Stress Inoculation Training (SIT)

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Category: Allied Health Options

What is it?

Stress Inoculation Training (SIT) is a form of Cognitive Behavioural Therapy which is used to reduce anxiety. It involves three phases of treatment. The first is a conceptualisation phase which involves psychological testing, interviewing and self-monitoring. This phase aims to allow the client to identify and understand the thoughts underlying their anxiety. The second phase is a skill acquisition and rehearsal phase, which involves teaching skills which can be used to address these thoughts and thereby reduce anxiety. These skills involve mainly thought processes but also include emotional skills and relaxation. The third and final stage involves the application and enhancement of these skills.

How does it work?

SIT targets negative thoughts, beliefs, attitudes and behaviours which reduce the individuals’ ability to cope with stress, which in turn leads to anxiety. It works by identifying the thoughts, beliefs, attitudes and behaviours that are unique to the client and then changing them to improve the client’s ability to cope with stressful thoughts or life events.

Is it effective?

The current American Psychological Association’s practice guidelines on the treatment of acute stress disorder and PTSD state that SIT may be indicated in the treatment of PTSD. There are currently no systematic reviews on the effectiveness of SIT for PTSD. Two randomised controlled trials have investigated the effectiveness of SIT. One trial compared SIT to counselling and the other compared SIT to exposure therapy. Both trials reported that SIT was effective in the treatment of PTSD.

Are there any disadvantages?

SIT may not be as effective for victims of sexual assault. One randomised controlled trial compared exposure therapy to SIT with a population of sexual assault victims. This trial found that exposure therapy was more effective than SIT in the long term.

Where do you get it?

Stress Inoculation Training can only be administered by a registered mental health professional.

What are the evidence limitations?

The evidence for the effectiveness of SIT originates from only two randomised controlled trials. Both trials were conducted on female sexual assault victims. Considering this, interpretation of this evidence should be undertaken with caution. Further trials investigating the effectiveness of SIT in different populations are required.

Recommendations

In light of the current evidence, SIT may be considered in select populations of clients with PTSD.

Key References

American Psychiatric Association Practice Guidelines
American Psychiatric Association Practice 2004 ‘Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder’, The American Journal of Psychiatry, vol. 161, no. 11, pp. 3-31.

Foa, E, Dancu, C, Hembree, E, Jaycox, L, Meadows, E & Street, G 1999, ‘A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims’, Journal of Consulting and Clinical Psychology, vol. 67, no. 2, pp. 194-200.

Foa, E, Rothbaum, B, Riggs, D & Murdock, T 1991, ‘Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counselling’, Journal of Consulting and Clinical Psychology, vol. 59, no. 5, pp. 715-723.

Meichenbaum, D & Deffenbacher, J 1988, ‘Stress inoculation training’ The Counseling Psychologist, vol. 16, no.1, pp. 69-90.

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