Table of ContentsView AllTable of ContentsBackgroundTechniquesExposure TherapyCognitive Processing TherapyEvidence

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Table of Contents

Background

Techniques

Exposure Therapy

Cognitive Processing Therapy

Evidence

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Stress inoculation training (SIT) is a form ofcognitive 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 ofcoping skillsthat are useful in managing anxiety, such as:

You also learn to use your new skills. Once you’ve identified the cues that can trigger your anxiety andfear, 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.

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.

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 (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.”

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.

Coping With PTSD

8 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Kashani F, Kashani P, Moghimian M, Shakour M.Effect of stress inoculation training on the levels of stress, anxiety, and depression in cancer patients.Iran J Nurs Midwifery Res. 2015;20(3):359-364.

Hourani L, Tueller S. et al.Effect of stress inoculation training with relaxation breathing on perceived stress and posttraumatic stress disorder in the military: A longitudinal study.International Journal of Stress Management. 2018;25(S1),124–136. doi:10.1037/str0000082

Tasman A, Kay J, et al.Psychiatry, Volume 1, Fourth Edition.Wiley. 2015.

Lancaster CL, Teeters JB, Gros DF, Back SE.Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment.J Clin Med. 2016;5(11).  doi:10.3390/jcm5110105

What Is Exposure Therapy?. American Psychological Association.

Watkins LE, Sprang KR, Rothbaum BO.Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions.Front Behav Neurosci. 2018;12:258.  doi:10.3389/fnbeh.2018.00258

How Do I Find a Good Therapist?. American Psychological Association.

American Psychological Association.Cognitive Processing Therapy (CPT). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. Updated July 31, 2017.Meichenbaum D.Stress Inoculation Training: A Preventative and Treatment Approach. In:The Evolution of Cognitive Behavior Therapy: A Personal and Professional Journey With Don Meichenbaum. New York, NY: Routledge; 2017.Rauch SAM, Foa EB.Stress Inoculation Training (SIT) for Posttraumatic Stress Disorder (PTSD). TherapyAdvisor.com. National Institute of Mental Health.U.S. Department of Veterans Affairs.Treatment of PTSD. National Center for PTSD. Updated August 18, 2017.

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