As stressors can take many forms (time-limited/persistent, controllable/uncontrollable, predictable/unpredictable, current/in the past), this approach is tailored to the individual needs of the client.
The idea of inoculation comes from vaccination, where a weak dose of a disease is thought to provide the body with the ability to fight a future strong dose; Stress Inoculation Training provides clients with the opportunity to deal with mild forms of a stressor in order to increase their perceived ability to cope with chronic stressors.
Stress Inoculation Training recognises that clients often have self-defeating attitudes, thoughts and behaviours that make it difficult for them to cope with stressors (see table 1). The therapy aims to modify these to make the person better equipped to deal with stressful occurrences. There are three phases of Stress Inoculation Training: Conceptualisation; Skills Acquisition and Consolidation; and Application and follow through.
Conceptualisation
In this phase a therapeutic relationship between the client and therapist is developed. Meichenbaum (2007) considers this relationship to be very important in that it provides the ‘glue’ that allows the various aspects of the therapy to work together.
Another aspect of this phase is to help the clients to understand the affect of their existing coping mechanisms. Self-defeating attitudes and coping mechanisms are also identified (see table 1). This occurs through a ‘Socratic type exchange’, where the therapist asks curious questions in order to guide the client to understand their cognitions and behaviour.
Table 1 Thoughts and behaviours that increase or prolong stress - From Michenbaum (2007)
|
A. SELF-FOCUSED COGNITIONS THAT HAVE A “VICTIM” THEME |
B. BELIEFS |
C. BLAME |
|
1. Seeing oneself as being continually vulnerable 2. Seeing oneself as being mentally defeated 3. Dwelling on negative implications 4. Being preoccupied with others’ views 5. Imagining and ruminating about what might have happened (“near miss experience”) |
1. Changes are permanent 2. The world is unsafe, unpredictable and untrustworthy 3. The future will be negative 4. Life has lost its meaning |
1. Blaming others, with accompanying anger. 2. Blaming oneself, with accompanying guilt, shame, and humiliation |
|
D. COMPARISONS |
E. ACTIONS TAKEN |
F. ACTIONS NOT TAKEN |
|
1. Oneself with others 2. Before with now 3. Now with what might have been |
1. Being continually hypervigilant 2. Being avoidant cognitive level (suppressing unwanted thoughts, dissociating, engaging in “undoing” behaviours) 3. Being avoidant behavioural level (avoiding reminders, using substances,withdrawing, abandoning normal routines, engaging in avoidant safetyBehaviours) 4. Ruminating and engaging in contrafactual thinking (“Only if”) 5. Delaying change behaviours 6. Fail to resolve and share trauma story (keeping secrets) 7. Putting oneself at risk for revictimization |
1. Believing that anything positive could result from trauma experience 2. Retrieving, and accepting data of positive self-identity 3. Seeking social supports 4. Protecting oneself from negative, unsupportive stress-engendering environments(indifference, criticism, “moving on” statements) 5. Using faith as means of coping, as a way of imposing meaning |
Skills Acquisition and Consolidation
In this phase, the client is taught skills that are specific to their particular circumstances, for example: anxiety management, cognitive restructuring, self-instructional training, communication, assertion, problem solving, anger control, applied cue-controlled relaxation training, parenting, study skills and using social supports (Meichenbaum, 2007). These skills are practised in the therapeutic setting.
Application and follow through
In the final phase, the skills learned in phase 2 are carried out in real-life settings. The exposure to real stressors is graded (low stress to start with and gradually increasing). Follow through procedures are employed to ensure that any warning signs of relapse are dealt with.
Evaluation of Stress Inoculation Training
An important strength of Stress Inoculation Training is that it is very flexible. Because it consists of a wide variety of cognitive and behavioural techniques tailored to the individual needs of the client, it can be used to deal with many types of stressor (e.g., time-limited/persistent, controllable/uncontrollable, predictable/unpredictable, current/in the past). It has been found to be successful in helping people deal with the stress of chronic pain, performance anxiety, specific phobias, work related stress (Meichenbaum, 2007), as well as helping athletes deal with the stress of competition (Mace, Eastmen & Carroll, 1986) and helping patients prepare for surgery (Langer, Janis & Wolfer, 1975).
