Client Responses

The civilian in the group, a fifty-three-year-old woman, who had hurricane-related acute stress disorder, made significant progress. She entered group attributing her significant anxiety symptoms to fears and memories of dying during the storm. She had married later in life to a much older man, who during the storm, simply turned off his hearing aid and went to sleep, while his wife remained awake fearing for her life. During the course of therapy, she was transformed from a dependent and passive person to an action-oriented self-starter. The experience of the storm created a sense that she was alone and that her husband was unable to protect her. Over time and with the assistance of the group in reconceptualizing the meaning of the traumatic event, she transformed this memory of fear and vulnerability into motivation to become self-sufficient. By the end of therapy she had taken on the role of a consultant to her much younger counterparts, enrolled in college for the first time, and was producing a play in the local theater. It became evident that her passivity had diminished when she threatened to leave her job of ten years and demanded a substantial raise—she received the raise. Also, she no longer blamed her avoidance of social activities on her husband's laziness or obesity. With a new sense of confidence and a little persistence she persuaded her once-sedentary husband to break his symbiotic relationship with his La-Z-Boy chair, and assist his industrious wife with her theater production.

A combat veteran was referred to group after a domestic violence dispute. He benefited most from the psychoeducational component of SIT in understanding his hyperarousal and impulsive, reactions to his wife's reactions during even the most benign arguments. The SIT group also assisted him in generating a strategy to evoke "more normal" reactions to stressors involving his wife. Another active duty service member, who had been sexually assaulted by a co-worker, acquired the anxiety management skills to cope with frequent interactions with the perpetrator and his friends during the investigation. The vulnerability experienced while discussing the event, several times in a group setting, desensitized her and promoted a healthier integration of her traumatic memory.


The goal of SIT is consistent with my objective of returning patients to optimal functioning in an expeditious manner with the aim of bolstering their coping skills and self-reliance.

There is, however, a general contraindication to this intervention. When dealing with anxiety and stress-related disorders, the resurfacing of traumatic memories is the rule rather than the exception. One can expect patients to react strongly to these memories and trauma-related fears and projections about the future. Therefore, it is imperative that those with significant personality dysfunction and poor affect regulatory abilities, be excluded from this type of group modality and be treated on an individual basis until they are more suitable for SIT.


Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339-376. Deffenbacher, J. L., & McKay, M. (2000). Overcoming situations and general anger. Oakland, CA: New Harbinger. Department of Veterans Affairs and Department of Defense (2004). VA/DoD clinical practice guideline for the management of posttraumatic stress. Washington, DC. Retrieved on 01 April 2007 from PTSDcpg/frameset.htm. Ehlers, A., & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345. Lazarus, R. S., & Folkman, S. (1984). Stress appraised and coping. New York: Springer-Veriag.

Meichenbaum, D. (1993). Stress inoculation training: A 20-year update. In R. L. Woolfolk & P.M. Lehrer (Eds.). Principles and practices of stress management. (pp. 373-406). New York: Guilford Press. Meichenbaum, D. (1996). Stress inoculation training for coping with stressors. The

Clinical Psychologist, 49, 4-7. Meichenbaum, D. (2005). Stress inoculation training: A preventative and treatment approach. In P.M. Lehrer, R.L. Woolfolk & W. S. Sime (Eds.). Principles and practice of stress management. (3rd ed.). (pp. 203-219). New York: Guilford Press.

Suinn, R. M. ( 1990). Anxiety management training. New York: Plenum Press.

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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