PTSD Treatment How Stress Inoculation Training Treats PTSD By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on August 12, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Steve Debenport / Getty Images Table of Contents View All Table of Contents Background Techniques Exposure Therapy Cognitive Processing Therapy Evidence Stress inoculation training (SIT) is a form of cognitive 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 of coping skills that are useful in managing anxiety, such as: Deep breathing from your diaphragm: There are two parts to this coping training—learning how to breathe deeply and then practicing it between therapy sessions so it becomes a healthy habit. Learning to silently talk to yourself: If you’re like many people, with and without PTSD, you probably do this already, but in stress inoculation training, you learn to focus your internal talks on quickly recognizing negative, down-putting thoughts about yourself, stopping them, and changing them to positive, encouraging statements. Muscle relaxation training: : You'll learn how to relax each of your major muscle groups by tensing and releasing them in the correct way. These exercises are also recorded so you can practice them between training sessions. Role-playing: Here’s where you start to practice the coping techniques you’ve learned. After you and your therapist set up an anxiety-provoking situation, you role-play coping effectively using specific anxiety management strategies. Thinking about and changing negative behaviors: This is where you learn to use your imagination to practice effective coping. Your therapist guides you through an entire anxiety-provoking situation in which you successfully recognize trauma-related cues and take action to prevent them from getting out of control. You also learn to use your new skills. Once you’ve identified the cues that can trigger your anxiety and fear, 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. Exposure Therapy 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. The goal of exposure therapy is to help reduce the level of fear and anxiety connected with these reminders, thereby also reducing avoidance. You may need to confront (or be exposed to) the reminders that you fear without avoiding them. This may be done by actively exposing you to reminders, for example, showing you a picture that reminds you of the traumatic event, or through the use of imagination. 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 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." Errors in thinking may include, for example, "I'm a bad person" or "I did something to deserve this." Your therapist may help you address these errors or stuck points by having you gather evidence for and against those thoughts. Evidence 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. PTSD: Coping, Support, and Living Well 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to 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 Dunleavy K, Kubo Slowik A. Emergence of delayed posttraumatic stress disorder symptoms related to sexual trauma: patient-centered and trauma-cognizant management by physical therapists. Phys Ther. 2012;92(2):339-51. doi:10.2522/ptj.20100344 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. Additional Reading 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. By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.