IMH studies modified PTSD treatment to stop mild depression from worsening
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Researchers are studying whether the modified intervention, i-STAIR, is effective in managing symptoms of depression.
ST PHOTO: KELVIN CHNG
Follow topic:
- IMH adapts STAIR, used for PTSD, into i-STAIR for preventing major depression in adults with mild symptoms and childhood adversity.
- The three-year study (Nov 2025-2028) will recruit 150 participants.
- i-STAIR aims to be a cost-effective, accessible intervention for subsyndromal depression, addressing current lack of preventative trauma-related care.
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SINGAPORE - The Institute of Mental Health researchers are studying whether a modified version of a treatment typically used for post-traumatic stress disorder (PTSD) can help prevent major depression in those who have mild symptoms of the condition and a history of childhood adversity.
Participants in the study will learn strategies on how to regulate their emotions and improve interpersonal skills.
Dr Liu Jianlin, lead researcher for the study, said adverse childhood experiences are considered a form of traumatic stress
“Trauma impacts such skills development by distorting the way we relate to others. For example, it impacts the way we trust others and the way we see ourselves in the context of other people.
“Experiencing very, very strong emotions at a young age may also impact how we respond later on in life,” said Dr Liu, who is also a research fellow at IMH’s research division.
The modified intervention, called Internet-delivered Skills Training in Affective and Interpersonal Regulation or i-STAIR, is a one-on-one treatment that will take place for an hour weekly over eight months. It will be facilitated by a research psychologist over online consultations.
The study will take place over three years from November 2025 to November 2028. It aims to recruit 150 participants aged between 21 to 65, who have a history of adverse childhood experiences and have subsyndromal depression.
Subsyndromal depression (SSD) is a milder form of depression where the symptoms may impact day-to-day functioning, but do not meet the diagnostic criteria for major depressive disorder.
There are currently no official statistics on the prevalence of subsyndromal depression in Singapore, partly also because it often goes undiagnosed and untreated.
However, based on international literature, about 17 per cent of those with subsyndromal depression go on to develop full-blown depression.
Those who have suffered childhood adversity, such as emotional neglect, emotional abuse, parental loss or separation, are three times more likely to have mood or anxiety disorders.
The i-STAIR study is part of the larger five-year Predict study, a nationwide longitudinal study to track the development and trajectory of major depressive disorder (MDD).
Symptoms of MDD include persistent depressed mood, loss of interest or pleasure in almost all activities, a sense of worthlessness or excessive, inappropriate or delusional guilt, and sleep disturbance nearly every day.
IMH has modified Skills Training in Affective and Interpersonal Regulation (STAIR) as a preventative intervention for MDD, as there is a current lack of prevention interventions for trauma-related mental health conditions, Dr Liu said.
Originally developed in the United States to treat PTSD, STAIR is delivered in two structured phases to help those who are not ready to undergo deeper trauma work.
In the first phase, they build the foundational skills to stabilise their emotional responses and relationships, before going on to exposure therapy in the second phase.
Dr Liu said that the first phase of STAIR, which helps build up emotional regulation and interpersonal capability in an individual, is relevant and can be directly translated in the prevention of MDD.
While other approaches that could help build emotional regulation and interpersonal skills were considered, Dr Liu said these approaches would take too long.
One such approach that was explored was dialectical behavioural therapy, used to treat borderline personality disorder. This programme can stretch up to a year, given its various different components like group therapy and phone coaching.
“To put it in perspective, (the first phase of) iSTAIR can be completed in two months, and that was what was attractive to us and beneficial for patients. They do not want to be on intervention for more than one year,” said Dr Liu.
During the study, participants will be randomly assigned to undergo either i-STAIR or general psychoeducation.
Under i-STAIR, participants will learn how to recognise and understand their emotions better and learn how to manage stress. It will also help them strengthen their interpersonal skills – from being more assertive and communicating clearly, to being respectful and compassionate to others and themselves.
They then have to complete online worksheets and role-play behavioural skills that are taught during sessions. Between sessions, homework assignments will be assigned and these include practising the skills taught during the sessions and recording them in a worksheet. The homework will be reviewed at the start of each session.
In the control group, participants will undergo a general psychoeducation intervention, where they will receive information about subsyndromal depression and adverse childhood experiences.
They will also learn healthy habits for better mental health, in the areas of diet, exercise and sleep.
Both interventions will be conducted virtually.
Dr Liu said i-STAIR was designed to be done online to improve accessibility, and reach out to those who are younger, isolated, or face stigma when seeking help.
The hope is to develop i-STAIR into a cost-effective, accessible, and scalable population-level intervention for individuals with subsyndromal depression and adverse childhood experiences, added Dr Liu.
Those interested in the study can visit /
