Intervention Guidelines

SIT is a flexible and individually tailored alliance-based intervention used with individuals, couples, and groups. Sessions are as short as twenty minutes and range in frequency from eight to forty sessions. SIT has been utilized successfully to prepare patients undergoing medical procedures (Meichenbaum, 2005) and with patients suffering from anxiety (Suinn, 1990), stress disorders, addictions (Meichenbaum, 2005), and anger control problems (Deffenbacher & McKay, 2000). The Joint Department of Defense and Veteran's Administration Clinical Practice Guidelines (2003) designates SIT as a "Class A" treatment for post-traumatic stress disorder (PTSD). Additionally, Meichenbaum (1993) found SIT to be useful for individuals adjusting to the military.

The objective of SIT is to strengthen the patients' coping repertoire (intrapersonal and interpersonal skills) and build their confidence to overcome the perceived demands of stressful situations. Moreover, the SIT model embraces the transactional view of stress described by Lazarus and Folkman (1984) where stress occurs because the perceived demands of a situation exceed the perceived resources to cope. In this view, stress is viewed as a dynamic relationship between the person and the environment. Similarly, SIT was influenced by the constructive narrative perspective (CNP) (Meichenbaum, 2005). In this view, individuals and groups are seen as "storytelling entities." Their stories are both personal and cultural. The nature and content of the stories that they tell themselves and others play a critical role in influencing the coping process (Meichenbaum, 2005; Brewin & Holmes, 2003; Ehlers & Clark, 2000).

The Three-Phase Stress Inoculation Training

1. Conceptual Education

Through Socratic discovery-based interviewing, the therapist assists the patients in identifying and then conceptualizing their symptoms and triggers. With greater knowledge and an understanding of the biopsychosocial underpinning of their responses, the group and therapist work collaboratively toward reconceptualizating each individual's presenting problem. The group then explores each member's established personal strengths, resources, and resiliencies to enhance personal control and mastery.

2. Skills Acquisition and Consolidation

In this phase each patient develops an action plan tailored to overcome his or her stressor. Interventions are problem focused and emotionally focused. Problem solving, rehearsal, in vivo exposure (in and out of group), and cognitive reframing may be used. Take advantage of the interpersonal interactions inherent in group therapy.

3. Application and Follow-through

During this final phase, patients are encouraged to practice their newly acquired coping skills across increasingly demanding levels of stressors utilizing the interventions described during the second phase. The objective is to achieve generalization and maintenance of changes. Use the group to develop individual relapse prevention plans especially targeting risky situations such as anniversaries, social pressures, or high and low emotional states. Reframe relapse as an opportunity for learning rather than a catastrophe destined to lead to further relapses. Lead patients to assume a consultative role for someone in the group or for a friend, and if appropriate, encourage group members to support one another beyond therapy sessions. Finally, provide a plan for future individual follow-up or booster sessions as needed.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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