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Stress inoculation, what is it?

Stress inoculation, what is it?

TheStress Inoculation (IE) It is an intervention framework in which the person is trained in a set of specific skills to deal with stressful situations.

The peculiarity of this type of interventions is that the person learns to interpret his problem from a specific model, allowing him select those techniques that best meet the demands of the problematic situation you face. In addition, EI functions as a “vaccine”, that is, once the coping skills, the person is subjected to stressful situations similar to the problems but of moderate intensity in which they are expected to implement these skills. The main skills to learn are all those that allow an effective control of the emotional tension (physiological), as well as the modification of the most superficial cognitive contents (eg, self-verbalizations) that occur before, during and after the confrontation With the problem situations.

Phases of stress inoculation

The procedure consists of three phases: educational, training or acquisition of skills and application.

Educational phase

It is about providing information about the genesis and maintenance of problematic emotional phenomena. The goal is not to eliminate stress, but to consider stressful situations as problems that can be solved. In this sense, an understandable model that allows the person to recognize its elements in the problem situation, as well as interpret the relationships between them, must be proposed. Figure 5 shows a model that can be used as an example.

It is important that the person understand the transactional nature of their stress reactions. The explanation of the model should make clear the interactive nature of the elements included. Once the person has understood the model, it is necessary to collect all possible information about the morphology and functional relationships between the elements of the environment and the response. For this purpose, records can be used in problem situations, interviews with the person and close people, self-report tools, etc. It is important to allow the person to tell "his story" or his vision of the problem. From this raw information it is easy to inquire about the relevant components for an adequate psychological formulation of the problem. The initial approach to the problem can be useful in planning and setting goals and objectives in the short, medium and long term. Special emphasis should be placed on the formulation of realistic objectives.

As a result of this phase, the person should: a) have an alternative model of maintaining their stress reactions; b) the triggers must have been identified and clarified, distinguishing global stressors from punctual or situational ones and those modifiable from those that are not; c) it should have been clarified if the person's deficit is due to a lack of competence (skills) or execution (secondary benefits, dysfunctional beliefs, etc.).

Training phase or skills acquisition

The person must be able to clearly distinguish between modifiable situations from those that are not. In the first (modifiable) efforts of the person will be directed to the control of situations (instrumental techniques), while in the second (non-modifiable), the efforts will be focused on the emotion that is experienced (palliative techniques). Is about acquire the necessary skills and abilities for the management of physiological and cognitive responses problematic as well as making sure that the person is able to put them into practice. These two objectives give rise to the acquisition and testing phases.

The strategies to train can be grouped into four broad categories: cognitive skills, emotional activation control, behavioral and palliative coping.

  • Cognitive habilyties. Cognitive restructuring, thought arrest, and self-instructions are the main strategies to train. Training in self-instructions consists in modifying the negative verbalizations present in the person's coping response by positive ones before, during and after the interaction with the problem situation. Self-instructions must have the following characteristics: a) they must be adapted to the specific needs of the patient; b) they must be constructed and written with the patient's words; c) they must be concrete, not too general (may lead to mechanical repetition); d) must be oriented to control and competition and focused on the present or immediate future; e) must be integrated naturally into situations and not considered as an isolated mechanical ritual. In addition, it may be useful to establish contracts to implement them and generate some type of mnemonic rule to facilitate their applicability. To facilitate the acquisition of this skill, cards can be used in which the person writes the trained positive self-verbalizations. Imagination is also useful. You can build a hierarchy of difficult situations to reproduce them in imagination, so that when the person imagines facing the problem situation, start the trained self-instructions.
  • Emotional control skills. The main strategy is relaxation. This can be obtained in different ways (eg, progressive muscle relaxation, imagination, breathing and meditation).
  • Behavioral skills. The main one is the exhibition8. Other strategies such as modeling or behavior testing are applied to modify morphological parameters of the problem responses.
  • Palliative Skills. The main ones are distraction, change of perspective, and social skills, such as adequate expression of affection and the management of social support available.

Guidelines for performing attention refocusing or distraction

  1. Explain the meaning of the technique: It is not about escaping the problem, it is about not paying attention to stimuli (eg, ruminant thoughts) when doing so does not modify the problem and amplify the symptoms or associated discomfort. The objective is to refocus or redirect attention to stimuli that at least produce a benefit in either of the two parameters (problem solution / emotional well-being).
  2. Select possible sources of distraction relevant to the person (counting cars of a brand, clothing, performing household chores, etc.).
  3. The tasks used as distractors must be an important behavioral involvement (Ex., Physical exercise), attention to external stimuli (eg, describe the environment), use of cognitive resources (eg, count backwards from a number) and social content (eg, perform group activities) .
  4. Once the problem situations and the distractors have been identified the person must be actively involved in refocusing, moving their “mental flashlight” towards the agreed stimuli Once the person is able to implement the main skills necessary for adequate coping with the problem, they must be organized according to the four steps of coping: preparation, coping (real confrontation and management of emotional activation) and analysis of the consequences of self-reinforcement of success. These principles should be used to build the so-called coping plans. These plans aim to integrate everything learned and organize it in a way that allows confrontation with problem situations. The control of one's behavior during these situations is done through self-instructions. These self-instructions must direct the activity during the situation, for which they must fulfill the following functions: a) identify and define the situation; b) prepare for coping; c) coordinate coping and activate the implementation of the necessary skills; d) correct possible difficulties and failures; e) organize the motivational processes and f) analyze the situation once finished.

Scheme for the preparation of coping plans

Preparing for a stressful situation
  • Identify and label the situation
  • Analysis of the possibilities of coping and preparation of the plan.
Coping
  • implementation of the plan
  • crisis prevention It is important to have a way out in the case of a partial failure.
Consequence Analysis
  • reward (from positive self-manifestations to physical or social rewards)
  • Facing failures and relapses.

Implementation or implementation phase and monitoring

During this phase the person must put into practice what they have learned in real situations. To achieve this, he is subjected to moderate and controllable levels of stress (inoculation) by way of behavioral "vaccines." This procedure is intended to activate the strategies learned as well as check how effective they are and if there are problems in their implementation. Table 10 shows the main objectives within this phase.

The main strategies are the imagination test, the behavioral essay and the graduated live exhibition.

  • Modeling, metaphors and imagination essay. A good way to strengthen what you have learned is to see someone do it. The use of observation of competent nearby people, filming (eg, movies), readings, metaphors or even the therapist in similar situations can be very useful. The models must be varied, similar to the person (sex, age, etc.), credible and with a level of competence slightly higher than the patient's. Instructions can be used simultaneously with the observation of the model. Attention should be maintained in a sustained manner on the model and ask the person to summarize or integrate what was observed after the session. It is preferable for the person to generate certain rules about the stimuli-response-consequences relationships that the model showed. To facilitate the generalization to situations of the person's life, they can use metaphors and the imagination test. A hierarchy is built with the most stressful situations facing the patient. They are ordered from highest to lowest level of difficulty. The person must reproduce the situations in imagination allowing the emergence of the stress response and coping with the skills learned.
  • Behavioral test. Role reversal (therapist-patient) can be used. The goal is for the person to face simulated or real situations at first more controllable and progressively with more unforeseen events. In these situations, the person will put their skills into practice while the therapist observes and gives feedback.
  • In vivo graduated exhibition. The person has to face progressively the real situations of the hierarchy previously constructed valuing the result obtained in each one of them.

Cognitive techniques to cope with stress

These are some of the most commonly used cognitive techniques for stress management. The most common barrier to cognitive stress intervention is the failure to fully utilize the imagination. In order to improve the ability to imagine it is recommended:

  1. Concentrate on other types of senses other than visual, such as touch, taste, hearing and smell.
  2. Record a detailed description of the scene you intend to imagine.
  3. Draw a picture of the original scene that is intended to be imagined, as a way to activate visual details. Appreciate what objects and details give the scene its unique identity.

Another important obstacle is not believing in the techniques. So is boredom, because many of these exercises are. But they work and that is what you have to believe in order to achieve stress reduction.

Finally, special emphasis should be placed on the risks of relapse and how to deal with them. The probability of relapse is especially high in extremely difficult situations., novel or in which a high number of problems occur simultaneously. Essentially it is about conceiving evolution with relapses as another learning process, in which the probability of small “slips” or mistakes about what is learned is high. The person must conceive these relapses as opportunities for learning and not as defeat situations. Together with this attitude, training in the early detection of signs of relapse, as well as high-risk situations, will allow the person to anticipate and implement skills necessary to resolve the situation. When the failure has occurred, the most important thing is to analyze the possible reasons why it has taken place. Once the person is able to anticipate certain high-risk situations, “controlled relapses” can be programmed in which the person starts what they have learned.

When these controlled situations are difficult to carry out, imagination tests can be used.

Once the training is finished, it is important to evaluate the immediate effects of the intervention. This evaluation should cover both the level of competence achieved in the techniques and the longer-term effect on the variables relevant to the patient. These evaluations can be done in scheduled follow-up sessions with the consent of the person that will be progressively spaced over time.

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