Stress inoculation training/therapy (SIT) is a cognitive-behavioral form of treatment. Its goals are to help the client understand and manage their fear reactions and to decrease the amount of avoidance behavior associated with fear.
The basic approach to SIT involves three stages. The first stage is education, followed by the development of skills and finally the application of what has been learned to real life situations. During the education stage clients are informed about why they feel they way they do. Attention is usually focused on the association between learned responses to fear and the search for security and avoidance. The client is taught how to identify their own emotions, thoughts and reactions and why this will be important during the treatment stage
Skills-building revolves around necessary strategies and techniques to cope with anxiety and panic reactions. The first skill to be taught is invariably relaxation training and this will include how to make use of relaxation imagery. Relaxation training helps the client to identify areas of their body that tense up during stress, for example the jaw, neck and shoulders and how stress triggers physical reactions. Because relaxation embraces physical, emotional and cognitive elements, the client is taught how to identify stress triggers and how to manage these while in a therapeutic and safe setting.
Cognitive aspects of stress are addressed by the use of certain techniques such as thought stopping, rehearsal, problem solving, and self-talk. Thought stopping is used to manage intrusive thoughts that promote anxiety. Self-talk is a process whereby the client is taught to recognize irrational thinking and replace this with more positive interpretations. Problem-solving skills help the person to better evaluate potential options. Role play is frequently used as a way to address particular issues with the client. Clients are encouraged to think of situations that evoke a fear reaction and are then encouraged to imagine using the coping strategies they have previously been taught.
During the third and final stage of treatment, clients are required to apply everything previously taught and learned to daily situations. The method used is a step-by-step approach in which the phases of stress inoculation are applied. These include assessing the likelihood of actual danger from a feared situation or event, managing avoidance behavior and engaging with feared behavior using problem-solving. Lastly, the client pats themselves on the back for coping with the situation.
It is unlikely that all feared events can be addressed during therapy sessions, which can last anywhere from 6 to 20 sessions. Therefore the therapist works with the client to draw up a fear hierarchy which the client is then encouraged to work on once the formal sessions have drawn to a close.
Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.