How to Manage PTSD Stress with Stress Inoculation Training

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Stress inoculation training (often abbreviated as 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.

How Does Stress Inoculation Training Help?

As you know, vaccination against a particular disease helps your body respond quickly when 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.

The basic goal of stress inoculation training is to boost your confidence that you can respond fast and effectively when trauma-related cues occur.

What Happens in Stress Inoculation Training?

This form of psychotherapy typically runs for nine to 12 90-minute sessions that may involve one person or a therapy group. However, it is mainly done one-on-one with a therapist.

Learning 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 breathingmuscle relaxation training, role-playing, thinking about and changing your negative behaviors, and learning to silently talk to and encourage yourself. (Assertiveness training is sometimes provided as well.)

  • Deep breathing from your diaphragm: There are two parts to this coping training: learning how to deep-breathe and then practicing it between therapy sessions so it becomes a healthy habit.
  • Muscle relaxation training: The parts of this coping training include learning how to relax each of your major muscle groups by tensing and releasing them in the correct way. These exercises are also tape-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: Here’s 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.
  • 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.

    Using 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.

    How Well Does Stress Inoculation Training Work?

    A number of studies have shown that the positive results from stress inoculation training can last for a year or longer. In addition to SIT, other forms of cognitive behavioral therapy have been found to reduce the symptoms of PTSD.

    These include exposure therapy and cognitive-processing therapy.

    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. This is usually done by having the client confront (or be exposed to) the reminders that he fears without avoiding them. This may be done by actively exposing someone to reminders (for example, showing someone a picture that reminds him of his traumatic event) or through the use of imagination.

    By dealing with the fear and anxiety, the patient can learn that anxiety and fear will lessen on its own, eventually reducing the extent with which these reminders are viewed as threatening and fearful. Exposure therapy is usually paired with teaching the patient different relaxation skills. That way the patient can better manage his anxiety and fear when it occurs (instead of avoiding).

    Cognitive-Processing Therapy

    Cognitive-processing therapy (CPT) was developed to specifically treat PTSD among people who have experienced a sexual assault. CPT lasts 12 sessions. CPT 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 the self and world (for example, the belief that nothing bad will happen to me) 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, the patient is asked to write about his traumatic event in detail. The patient is then instructed to read the story aloud repeatedly in and outside of session. The therapist helps the client identify and address stuck points and errors in thinking, sometimes called "cognitive restructuring." Errors in thinking may include, for example, "I am bad person" or "I did something to deserve this." The therapist may help the patient address these errors or stuck points by having the client gather evidence for and against those thoughts.

    Evidence for the Success of These Treatments

    All of the treatments discussed here have been found to be successful in the treatment of PTSD. Which one is right for you depends on what you feel most comfortable with. For example, some people do not feel comfortable with actively confronting reminders of a 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.


    “Cognitive behavioral therapy.” Mayo Clinic (2016). 

    Rauch SAM, Foa EB. “Stress inoculation training (SIT) for posttraumatic stress disorder (PTSD).” (2016). 

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