Stress Inoculation Training

Description of the Strategy

In recent decades, increased attention has been directed toward understanding the nature of stress, the impact of stress with regard to the etiology of mental illness, and its potentially negative consequences for physical health, individual performance, and productivity in the workplace. Stress generally is defined as a response that occurs when an individual perceives the demands of a particular situation or combination of situations as exceeding his or her coping resources. Stressful responding can include a variety of unwanted physiological, cognitive, behavioral, and interpersonal consequences. For example, chronic-pain patients may experience stress that partially results from an inability to find adequate relief from their ailments. The frequency and intensity of their physical pain may exceed their perceived (or actual) abilities to cope effectively and may subsequently involve increased levels of stress or anxiety, a response that may include heightened autonomic arousal, increased negative cognitions (e.g., worries about finding an adequate treatment, catastrophic thoughts regarding the future), and avoidance behaviors, which might include discontinuation of previously rewarding activities and disengagement in social activities. Unfortunately, such consequences may result in even more escalated levels of stress and also may increase one's vulnerability to a worsening of medical conditions and/or the development of a mental illness such as a mood or anxiety disorder.

Stress can be elicited by a variety of environmental situations (both positive and negative) and may be associated with significant impairment in life functioning. As a consequence of the stress response, for example, employees might exhibit decreased productivity, injured athletes might have an extended recovery time, students might experience a decline in [Page 570]academic performance, and primary caregivers may be less capable of caring for their children. Although minimal to moderate levels of stress may be useful in serving a motivational function and potentially increase performance in some situations, it is evident that significant detrimental consequences can occur when individuals are confronted with overwhelming levels of stress or anxiety. Accordingly, several interventions have been developed to assist individuals in learning the appropriate coping skills necessary to reduce the impact of stressful situations and events. Developed by Donald Meichenbaum, one such treatment is stress inoculation training (SIT). This intervention incorporates various treatment strategies designed to increase resistance to stress. For example, clients are taught the transactional nature of the stress and coping process, strategies for self-monitoring thoughts, feelings, and behaviors, as well as problemsolving skills, with subsequent utilization of these skills in both hypothetical and real-life situations. Through these psychoeducational processes, increased self-awareness, and an expanded repertoire of coping skills, clients become “vaccinated,” or better prepared to effectively cope with future stressful events or situations.

SIT most commonly consists of three stages: (1) conceptualization and education, (2) coping-skill acquisition and rehearsal, and (3) application and follow-through. The goal of the first stage, conceptualization and education, is to facilitate a more comprehensive understanding of the nature of stress and its consequences. Developing an increased awareness of stress and situations that elicit stressful responding enables the client to form accurate perceptions of situations in which anxiety is experienced and allows for an assessment of ideographic stress responses, as well as clients' resources or strategies to cope effectively with stress. This stage of SIT is in many ways consistent with a functional analytic (A-B-C) approach to conceptualizing stress responses, with a focus on establishing the role of maladaptive cognitions in eliciting stress-related responding and emphasizing that these cognitions can be modified to promote decreased anxiety in stressful situations. As a result of these processes, clients often develop an increased sense of predictability and control about onset of stress and ability to cope with stressful situations, as well as a basic skill repertoire that will allow for exposure and adjustment to future (perhaps novel) stressful events. An equally important objective of the first stage of SIT is for the therapist and client to develop a collaborative relationship, which is crucial insofar as the establishment of rapport may generate client involvement in treatment planning and intervention development, as well as increased motivation, accountability, and compliance with stress reduction strategies.

...