Stress inoculation: Can you train for stress?

Imagine a time when you were so stressed out about something, it made everything worse. Welcome to stress inoculation 101! In this article, we will cover: what is stress inoculation, the difference between therapy and training, the stages of it, how it helps with PTSD and cancer patients, and its benefits.

Stress Inoculation

What is stress inoculation?

Coming from Cognitive-Behavioral Therapy and psychotherapy (talk therapy), stress inoculation is intended to help people prepare themselves in advance for successfully handling stressful events with minimal upset. Exposure therapy and cognitive-processing therapy are other forms of stress inoculation. Inoculation is a term that is used by medical professionals to refer to something that helps a patient become resistant. For example, many people are yearly inoculated against the flu. Stress inoculation works in the same way as the flu inoculation except that one works with the effects of stressors and the other works with the effects of particular diseases.

Created by Donald Meichenbaum in his book Cognitive Behavior Modification during the early 1970’s, he describes it as teaching people how to cope with their anxiety- wherever and whenever it occurs. Meichenbaum argues that there are two elements that our bodies interact with when we feel anxiety and fear about something.

• First, a heightened physiological arousal which involves a sweating, increased heart rate, “lump in the throat,” chills, and muscle tension.
• Second, our thoughts that interpret if we are in danger or not attribute to our physiological arousal to fear. Our appraisal of danger and how we interpret our body’s response to the actual situation is what creates our anxiety.

Stress inoculation therapy and training are conducted on an individual, couple, or group (large and small) basis. They can vary between 20-90 minutes in a weekly or bi-weekly session. The most common course of treatment is 8-15 sessions, plus follow-sessions throughout the following 3-12 month period.  

Stress inoculation therapy

Stress inoculation therapy (SIT) involves learning to relax and reduce stress by using muscle relaxation and deep breathing techniques. More importantly, the person learns to create a private place for their coping thoughts which are used to counteract normal thoughts of danger that arise. People are educated about stressful situations, the general nature that stress has, the negative outcomes that can happen to those who are prone to stress, and the steps they can take to avoid those negative outcomes. The goal of stress inoculation therapy is to anticipate the pitfalls and dangers that can occur during a stressful event. And it’s important to have a practical and workable plan in order to avoid said dangers and pitfalls.

Acceptance-based coping is used for situations that cannot be altered while active interventions are used for changeable stressors.

Stress inoculation training

Stress inoculation training, also known as SIT, is inoculating someone against the effects of severe stressful situations by preparing them to effectively handle it well in advance. The idea is to prepare someone for the impact of the stressful situation by reducing the risk of developing post-traumatic stress disorder (PTSD) among other stress-related symptoms and disorders. Just like with vaccinations, stress inoculation training helps build up “psychological antibodies” in order to build resistance to strong stressors. It’s often used together with another supplement of treatment. The goals of SIT include broadening and strengthening a person’s coping skills, boosting their confidence that they will be able to apply their skills effectively, and helping them understand that coping can and must be adjusted to each individual situation. For example, what works in Situation A might not work in Situation B.

Stress inoculation therapy vs stress inoculation training

Stress inoculation therapy helps people cope with already existing stressors while stress inoculation training helps people prevent and/or cope with stressful situations in the future.

Stages of stress inoculation

Stress inoculation comes in three phases: conceptual phase, skills acquisition and consolidation phase, and application and follow-through phase. It’s not one-size-fits-all, so depending on the type of stressor (ongoing or time-limited), the resources and coping skills will vary from person-to-person. An ongoing stressor is something traumatic that happens on a regular basis like being a first responder or a soldier in combat. A time-limited stressor, also known as an acute stressor, is something like surgery, something that’s over quickly and won’t continue to happen.

• The conceptual phase provides the person with information about the nature of stress and the impact it can have on a person. The Transactional Model of Stress Coping is used to help the person understand how maladaptive coping behaviors, like cognitive distortion, can negatively influence their stress levels. People often and quite unknowingly worsen their stress through the unconscious operation of bad coping habits. Clinical techniques like Socratic-probing and questioning, self-monitoring, and modeling are used to help the person become more able to solve their problems while raising self-control and confidence. The person is asked to make a list that differentiates between their stressors and their stress-induced reactions so that coping ideas can be adjusted accordingly. This stage is key in showing the person that stressors are an opportunity and puzzle to solve rather than an obstacle.
• Skills acquisition and consolidation phase involves learning and practicing new stress management skills. Each skill learned depends on each person’s individual needs. Some common skills learned are relaxation training, cognitive restructuring, emotional self-regulation, problem-solving, and communication skills. Overall, the person will learn an array of techniques which they can then draw from in order to apply when coping with a stressful situation.
• Application and follow-through phase. The person needs to apply their new skills while gradually being exposed to higher levels of stress. This gradual exposing of stress is known as systematic desensitization. Consequently, the inoculation prepares the client for becoming more resistant towards stress. In turn, a sense of self-control and self-confidence is fostered. This stage also provides a relapse-prevention which involves “booster sessions” in order to fine-tune the person’s coping mechanisms as their life and stressful situations change. Role-play is important at this stage because the simulation of stress comes from acting out and dealing with it up front. For example, visualization exercises, modeling, and role-playing stressful or feared situations are common.

Stress inoculation and PTSD

Stress inoculation therapies and training are commonly used to those who suffer from post-traumatic stress disorder (PTSD). This is due to the fact that those who suffer anxiety from a past event use avoidance, among other methods, as a response to situations, memories, and thoughts that they find frightening. They do this in order to prevent the event from recurring. For example, a rape survivor may avoid dates, going out, and relationships for fear of being attacked again. There are many studies on the correlation between stress inoculation and PTSD.

• One study took 24 participants who suffered from PTSD and split them into two groups: Stress Inoculation Training with Prolonged Exposure (STIPE) and Eye Movement Desensitization and Reprocessing Stress Disorder (EMDR). The participants self-reported on their levels of PTSD and depression. Overall, desensitization scored higher than stress inoculation in terms of PTSD relief effectiveness.
• In a study done on 30 students at the Islamic Azad University in Dubai, United Arab Emirates, it was found that those who received stress inoculation for 90 minutes a week for eight weeks had a better ability to reduce perceived and foreseen stress than those who didn’t receive the training.
• A study done on Marine personnel before and after deployment involves PRESIT, a program also known as pre-deployment stress inoculation training as a preventive way to help deploying personnel cope with combat-related stressors. The study consisted of 351 U.S. Marines predeployment and 259 of whom responded after their return from deployment. PRESIT consists of three steps: (1) educating materials on operational and combat stress control, (2) coping skills that involve focused and relaxing breathing techniques with biofeedback, and (3) exposure to a video stressor environment to practice the skills and knowledge learned within the first two steps. The findings show that the PRESIT group of Marines were able to reduce their physiological arousal by breathing exercises. After measuring their PTSD with the Post-Traumatic Stress Checklist, the study found that those who went through PRESIT had benefited from the training in terms of their amount of PTSD and how they were able to handle it in comparison to those who did not go through PRESIT.

Stress inoculation and cancer patients

There are over 270 types of cancer. However, they all maintain one true thing in common, each one causes immense stress which can lead to depression and severe anxiety. There have been many different studies on how stress inoculation affects cancer patients. The results were all the same: when used, stress inoculation helps lower stress, anxiety, and depression in those with cancer.

• A 2013 study looked at chemotherapy patients from a clinic (in the Seyed Al-Shohada hospital) in Isfahan, Iran. The group of forty people was randomly split into two groups: the case group and the control group. Each group had the same treatment plans, except that the case group also was administered stress inoculation training. This training was composed of eight 90-minute sessions over an eight week period. Data were collected using the Depression, Anxiety, Stress Scales 42 (DASS-42) questionnaire. Data were analyzed by ANCOVA. The results showed that there was a significant difference between the two groups in terms of anxiety, stress, and depression.
• During a 10 week study of 100 women with Stage 0-II breast cancer, it was found that stress inoculation helped these women’s level of depression remain relatively stable and increased their general optimism. The results show that there is no downside to stress inoculation in cancer patients.
• In a Florida study using nine outpatient chemotherapy patients, it was found that those who had fears of needles and pre-chemotherapy vomiting (four of the five patients studied) bettered their anxiety and vomiting after going through a stress inoculation therapy.

People who can benefit from SIT

People who suffer from:

• Specific phobias
• Severe anxiety
• PTSD (due to things from sexual assault to battle)
• Pain disorders
• Trauma-related anger or depression
• Anger management problems
• Stress due to challenges of living with a chronic mental illness
• Performance anxiety (sports, public speaking, dating)
  • One study on two squash players, one male and one female, studied how their anxiety affected their game. After completing eight sessions of stress inoculation therapy, they reported lower anxiety levels and their overall performance had improved.
• Stressful life situations (divorce, unemployment, relocation)

It can also be used as a preventative measure for those suffering from a serious medical problem like cancer, hypertension, rheumatoid arthritis, or first degree burns who are preparing for a difficult medical procedure

Tips to help lower stress in stressful situations

• Deep breathing. Just take a couple deep breaths.
• Learning to talk silently to yourself in order to quickly recognize negative and down-putting thoughts about oneself, stop them, and then change them to encouraging and positive statements.
• Laugh it off because laughter releases endorphins that are able to improve our moods and lower our stress levels.
• Avoid caffeine, alcohol, and nicotine because they are scientifically proven to increase our stress levels when ingested.
• Be mindful because mindfulness is a long-term investment in your mental health and is shown to lower overall anxiety levels. Hypnotherapy and self-hypnosis are another option to help prevent while being mindful.
• Keep a stress diary and log how to react when you’re stressed and how you would like to react when you’re stressed. This way you will be able to better control your stress with practice in stressful situations.

Have you or anyone you know tried stress inoculation? How did it go? Let us know in the comments below!

Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.