Stress Inoculation Training

What is Stress Inoculation Training?

Stress inoculation training is based on the notion that skills can be developed that allow one to perform optimally in difficult situations. These skills are primarily state dependent, learned for a particular context, although the more skills one develops, the better one functions across a variety of difficult situations. Although a variety of approaches to SIT have emerged during the past 40 years, three phases are generally employed in all approaches to SIT:

• 1.
  Conceptualization through psychoeducation: This first stage attempts to educate the learner about the nature of stress in the face of a crisis, in general, and then to the particular situation at hand. Much like cognitive behavioral therapy (CBT), this phase of SIT explains the automatic responses to a stressor, including cognitive, emotional, physiological, and behavioral responses. The adaptive and maladaptive aspects of the organism's response are explained.
• 2.
  Skills acquisition and practice: The second stage trains the learner to gain control over cognitive, affective, physiological, and behavioral reactivity to a stressor. Learners' attention is brought to bear on their reactivity that arises during the stressful situation, so that they can consider and practice alternatives. Such alternatives can be generated by the learner or can be suggested by the instructor. Thought content (what one thinks about) and the thought processes (how one's thinking changes in response to an identified stressor) are addressed. Noting and reducing excessive emotional reactivity is also addressed. Physiological responses, especially sympathetic nervous system (SNS) activation, are noted, and parasympathetic nervous system (PSNS) activation is developed through such techniques as slowed abdominal breathing, biofeedback, and meditation. Behavioral reactivity is addressed, learning to both notice and reduce automatic behaviors and use appropriate actions in the stressful environment. Consequences of responding in an automatic versus controlled fashion are discussed.
• 3.
  Application and follow through: Finally, the learner is assisted in practicing the skills initially developed “in the laboratory” integrated into an in vivo context. Typically, a series of gradated environments is used, increasingly stressful and approximating the actual stressor the learner expects to encounter. This phase distinguishes SIT from many other forms of therapy in that integration and practice in a contextually rich environment ensure that skills learned in the laboratory can be implemented in the context where the skill is needed.

SIT is often thought of as useful before encountering a stressful situation, as in primary prevention (preventing the onset of problems stemming from stress) to prevent common symptoms from developing. However, SIT can also be used for secondary prevention (eliminating or controlling the onset of stress-related symptoms) once symptoms begin to emerge to gain control so that performance does not suffer. Most recently, SIT has been used in tertiary prevention (treating individuals who have significant stress-related dysfunction) to overcome the negative symptoms (including debilitating disorders such as posttraumatic stress disorder, PTSD) individuals have developed in the face of repeat stressors that have significantly impaired their lives. SIT can be readily taught in group settings, as well as conducted individually or in groups for primary, secondary, and tertiary prevention.

...