The word “inoculation” often conjures imaginations of children given shots to protect them from serious illnesses such as the measles, smallpox and polio. The theory behind vaccinations dates back to the late 1700s, when English physician Edward Jenner discovered that exposing individuals to a less potent form of a particular disease enabled their bodies to create protective defenses (antibodies) against more severe and potentially deadly infections in the future.
This is the premise on which a specific type of cognitive behavioral therapy, known as Stress Inoculation Training, is based. Stress inoculation training – or SIT for short – essentially inoculates” individuals against the effects of severe stress (e.g. going into combat) by preparing them to handle it effectively in advance. Developed by psychologist Donald Meichenbaum, the idea is that preparing for the impact of stressful situations helps reduce the risk of developing posttraumatic stress disorder (PTSD) and other stress-related disorders and symptoms.
Just like vaccinations protect against illness, SIT enables individuals to build up “psychological antibodies” which reinforce their resistance to powerful stressors. This is done by exposing them to just enough stress to gently evoke their defenses, yet not so much stress that it completely overwhelms them. SIT helps them develop effective coping strategies that they can implement when confronted with more serious stressors.
Stress inoculation is similar in many ways to the relapse prevention strategies taught in drug and alcohol treatment programs. Therapy clients are taught about stress, including the different ways it can manifest, the potential negative effects it can have on their lives, and what they can do to greatly reduce or avoid those adverse effects. By going through the training, individuals are better able to anticipate potential problems that a highly stressful or traumatic event can trigger. They’re now equipped to avoid these issues because they’ve got a workable plan in place. Just like an alcoholic or drug addict leaving an intensive rehab program, they’re empowered with a stronger and broader repertoire of coping skills and strategies for avoiding “relapse.”
This particular form of cognitive behavior therapy is flexible – i.e., it’s not a rigid, “one-size-fits-all” treatment protocol, it’s tailored to each individual, and the approach is multifaceted. Stress inoculation training isn’t a cure-all. In fact, it is frequently used in conjunction with or to supplement other types of treatment. For example, it’s often combined with prolonged exposure therapy for individuals in trauma recovery. It’s also often used to help individuals who are dealing with chronic stressors.
Goals of Stress Inoculation Training
The primary goals of SIT include:
- Strengthening and broadening clients’ repertoire of coping skills
- Boosting clients’ belief in themselves that they’ll be able to apply the skills effectively
- Helping clients understand that coping can and must be adjusted to the specific situation (e.g. taking direct action vs. reframing) – in other words, what works in situation A may not be effective or applicable to situation B
Brief History of SIT
Stress inoculation training was developed back in the early 1980s by psychologist Donald Meichenbaum, PhD. Dr. Meichenbaum is a renowned expert on the treatment of PTSD. His work with trauma victims over the years covers the gamut of age groups, from children to the elderly. Meichenbaum holds the prestigious title of Distinguished Professor Emeritus at the University of Waterloo, located in Ontario, Canada.
He has written several books including the 2012 publication of his most recent book, which is titled Roadmap to Resilience: A Guide for Military, Trauma Victims and Their Families. In addition to having a private practice, Dr. Meichenbaum conducts training workshops all over the world.
Three Phases of Treatment
Stress inoculation training is comprised of three treatment phases:
- Conceptualization phase
- Skills acquisition and rehearsal phase
- Application and follow through phase
The manner in which these phases are implemented will depend on two primary factors: the type of stressor (e.g. ongoing versus time-limited) and the individual’s resources and coping skills. An example of an ongoing stressor would be a job in which the exposure to stressful or traumatic situations is a regular occurrence (e.g. a soldier in combat or a first responder). An example of a time-limited or acute stressor would be surgery.
Conceptualization phase – During the initial conceptualization phase, clients are interviewed and may undergo psychological testing. It’s during this phase that they are educated about the nature and potential impact of stress, including various ways in which they may unintentionally make it worse. Clients are instructed to monitor themselves in order to identify and understand how their thoughts (i.e. cognitive distortions such as catastrophizing or blaming) create and / or worsen their anxiety.
Clients are taught to re-conceptualize the stressor as an opportunity – a problem they need to fix or solve – rather than an obstacle that can’t be overcome. During this phase they are also taught to differentiate between the elements of the stressor and their reaction to it that can be changed and those that can’t. By making this distinction, they’re able to adjust the way they cope accordingly – i.e. accepting what can’t be changed and taking action to change the things that can.
Skills acquisition and rehearsal phase – The second phase of SIT involves teaching the client coping skills that will enable them to reduce their anxiety. The skills taught by the therapist are tailored to each individual client, based on that client’s needs (i.e. the type of stressors, strengths, and weaknesses. The types of skills clients will learn may include:
- Relaxation techniques
- Cognitive restructuring
- Emotional regulation
- Problem solving strategies
- Interpersonal communication skills
- Self-instructional skills
- Attention diversion methods
As clients learn the skills, they’ll gradually begin practicing them – initially in the clinic followed by in vivo settings that relate specifically to whatever stressor the client will face (e.g. a medical procedure such as surgery or combat).
Application and follow through – The last phase of SIT involves practicing and applying the skills that have been learned, and reinforcing them with follow through. The therapist will provide opportunities for the clients to do this.
Simulation techniques used during this phase may include:
- Role playing (of the feared situation)
- Graded in vivo exposure (e.g. personal experiments)
- Helping others with similar struggles
Disorders, Conditions, Situations and Professional Groups that can Benefit from SIT
Stress inoculation training is beneficial in the treatment of many different disorders and conditions, including:
- PTSD due to sexual assault
- Severe anxiety, including panic disorder
- Performance anxiety (sports, dating, public speaking)
- Specific phobias
- Anger management problems
- Stress due to the challenges of living with chronic mental illness
- Depression related to trauma
- Anger related to trauma
- Pain disorders
- Stressful life transitions or situations (e.g. relocation, divorce, unemployment)
- As a preventative measure with individuals battling serious medical problems such as cancer, rheumatoid arthritis, hypertension, or first degree burns who are preparing for a difficult medical procedure
Professional groups and other individuals who work in chronic (or intermittently chronic) high stress situations, including:
- Caretakers of individuals who are ill
- First responders
- Military personnel
- Disaster teams
- Probation officers
- Police officers
- School teachers
- Mental health professionals
What to Expect
Stress inoculation is flexible in that it can be conducted on a one-on-one basis or in a group setting. It can also be used to treat couples and families.
The length of treatment varies, depending on the unique needs of the client. For example, someone preparing for a medical procedure may require one brief 30-minute session, whereas individuals battling recurrent or chronic mental health or medical conditions may require several months of weekly or biweekly hour-long sessions.
On average, SIT is comprised of eight to 15 sessions. Those may be followed by additional sessions over the next three months to a year in order to reinforce what was learned.
Potential Disadvantages of SIT
Although SIT has been shown to be a very effective treatment in a wide range of stressful settings and situations, it’s not without its disadvantages. Those include:
- The training is rigorous and time consuming
- It’s not appropriate for everyone, particularly individuals who are resistant to changing the way they think
- In order for it to be effective, clients must have a strong level of commitment and motivation
Formal training programs for clinicians interested in conducting SIT don’t exist. Training is typically obtained via one of Dr. Meichenbaum’s workshops.