Stress Inoculation Training, PTSD, and Case Study Analysis

This report delves into Stress Inoculation Training (SIT) as a Cognitive Behavioral Therapy (CBT) approach for Post-Traumatic Stress Disorder (PTSD) and complex trauma. It examines how SIT prepares individuals to cope with trauma-related fear and anxiety by teaching them various coping skills, including deep breathing, muscle relaxation, and cognitive restructuring. The report also explores other therapeutic methods like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). It discusses the causes of complex trauma, which can arise from repeated traumatic events, adverse childhood experiences, or violence. A case study of a woman named Mia, who experienced the death of her son, illustrates the practical application of EMDR and SIT in treating PTSD symptoms, including nightmares, obsessive thoughts, and depression. The report highlights the effectiveness of SIT, particularly in reducing PTSD symptoms, and provides evidence supporting its success in clinical trials. The report also includes relevant references to support the findings and provides a comprehensive overview of SIT and related treatments for PTSD.

STRESS
INOCULATIO
N TRAINING

ABOUT STRESS
• When the level of stress becomes high, it affects the
mental or physical functions, that develops a serious
problem (De Bellis & Zisk, 2014).
• When level of the pressure gets very high, the level of
stress will eventually cross the ability of an individual to
cope up with the stress in a more positive manner.
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ADDRESSING STRESS
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• Stress can be due any type of physical
or any emotional stimuli or situation.
• Thus, there is a need to have a more
productive and positive manner to
handle the stress.
• Addressing the situation or the person
that is responsible or linked to the level
of stress is very important (Hodges et
al., 2013).

COMPLEX TRAUMA
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• It arises due to a number of traumatic events
• These events can be due to interpersonal problems, invasive
events, or some wide range of traumatic events.
• Complex trauma is interpersonal and is related to a feeling of
being trapped and has more severe or cumulative effects as
compared to a single event leading to stress.

COMPLEX TRAUMA
CAUSES
• It can arise due to repeated incidents of trauma against a
child (Machtinger et al., 2015).
• In some cases, a parent or the caregiver has
experienced their own set of traumatic events for
example, alcohol abuse, emotional or physical abuse,
which still affects them.
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COMPLEX TRAUMA
CAUSES
• For a complex trauma to occur the situations need not
be always damaging.
• The generation of complex trauma can be due to child
abuse, adverse childhood experiences, negligence at
childhood, domestic violence, community violence,
civil war, cultural dislocation, trafficking and sexual
exploitation (Shapiro, 2014).
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COMPLEX TRAUMA CAUSES
• Complex trauma is not always due to the childhood trauma.
• It can also be present due to experiences of an adult that represent
violence in the community. For example, family violence, civil war or
asylum trauma (Jeffries & Davis, 2013)
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COMPLEX PTSD
• Complex PTSD is seen in children or in adults who have had
frequently experienced the traumatic events, such as abuse,
violence, or neglect.
• It might take several years for the recognition of the complex
PTSD (Sigel et al., 2013)
• It may affect the development of a child that includes their self-
confidence and behaviour that can be changed as they get older.
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COMPLEX PTSD
Complex PTSD is more severe if:
• traumatic events happen at a preliminary stage in the
life
• abuse was done by a carer or parent
• the individual has faced the trauma for quiet a long time
• the individual was all alone during the trauma
• There is still contact of the individual with the person
who was responsible for the trauma (Dorahy et al.,
2013)
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TREATMENT OF COMPLEX TRAUMA
• Complex trauma can be treated by the use of number of
therapies (Cook et al., 2017)
• The most common therapy in the treatment of complex
trauma are the trauma-focused cognitive behavioral
therapy or eye movement desensitization and
reprocessing (EMDR) and Stress Inoculation Training.
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TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY
• It is a form of cognitive behavioral therapy that can
address emotional and the needs of mental health of the
children, adult survivors, adolescents, and the families
who are trying hard to overcome the bad effects of early
trauma (Biederman et al., 2014).
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TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY
• Trauma-focused cognitive behavioral therapy or TF-
CBT is sensitive to the problems of the youth suffering
from mood disorders and the post-traumatic events that
results from violence, grief or abuse(Zovkic & Sweatt,
2013)
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TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY
• The individuals who experience either repeated or single
events of mental abuse, physical or sexual abuse, that
has resulted in the development of depression, post-
traumatic symptoms, or anxiety can be benefitted from
TF-CBT (VanElzakker et al., 2014).
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TRAUMA FOCUSED COGNITIVE BEHAVIORAL THERAPY
• If an adolescent or a child shows the signs of substance-
abuse, serious behavioral, or the idea of suicide is
frequent, there are some other forms of diagnosis, that
includes dialectical behavior therapy that will be more
appropriate as an initial step and can also be followed
up with an approach that is much more trauma-sensitive
(Frodl & O'Keane, 2013).
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EYE MOVEMENT DESENSITISATION AND REPROCESSING (EMDR)
• Eye Movement Desensitization and Reprocessing
(EMDR) is a type of treatment method that was initially
related to the alleviation of the distress that is being
associated with the traumatic events (Jeffries & Davis,
2013).
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EYE MOVEMENT DESENSITISATION AND REPROCESSING
(EMDR)
• The therapy helps the processing and accessing of the
traumatic events and the other negative life events in
order to bring an adaptive resolution. After the booming
treatment with EMDR, distress is removed, the negative
thoughts are reformulated, and the physiological
disbalance is lowered (Jeffries & Davis, 2013).
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EYE MOVEMENT DESENSITISATION AND REPROCESSING
(EMDR)
• EMDR (Eye Movement Desensitization and
Reprocessing) is a type of therapy that helps the patients
to heal from signs and symptoms of emotional stress
that occur from adverse life experiences (Kilpatrick et
al., 2013).
• EMDR can help the people to experience the benefits of
psychotherapy that used to take years in order to make a
difference.
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EYE MOVEMENT DESENSITISATION AND REPROCESSING
(EMDR)
• It is thought that there are a number of severe emotional
trauma that needs time to heal. EMDR therapy
highlights the fact that the mind can heal the
psychological trauma in a similar manner as the body
recovers from the physical trauma (Kilpatrick et al.,
2013).
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STRESS INOCULATION TRAINING
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• The Stress inoculation training or SIT is another type of CBT or
Cognitive Behavioral Therapy for the patients who are suffering
from post-traumatic stress disorder (PTSD).
• CBT is one of the most commonly used form of psychotherapy
or the talk therapy that helps in the recognition and changing the
incorrect or the negative thoughts that influences the behavior
(Lancaster, et al., 2016).
• Examples of the SIT are cognitive-processing therapy and
Exposure therapy.

STRESS INOCULATION TRAINING
• The stress inoculation training prepare the client to defend
against the fear related to PTSD and the anxiety when the
patient is exposed to the signs, cues and reminders that help to
trigger all these symptoms.
• This type of psychotherapy typically goes for 9-12 times in
each 90-minute session that might involve the patient or an
entire group therapy (Haagen et al., 2015).
• The therapist will assist the person to become more conscious
of the particular triggers that cite trauma-related fear and
anxiety and receive stress inoculation training. The patient
will also learn a range of abilities to cope with anxiety that are
helpful in managing
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STRESS INOCULATION TRAINING
• Intensive breathing
• Muscle relax training
• Role-playing
• Thinking and altering the negative behaviors
• Learning to talk silently to yourself (Haagen et al., 2015)
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STRESS INOCULATION TRAINING
• Deep breathing from the patient’s diaphragm is one of the method that is being used in this strategy for coping with
PTSD. In this method it is told that the patients will be trained to take deep breaths and to practice it between the
training sessions so that it becomes a good and healthy practice for the client (Haagen et al., 2015)
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STRESS INOCULATION TRAINING
• In the training involving the relaxation of muscle the client is taught about the various ways that can by=e used
to relax the muscles in proper ways (Haagen et al., 2015)
• Role-playing is used to practice the strategies that the client have learned during the sessions.
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STRESS INOCULATION TRAINING
• It also involves the change in the thinking and attitude of the patient regarding the negative thoughts and fears.
• SIT also encourages the patient to talk to themselves in silent that will help them to quickly recognise the
negative thoughts, changes in themselves and positive outcomes (Haagen et al., 2015)
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STRESS INOCULATION TRAINING
• Exposure Therapy aims to decrease the amount of fear and anxiety associated with these reminders,
decreasing avoidance as well.
• This is done by facing the patient to the past experiences and the reminders that they fear without ignoring
them (Lancaster, et al., 2016).
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BETTER TREATMENT PLAN
• SIT can be used as a single therapy or with other kinds
of CBT treatment
• SIT is another form of CBT aimed at reducing anxiety
by learning coping skills that can accompany PTSD to
cope with stress.
• The primary objective is to educate individuals to
respond differently to their symptoms in order to
respond differently (Lancaster, et al., 2016).
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EVIDENCE FOR SUCCESS OF SIT
• When clinical trials for PTSD were carried out the results highlighted that the SIT outperforms every other
treatment method that are available (Lancaster, et al., 2016).
• As therapy advances, strategies for managing anxiety are being exercised in the framework of increasingly
difficult and anxious circumstances.
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CASE STUDY
• Mia who was a single mother of a 12 year old son
• He was killed by a train accident as his shoe got struck
with the train track.
• After a year she started to have nightmares about the
accident along with obsessive thoughts.
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CASE STUDY
• She started to have intense depression and thought of
suicide.
• She took leave from office as she could not concentrate
or could function well.
• The doctor analzed her with Ativan, Prozac, and with
weekly talk therapy, however even after 13 months of
the death of her son she felt distressed and hopeless.
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CASE STUDY
• Her doctor told her to enroll for a free PTSD research study at the Yale Psychiatric Institute. There she
visited psychiatrist for the three sessions of EMDR.
• In the first session she gave the details about the bad part of the event and rated it “10” on a disturbance
scale of 0-10.
• Mia said that the emotion was the worst pain in her chest as she thought that her son was her
responsibility and she felt guilty at her loss.
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CASE STUDY
• Gradually, after an hour of the course, and eye movements after of 23 sets, the details about the memory became
less disturbing.
• After the first session ended she told that she was able to think regarding the accident and it was not at all
distressing.
• At the end of all the three sessions Mia felt that it was not her fault nor her son’s fault. At the visit of a 8-month
follow-up she reported she started working again. She can sleep well and there was no thoughts about the
incident.
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TREATMENT PLAN
• The treatment plan that has been used to solve the case
of Mia involves the use of the SIT.
• Studies discovered that SIT was more efficient than WL
in decreasing PTSD and associated symptoms
(Lancaster, et al., 2016).
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REFERENCES
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Biederman, J., Petty, C., Spencer, T. J., Woodworth, K. Y., Bhide, P., Zhu, J., & Faraone, S. V.
(2014). Is ADHD a risk for posttraumatic stress disorder (PTSD)? Results from a large
longitudinal study of referred children with and without ADHD. The World Journal of Biological
Psychiatry, 15(1), 49-55.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., ... & Mallah, K. (2017).
Complex trauma in children and adolescents. Psychiatric annals, 35(5), 390-398.
De Bellis, M. D., & Zisk, A. (2014). The biological effects of childhood trauma. Child and
Adolescent Psychiatric Clinics, 23(2), 185-222.
Dorahy, M. J., Corry, M., Shannon, M., Webb, K., McDermott, B., Ryan, M., & Dyer, K. F. (2013).
Complex trauma and intimate relationships: The impact of shame, guilt and
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REFERENCES
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Jeffries, F. W., & Davis, P. (2013). What is the role of eye movements in eye movement
desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? A
review. Behavioural and cognitive psychotherapy, 41(3), 290-300.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J.
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