Stress inoculation training refers to a type of therapeutic intervention that aims to “inoculate” or protect you from future stressors. Specifically, it has been used successfully to help individuals cope with exposure to personal or work-related traumatic events, post-traumatic stress disorder (PTSD), anxiety, medical treatments and surgery, job loss, competitive athletics, performance anxiety, and ongoing medical conditions.1
What Is Stress Inoculation Training?
Stress inoculation training, also called stress inoculation therapy, is a type of cognitive behavioral therapy (CBT) that focuses on changing the way your mind and body responds to stressors. It might be offered individually or in a group. For those with PTSD, stress inoculation training might be offered on its own or in conjunction with other types of trauma therapy like prolonged exposure therapy.2
Stress inoculation training teaches you how to more effectively cope with and manage distress that results from specific types of stressors. You will learn how to recognize your strengths and who you can rely on for support, and more effectively leverage them. You will also learn and practice new skills that focus on developing more adaptive ways to think about and respond to these stressors.
Stress inoculation training proposes that by improving your confidence in applying your coping skills in flexible and effective ways, you will be better prepared to deal with any stressors that might arise in your life.1
Is Stress Inoculation Training Effective?
Stress inoculation training is effective in preparing individuals to deal with stressful events, by not only changing the way they think about these events, but also by changing how they emotionally and physically respond to them.
Specifically, stress inoculation therapy has proven effective in treating:
- Anxiety among parents of children undergoing painful medical procedures3
- Anxiety disorders4
- Stress, anxiety, and depression among cancer patients5
- Performance anxiety (e.g., test anxiety, musical performance, etc)6
- Sports performance anxiety7
- PTSD among sexual assault survivors and physical assault survivors8,9
- Military veterans suffering from PTSD and anger issues or depressive symptoms10,11
Pre-deployment stress inoculation training has also shown promise in protecting soldiers against developing PTSD as a result of exposure to combat.12
More research is needed to better understand what specific components are actually responsible for observed improvement.13 More research is also needed to identify the stressors to be targeted and exactly how much exposure to specific stressors is needed to bring about change.
How Does Stress Inoculation Training Work?
Stress inoculation training is based on the premise that by working with you to shift your attitudes and behaviors you will be protected from any subsequent, more intense stressors. You will also receive training to further develop more effective coping and problem-solving skills.1 This training is tailored to meet individual needs and circumstances, and is often used to supplement other types of trauma therapy if being used to treat PTSD.1,2
3 Phases of Stress Inoculation Training
Stress inoculation training uses a three-phase approach: conceptional education phase; skills development and consolidation phase; and the application phase.1 What happens in each phase will be customized to meet your needs, and it will take into account the type of stressor you are dealing with.
The three phases of stress inoculation training are:
1. Conceptual Education Phase
During this phase, the therapist provides education on stress or PTSD and coping.1 They will help you to identify your specific stress-related concerns, as well as your coping strengths, supports, and challenges. Together, you determine which aspects of the stressful situations identified are within your control to change.
In some cases, you might be able to deal with the stressor directly by influencing change in the external situation itself. In other cases, you work with the therapist to deal with them indirectly by working on changing how you respond to them through your thoughts and behaviors.
This first phase helps you to clarify what specific factors are causing your distress, as well as identifying and mobilizing your supports and strengths (within areas that you have control over) to leverage them more effectively. This increased understanding of why you are experiencing distress and how you can enhance your coping abilities can result in increased hope and a sense of empowerment.
2. Skills Development & Consolidation Phase
The second phase involves building upon your current coping skills and learning new ones that are tailored to meet your needs. Some of these coping skills might focus on problem-solving (e.g., assertiveness and using social supports), while others might focus on coping with your emotions (e.g., emotional regulation and reframing how you look at a situation).
You will be asked to practice these skills in session by imagining the situations where they might be needed. You will also be encouraged to use these skills in your daily life. This phase allows you to notice, refine, and develop confidence in your coping skills, as well as enhance your understanding of how they might be generalized to deal with different types of stressors. With this increased ability to respond to stressors in effective ways, you will likely feel a greater sense of control.
3. Application Phase
In this last phase, you continue to practice and become confident in using your coping skills, both in session and in your daily life.1 You will be encouraged to use your coping skills to gradually deal with more stressful situations in your life. This phase will also focus on problem-solving in order to prevent relapse.
When you have developed confidence in your coping abilities, you will end treatment, but will be invited to come in for a “booster” session at some point in the future to check in on your progress and address any challenges. As you experience success in dealing with incrementally more stressful situations, you will no longer need ongoing treatment.
Stress Inoculation Therapy Techniques
Stress inoculation therapy techniques are tailored to the individual and the specific types of stressors they are dealing with. For stressors that can be directly addressed, skills will focus on trying to influence the identified stressor. If a stressor can’t be dealt with directly, the focus will be on building skills to shift your related thoughts and behaviors.
Dealing Directly With the Stressor
Sometimes, the stressor is based in a relationship or life situation that you might be able to influence; however, when other people are involved, they choose their reactions, no matter how skilled you are. None of us can change another’s behavior or beliefs, but you can try to approach the situation in a skilled way.
Three skills to directly deal with stressors are:
- Assertiveness skills: You will be taught how to respectfully and assertively (not aggressively) express your needs and wants in a relationship. You will also be taught how to let someone know if their behavior is unwelcome, how another’s behavior is affecting you, and what you want/need from them instead.
- Problem-solving skills: You will be taught how to identify a problem, as well as how to identify the resources available to support you in solving the problem. You will learn how to generate possible solutions and how to evaluate these solutions to help you to decide which one to pursue.
- Conflict resolution skills: Assertiveness skill training is often part of conflict resolution skills training. In conflict resolution training, you might also be taught emotional de-escalation skills and how to use reframing skills.
Dealing Indirectly With the Stressor
There are some stressors in life that you won’t be able to deal with directly. For these, you will need to focus on skills that allow you to decrease your internal emotional and physical distress by changing your thoughts and/or behaviors.
Three skills to indirectly deal with stressors are:
- Breathing exercises: Learning breathing exercises, such as deep breathing from your diaphragm, can help to recenter you and reduce emotional distress. These are a type of mindfulness exercise that can help you to calm your mind and body and anchor yourself in the present moment. This can be particularly helpful to those suffering from PTSD as it can stave off dissociation and pull you out of flashbacks (which are a reliving of the trauma).
- Relaxation training: Similar to breathing exercises, muscle relaxation training can help reset the mind and body. If you are in a constant state of tension due to the stressors in your life, this type of training can allow your body to relearn how to relax. While this is helpful generally to most people who are dealing with stress, it can be particularly helpful to those suffering from PTSD.
- Changing self-talk: Each of us carries on an internal dialogue with ourselves throughout our day. Depending on the content of those dialogues, we are influencing our level of stress and thus distress, either positively or negatively. Becoming aware of your self-talk and learning how to slant it in a more compassionate and hopeful way can make a significant difference in your physical and emotional well-being.
How to Find a Therapist Who Provides Stress Inoculation Training
Many therapists who provide CBT also utilize a stress inoculation training/therapy approach; although, they might not specifically call it that. To find out whether they are taking an approach that is similar to stress inoculation training, ask them outright. Also, if looking for a therapist to provide stress inoculation training to treat PTSD, you might want to look for a therapist who has specialization in both areas.
If you have health insurance, check with your provider to find out what specific types of mental health professionals you have coverage for (e.g., psychologists, professional counselors, social workers, etc.). States that license their mental health professionals might provide online directories of these providers. You might also want to check out finding a therapist article and this therapist directory.
In terms of cost, health insurance will likely cover all or part of the cost of visits to specific practitioners. Typically, with health insurance coverage, the cost to the client will be $20-$50 per session; and without coverage, the cost is likely to be $60-$120 per session.14,15
What to Expect at Your First SIT Appointment
Stress inoculation therapy is tailored to meet individual needs. Some will require multiple sessions, while others might only need one session. Typically in your first appointment, your therapist will provide you with information on stress/PTSD and coping. You will work together to identify the stressors that are resulting in your distress and the strategies you have been using to cope.
As time passes, you will be taught and have the opportunity to practice new problem-solving and coping strategies in session. Then, you will be encouraged to practice at home. These strategies will focus on changing the ways you think about and respond to identified stressors (physically and emotionally).
Final Thoughts on Stress Inoculation Therapy
Dealing with PTSD or anxiety can feel overwhelming at times, but stress inoculation therapy can provide some relief. No one type of therapy is the answer for every single person, but for some, this therapy is effective in enhancing coping strategies and significantly reducing distress.
