Stress inoculation training (SIT) is a form of cognitive behavioral therapy (CBT) for post-traumatic stress disorder (PTSD). CBT is a commonly used form of psychotherapy (talk therapy) that can help you recognize and change incorrect and/or negative thoughts that have been influencing your behavior. Exposure therapy and cognitive-processing therapy are other examples of such therapy.
Stress Inoculation Training
Just as a vaccination against a particular disease helps your body respond quickly when it’s exposed to that disease, in the same way, stress inoculation training prepares you to quickly defend against PTSD-related fear and anxiety when you’re exposed to reminders, or cues, that trigger these symptoms.
By exposing you to milder forms of stress, your confidence is boosted so that you can respond quickly and effectively when trauma-related cues occur.
This form of psychotherapy may run in 90-minute sessions over several weeks. It may be done in a therapy group; however, it’s mainly done one-on-one with a therapist.
Stress Inoculation Training Techniques
You learn coping skills. If you have PTSD and receive stress inoculation training, your therapist will help you become more aware of the specific triggers that cue your trauma-related fear and anxiety. In addition, you’ll learn a variety of coping skills that are useful in managing anxiety, such as:
- Deep breathing from your diaphragm:
There are two parts to this coping training—learning how to breathe deeply and then practicing it between therapy sessions so it becomes a healthy habit.
- Learning to silently talk to yourself:
If you’re like many people, with and without PTSD, you probably do this already, but in stress inoculation training, you learn to focus your internal talks on quickly recognizing negative, down-putting thoughts about yourself, stopping them, and changing them to positive, encouraging statements.
- Muscle relaxation training:
: You’ll learn how to relax each of your major muscle groups by tensing and releasing them in the correct way. These exercises are also recorded so you can practice them between training sessions.
- Role-playing: Here’s where you start to practice the coping techniques you’ve learned. After you and your therapist set up an anxiety-provoking situation, you role-play coping effectively using specific anxiety management strategies.
- Thinking about and changing negative behaviors:
This is where you learn to use your imagination to practice effective coping. Your therapist guides you through an entire anxiety-provoking situation in which you successfully recognize trauma-related cues and take action to prevent them from getting out of control.
You also learn to use your new skills. Once you’ve identified the cues that can trigger your anxiety and fear, your therapist will help you learn to detect and identify these reminders as soon as they appear. This lets you put your newly learned coping skills into action immediately to manage your anxiety and stress before they have a chance to get out of control.
Exposure Therapy
Over time, people with PTSD may develop fears of reminders of their traumatic event. These reminders may be in the environment. For example, certain pictures, smells, or sounds may bring about thoughts and feelings connected with the traumatic event.
These reminders may also be in the form of memories, nightmares, or intrusive thoughts. Because these reminders often bring about considerable distress, a person may fear and avoid them.
The goal of exposure therapy is to help reduce the level of fear and anxiety connected with these reminders, thereby also reducing avoidance. You may need to confront (or be exposed to) the reminders that you fear without avoiding them. This may be done by actively exposing you to reminders, for example, showing you a picture that reminds you of the traumatic event, or through the use of imagination.
By dealing with fear and anxiety, you can learn that anxiety and fear will lessen on its own, eventually reducing the extent to which these reminders are viewed as threatening and fearful. Exposure therapy is usually paired with teaching you different relaxation skills. That way you can better manage your anxiety and fear when it occurs instead of avoiding it.
Cognitive Processing Therapy
Cognitive processing therapy (CPT) is effective in treating PTSD among people who have experienced a trauma like sexual assault, child abuse, combat, or natural disasters. CPT usually lasts 12 sessions and can be viewed as a combination of cognitive therapy and exposure therapy.
CPT is like cognitive therapy in that it is based in the idea that PTSD symptoms stem from a conflict between pre-trauma beliefs about yourself and the world (for example, the belief that nothing bad will happen to you) and post-trauma information (for example, the trauma as evidence that the world is not a safe place).
These conflicts are called “stuck points” and are addressed through the next component in CPT—writing about the trauma.
Like exposure therapy, in CPT, you’re asked to write about your traumatic event in detail and then to read the story out loud repeatedly inside and outside of the session. Your therapist helps you identify and address stuck points and errors in thinking, sometimes called “cognitive restructuring.”
Errors in thinking may include, for example, “I’m a bad person” or “I did something to deserve this.” Your therapist may help you address these errors or stuck points by having you gather evidence for and against those thoughts.
Evidence
All of the treatments discussed here have been found to be successful in the treatment of PTSD, though the research is stronger in favor of trauma-focused psychotherapies like CPT and exposure therapy. Which one is right for you depends on what you feel most comfortable with.
For example, some people don’t feel comfortable with actively confronting reminders of trauma or writing about a past traumatic experience. Therefore, SIT may be a better choice. The most important thing is that you find a therapist that you feel comfortable with and trust.
Stress Inoculation Training (SIT) for PTSD
The treatments that work best for PTSD focus on the trauma you experienced. You may prefer a treatment that does not have this focus. The research support is not as strong for these therapies, but they do help you work through your reactions to the trauma and PTSD symptoms. Learn about Stress Inoculation Training (SIT), which teaches you skills and techniques to manage stress and reduce anxiety.
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What Type of Treatment Is This?
Stress Inoculation Training (SIT) is a psychotherapy—or talk therapy—for PTSD. It is one specific type of cognitive behavioral therapy. By teaching you coping skills, SIT can help you find new ways to deal with PTSD symptoms. These skills can also help you manage other stressful situations or events in your life.
How Does It Work?
People with PTSD are often under a lot of stress and may have a hard time coping with their symptoms. SIT teaches you skills to react differently to stressful situations and to manage your PTSD symptoms. You will consider how different situations, thoughts, and behaviors could be making it hard for you to deal with your PTSD symptoms. With your provider, you will learn how to develop more helpful ways of coping. With practice, you will become more confident in your ability to use the coping skills to manage your PTSD symptoms.
What Can I Expect?
During the first phase of SIT you will learn about PTSD symptoms and identify the sources of your stress. You will talk about your usual ways of coping with PTSD symptoms. You will also learn how to keep track of your stress level. The next phase involves learning and practicing new problem-solving strategies and coping skills that can help you relax your body and your breathing, stop upsetting thoughts, and stay in the moment. You will practice each skill in session, and then at home on your own. You also discuss whether you can change any of the things in your life causing you stress—or at least change how you react to them. Towards the end of treatment, you will review your progress and make a plan for how to handle stressful situations that could come up in the future.
Is It Effective?
Yes, SIT is a therapy supported by research. The evidence for this therapy is not as strong as research supporting trauma-focused psychotherapies like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR). However, SIT may be a good option if trauma-focused psychotherapy is not of interest or available to you.
How Long Does Treatment Last?
About 3 months of weekly 60-90 minute sessions. You may decide to meet with your provider less often (for example, every other week) towards the end of treatment. Many people notice improvement after a few sessions.
What Are the Risks?
You may feel uncomfortable talking about your problems or PTSD symptoms. These feelings are usually brief, and people tend to feel better as they keep doing SIT. Most people who complete SIT find that the benefits outweigh any initial discomfort.
Group or Individual?
SIT is often done in a group with one or two providers and other people who also have PTSD. SIT can also be done individually, where you meet one-to-one with a provider.
Will I Talk in Detail About My Trauma?
No, SIT does not require you to talk in detail about the trauma. In fact, you may be asked not to mention any details of your trauma at all.
Will I Have Homework?
Yes, you will practice using stress management skills learned in therapy.
How Available Is This in VA?
Low. This specific treatment is not common in VA. However, some therapists inside and outside VA use a cognitive behavioral therapy approach to teach coping skills to deal with PTSD symptoms or current problems.
Does VA Have an App for That?
No, currently VA has not developed an app for SIT.
Choosing the Best Treatment for You
Trying to figure out which PTSD treatment is best for you? For more information about treatments that work, get started with the PTSD Treatment Decision Aid.
