➣ Professor Dr. Brenda K. Wiederhold
Stress inoculation training (SIT) is a type of training used to prepare individuals for stressful situations and helps diminish the potential for a negative psychological reaction. In cognitive-behavioral therapy, SIT is accomplished through gradual, controlled, and repeated exposure to a stressor. The goal behind this exposure is to desensitize or “inoculate” the person to the possible stimuli of a stressful situation, avoiding a panic or “fight or flight” response to the real thing. This repetition allows the individual to calmly and accurately accomplish the tasks at hand in a stressful environment. Developed in the late 1970s by Meichenbaum, controlled exposure to stress-related cues continues to be a key feature of resiliency training.
Because SIT is a technique used to help harden individuals to future potentially traumatizing stressors, it makes sense to use this method to help train those who must treat trauma patients. These personnel must often perform in extremely stressful environments, and optimum performance under such conditions requires effective management of physiological, psychological, and emotional responses to stressful stimuli. An acute stress reaction can occur during exposure to exceptionally stressful events, resulting in extreme sympathetic nervous system arousal and impaired performance. Longer-term reactions to these situations can include acute stress disorder, Posttraumatic Stress Disorder (PTSD), and burnout.
One method to attenuate or prevent these reactions is Virtual Reality-enhanced SIT, in which personnel “experience” highly stressful situations in a virtual environment. Repeated exposure enables performers to gradually become desensitized to stimuli that may initially elicit such strong physiological arousal that performance is impeded (e.g., freezing under gunfire instead of moving a wounded soldier to safety), and therefore, psychological trauma should be less likely. Stress inoculation training is associated with a reduction in anxiety and an enhancement in work-related performance. Preliminary results of a study by Stetz and colleagues showed that virtual environments do succeed in stressing medics enough to produce an “inoculation” effect by increasing anxiety and dysphoria.
There is evidence that SIT can reduce PTSD. In a 2000 study by Deahl and colleagues, a group of 106 male British soldiers preparing for a six-month tour of duty in Bosnia received a combination of pre-deployment stress training and post-deployment psychological debriefing. After deployment, participants demonstrated a drastically reduced incidence of PTSD and other psychopathology as compared to controls, approximately 10 times less than figures reported from other military samples. In fact, the level was so low that it precluded any possible debriefing effect.
A recent Rand review of the evidence of effectiveness of various treatments for PTSD rated SIT as a Level A intervention as of 2000, based on two wellcontrolled and two less well-controlled studies in female sexual-assault survivors. Level A is the most rigorous, defined as “Evidence is based on randomized, well-controlled clinical trials for individuals with PTSD.”
Evidence of the effectiveness of SIT is certain to grow with advances in the fields of psychophysiology and neurobiology. An example of the former is a recent study of Belgian Special Forces candidates, which showed robust increases in cortisol in a highintensity stress (vs. a no-stress) group, with significant correlations to decreased performance on working memory and visuo-spatial tests.
An example of the latter is a review article by Lyons and colleagues that uses their longitudinal work with squirrel monkeys to inform areas of investigation for human studies of resilience. Specifically, stress inoculation in monkeys enhances prefrontaldependent cognitive control of behavior and increases ventromedial prefrontal cortical volumes. These and other findings “suggest that early life stress inoculation triggers developmental cascades across multiple domains of adaptive functioning. Prefrontal myelination and cortical expansion induced by the process of coping with stress support broad and enduring trait-like transformations in cognitive, motivational, and emotional aspects of behavior.”
Science points the way for those leading and studying trauma training: Transform such training, protecting the psychological well-being of first responders by including resilience training exercises such as SIT.
Create your own reality!
President of Virtual Reality Medical Institute (VRMI) in Brussels, Belgium. Executive VP Virtual Reality Medical Center (VRMC), based in San Diego and Los Angeles, California. CEO of Interactive Media Institute a 501c3 non-profit Clinical Instructor in Department of Psychiatry at UCSD Founder of CyberPsychology, CyberTherapy, & Social Networking Conference Visiting Professor at Catholic University Milan.