Lose sense of unique identity
Not getting your needs/goals met
Not enough self-reliance

OPTIMAL
Healthy Boundaries
Me You Pros:
Feel connected
Feel supported
Strong sense of individual identity
Mutual support of goals/needs

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Me You

What leads people to create emotional distance in relationships?

What behaviors created emotional distance?

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HOW TO REPAIR RELATIONSHIPS AFTER A FIGHT OR CONFLICT

1. Ask if the other person is willing to talk about what happened.

2. Acknowledge that the last contact did not go well.
3. Convey your respect and caring for the other person.
4. Acknowledge the mistakes made and the hurt/damage that you think you caused.
5. Share your feelings and thoughts about your behavior. Share your feelings/thoughts
about their behavior in a way that is respectful and minimizes the risk of the other
person feeling defensive (e.g., use I statements).
6. Ask how the other person felt about what happened.
7. Ask questions for clarification and invite questions for their clarification.
8. Ask if you can make amends and ask the other person to make amends.
9. Discuss how you can avoid similar situations in the future.

HOW TO DEVELOP NEW RELATIONSHIPS

1. Initiate contact with small talk.

2. Get to know the other person and identify common interests/values.
3. Make a point of acting respectfully and expressing positive emotions.
4. Initiate spending time together in low-effort ways (e.g., coffee).
5. If things go well, initiate spending more time together (e.g., meals or activities).

GETTING AND STAYING CLOSER TO OTHERS

Address unresolved conflicts and issues respectfully.

Share interests and opinions.
Spend time with them in enjoyable ways.
Express caring and respect.
Share life events.
Invite them to weigh in on your decision-making processes.
Be genuine and sincere.
Offer help.
Ask for help and support.
Ask about their lives, values, and interests.
Be willing to support them in their interests and activities.
Express positive emotions.

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PRACTICE EXERCISES BEFORE SESSION 12

Fill out Relationship Patterns Worksheet 2 twice during the week with a focus on increasing
intimacy and closeness.
Practice interacting in a situation where there is an opportunity to increase closeness and see if
you reach your goal.
Use body, thought, and behavioral channel activities to support interpersonal situations.
Practice at least one strategy to increase positive emotions daily.

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Skills Training in Affective and Interpersonal Regulation

STAIR
SESSION # 12 Summary of Work and Self-Compassion

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PURPOSE:
Learn skills to cope with distressing feelings and thoughts
Learn how to improve your relationships

AGENDA:
o Review accomplishments
o Identify useful skills and lessons learned
o Consider compassion for the past and continuing struggles

SUMMARY OF PREVIOUS SESSION:

o Emotional distance and how to repair it
o How to create intimacy in relationships

PRACTICE EXERCISE REVIEW

Did you complete your practice exercises? How did it go? If not, what other healthy coping
strategies have you used this week?

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SUMMARY OF ACCOMPLISHMENTS
accomplished during this program!

We discussed how trauma impacts emotion, and how it affected you.

Before STAIR, I experienced my emotions:

We then explored ways that could change how you managed your emotions. Using the three
channels worksheet in this packet, check off the emotion management skills that you expect
to continue using. Also consider:
What are some ways you are experiencing your emotions differently?

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We also explored how trauma impacts relationships and identified different ways to
approach relationships.
What are some ways you are approaching relationships differently in what you believe, feel, and
do?

What are the most important

lessons you learned?

What lessons felt most helpful?

How have your thoughts,

emotions, and behaviors
changed?

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RECOVERY IS A JOURNEY
Having compassion for yourself can be challenging given the messages you may have gotten from
others and the negative beliefs you may still hold about yourself.

There are several benefits to self-compassion:

- COMPASSION FOR YOURSELF GOES HAND-IN-HAND WITH COMPASSION FOR OTHERS. SELF-COMPASSION
WILL LEAD TO HAVING MORE COMPASSION FOR OTHERS AND WILL IMPROVE YOUR RELATIONSHIPS.

- HAVING COMPASSION FOR YOURSELF ALSO ALLOWS YOU TO CHANGE AND EXPERIMENT WITH NEW WAYS
OF BEHAVING AND FEELING, SUCH AS ASKING FOR HELP OR BEING MORE ASSERTIVE.

- PRACTICING YOUR NEW SKILLS WILL LEAD TO LESS FEAR IF YOU ARE ABLE TO HAVE COMPASSION FOR
YOURSELF AS A PERSON WHO IS LEARNING, GROWING, AND CHANGING.

- COMPASSION FOR YOURSELF SUPPORTS SUCCESS IN THE JOURNEY OF RECOVERY. THERE WILL BE
LAPSES AND FAILURES, BUT THE MORE ACCEPTING YOU ARE OF YOUR SHORTCOMINGS, THE EASIER IT WILL
BE FOR YOU TO FOCUS YOUR EFFORTS ON CHANGE. THE ENERGY YOU USED UP CRITICIZING OR
DEFENDING YOURSELF CAN BE CHANNELED INTO THE WORK NEEDED TO REACH YOUR GOALS.

Consider your successes in this work and accept them. Consider your challenges and limitations and
accept them too. Continue to work towards your goals with compassion for your past and your
continuing struggles

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SELF-COMPASSION MEDITATION EXERCISE

Take a moment to focus on your breathing. If

you feel comfortable, begin to close your eyes.
Take a moment to breathe and settle into your
body. (Pause)

Now, take a slow, deep breath. Exhale slowly,

allowing all of the air to leave your lungs. Inhale.
And exhale slowly.

Continue to breathe at this pace.

Now imagine yourself. See all the parts of

yourself.

View the parts that represent some of the positive aspects of yourself, such as happiness, joy, pleasurable
feelings, positive beliefs, loving memories. What do you notice?

Now, take a moment to view the negative parts of yourself, those that represent your painful emotions,
fears, negative beliefs, and traumatic or painful life experiences. What do you notice?

that has been going on for many years. The negative parts are fighting with the positive parts for the
advantage, while the positive parts desperately retaliate with all of their might to avoid being taken over by
the enemy. What do you notice?

Now imagine that instead of allowing the positive and negative parts that represent yourself to fight
against each other, you allow them to exist together. Rather than allowing the negative pieces to win and
viewing yourself as all bad, worthless, or unlovable, allow yourself to hold all of these parts together.

Focus on what this experience feels like. View all the parts of yourself without judgment.

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