An Overview Of Stress Inoculation Therapy (SIT)

Have you been experiencing excessive stress or dealing with post-traumatic stress disorder? Are you looking for a way to keep it from affecting you? If so, you’re not alone. Stress is common, and it is often experienced as worry or nervousness regarding a potentially negative outcome in the future. Stress inoculation therapy is here to address these concerns. 

In the early 1980s, psychologist Donald Meichenbaum developed a therapeutic intervention intended to work as a preventative measure for people at risk of stress. He introduced the practice as SIT—a type of cognitive behavioral therapy (CBT) designed to prepare participants for stress-inducing scenarios so that they would experience less anxiety when a real event occurred.

While developing the practice of stress inoculation training, Meichenbaum included three distinct phases: the conceptualization phase, the skills acquisition and rehearsal phase, and the application and follow-through phase. Before exploring these phases, we’ll take a closer look at the main goals of this therapy, along with who may benefit from this therapeutic approach.

Three Primary Goals Of SIT

When Dr. Meichenbaum introduced SIT, he had three goals in mind:

1. To strengthen participants’ coping skills and help them develop new ones

2. To increase participants’ confidence in their ability to utilize effective coping strategies

3. To help participants recognize the need to implement necessary coping skills based on the unique circumstances of a situation and to realize that not every strategy works for every situation

Stress can have a detrimental impact on the body. While SIT may be used with couples, families, and groups, it is often conducted one on one. 

Because SIT is often adapted to fit a person's specific needs, it can be beneficial for people experiencing persistent negative thoughts and a variety of other mental health challenges. However, it is most commonly used to support people at risk of PTSD, such as people working in challenging or high-stress jobs. 

SIT may help you develop new skills if you experience any of the following challenges:

• Extreme anxiety, panic attacks, or panic disorder

• Phobias

• Stress related to chronic mental illness or diseases

• Pain disorders

• PTSD

• Anger

• Performance anxiety

• Trauma-related depression

• Difficult life transitions

• Serious medical problems, in which stress may be related to an operation or procedure

Along with the above-mentioned conditions and circumstances, individuals and groups working in high-stress fields may also benefit from this type of therapy. Examples include:

• Healthcare workers

• Caretakers

• Disaster and rescue teams

• Police officers and probation officers

• Firefighters

• Prison guards

• Teachers

• Social workers

These professionals may be at the highest risk of mental health challenges like PTSD or other trauma disorders. 

Three Phases Of Stress Inoculation Therapy

There are three primary stages of stress inoculation training that may be used in therapy. When developing a treatment plan, the therapist typically considers two primary factors: the types of the stressors a person is facing and their current coping skills. As previously mentioned, individuals in SIT typically work through three phases. By breaking this therapeutic approach into three distinct stages, practitioners can choose a pace that's appropriate for the individual.

Conceptualization Phase

The initial phase of SIT usually involves an interview, education, and self-monitoring. In addition to a comprehensive consultation, practitioners may conduct further psychological testing. In this stage, the therapist aims to get an idea of who the person is and what types of pressures they are facing, before deciding what method of treatment is best. If a client has received a previous diagnosis of an anxiety disorder or PTSD, the therapist may ask for this information to aid in the stress inoculation training process. 

Here, the individual can become educated and aware of their patterns regarding stress. They can also learn how it affects their lives and how they may inadvertently perpetuate stress. They then begin self-monitoring, which can help them recognize how their thought patterns cause or exacerbate it. Then, the therapist typically teaches the person to reframe the pressures as an opportunity to resolve a problem.

Phase one usually involves deciphering whether specific elements of a stressor, and the subsequent reaction, can be changed. This allows the individual to adapt their coping strategies by initiating change and accepting the circumstances that can't be changed.

Skills Acquisition And Rehearsal Phase

During the second phase of SIT, participants can usually begin to reduce their stress and anxiety by learning valuable coping skills for their unique circumstances. The therapist typically considers individual pressures, as well as the strengths and weaknesses of the individual. They may talk through the beliefs one has developed due to PTSD, if applicable. 

The individual may receive a combination of therapies during this phase and may be taught a variety of useful skills, including the following:

• Emotional self-control

• Exposure therapy

• Effective communication skills

• Muscle relaxation training

• Problem-solving skills

• Self-soothing (deep breathing, etc) for mental health 

• Mindfulness

• Diversion techniques

Throughout this phase, participants add many techniques to their stress reduction toolkit to ensure they have a variety of coping strategies from which to choose in various provoking situations or as a way to cope with post-traumatic stress. During this time, they may start to notice opportunities in their daily lives where they can use these skills. In the next stage, the application and follow-through phase, these strategies are practiced in the clinical setting before being implemented in real-life scenarios.

Application And Follow-Through Phase

Finally, the third phase of SIT allows participants to role-play and utilize the skills and strategies they learned in phases one and two. These techniques are reinforced through simulation techniques put into place by the therapist. These role-playing exercises are conducted in a controlled, safe environment. This way, participants are able to practice coping skills before utilizing them in real life. Cognitive or behavioral techniques may include:

• Visualizing a stressful scene or situation

• Role-playing a stressful scene or situation

• Engaging in real-world exposure (in vivo exposure therapy) 

Stress Inoculation Therapy Sessions

Because SIT can be adaptable, most people’s experiences will be different. Treatment time can vary based on an individual’s specific circumstances and needs, with sessions ranging in length from 20 minutes to an hour or more, weekly or biweekly. Generally, participants start with 8-15 sessions and may return for routine follow-up sessions for anywhere from three months to a year. In some cases, practitioners may recommend up to 40 sessions.

While several consecutive sessions are often recommended, some participants may benefit from a single visit before worrisome situations, such as a medical procedure or other short-term pressures.

Below are a few tips to keep in mind when beginning your stress inoculation therapy journey:

• Choose a therapist to whom you're comfortable opening up. You might not mesh well with all experts, so find one you can sit and discuss things comfortably.

• Be completely honest.

• Keep the lines of communication open. If you become overwhelmed by the process, you can ask your practitioner to pause until you're comfortable moving on. It can be easier to experience the full benefits of each phase when you're not struggling to keep up.

While SIT requires motivation, time, and ongoing commitment, the benefits outweigh the drawbacks for many people. The most important aspects include:

• Increased functioning and focus. Research shows that individuals who participate in SIT can better perform in worrisome situations.

• Identify skills to improve calm states. A meta-analysis that included over 1,400 participants concluded that SIT can effectively reduce symptoms of anxiety and stress.

• Increased confidence. People who participate in SIT often feel more comfortable in situations that may have left them feeling vulnerable before treatment.

• Improved sense of self. People who participate in SIT often find greater internal strength and resiliency and tend to view themselves in a more positive light.

• Decreased anxiety, even in high-stress situations. This therapy can help stop it before it starts, even in high-pressure scenarios. A 2016 study published by Oxford University Press (OUP) found that pre-deployment SIT resulted in fewer instances of PTSD in US Marines, as well as an improvement in their ability to handle PTSD symptoms. 

An increasingly large number of studies show that online therapy can help individuals reduce their levels. For example, in a meta-analysis of 13 studies, which included over 1,800 total participants, researchers concluded that online cognitive behavioral therapy could effectively manage symptoms. The analysis also mentions the cost-effectiveness and availability of online therapy when compared to in-person treatment. 

Online therapy is a convenient and affordable option if you’re seeking care for elevated levels or a similar concern. With an online therapy platform like BetterHelp, you can work with a therapist remotely—through video call, voice call, or in-app messaging—without the potential added worry of commuting to an office. Your therapist can also connect you with useful helps by connecting you with valuable educational resources, which can help reinforce important concepts from sessions and allow you to work on managing it on your own time.