Stress Inoculation Stages
The steps, or stages, involved in stress inoculation are:
- Conceptual Framework Stage – the student is taught basic concepts regarding stress and stress management.
- Relaxation Training Stage – the student learns to master some form of relaxation training, usually PRT.
- Cognitive Restructuring Stage – the student disputes any irrational beliefs that might be contributing to his high levels of anxiety or anger.
- Stress Script Stage – the student writes down everything he needs to say and/or do to manage his stress before, during, and after being exposed to the stressor.
- Inoculation Stage – the student uses his stress script as he is gradually exposed to larger and larger “doses” of the stressor (see Figure 1.1).
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The following is an example of a stress script that might be used to help a student manage his/her anger in the face of peer teasing (e.g., name-calling such as “retard,” “faggot,” “stupid”). Before confrontations with peers:
“What do I have to do?” Take a few belly breaths to get ready. “This is going to be hard but I can do it. I just have to remember to take deep breaths and keep telling myself the magic words, ‘saying it doesn’t make it so.’ Here they come. I’m ready for them.” During confrontation with peers:
“Stay cool. Saying it doesn’t make it so. Take some deep breaths. Watch my SUD level. Saying it doesn’t make it so. Just ignore them. Look away. Saying it doesn’t make it so. Saying it doesn’t make it so.” After confrontation with peers:
“I did it! I kept myself from getting angry. It worked. I can control myself. They didn’t tease me as much as they usually do. Pretty soon they won’t tease me at all. Now let’s see… Was there anything I could improve on for the next time?” |
Figure 1.1: Stress Script
Let's go through the stress inoculation strategy, using it in an anger management intervention with our hypothetical student from another unit, Rosario. You may recall that R's problem is that when he's teased by his peers he gets angry and responds with aggressive behavior.
Conceptual Framework Stage
You begin by teaching R. some basic precepts regarding anger, as well as Ellis's A-B-C rule and the concept of cognitively mediated anger. Figure 1.2 is a list of anger management principles adapted from the work of Raymond Novaco (1975).
The following was adapted from Anger Control: The Development and Evaluation of an Experimental Treatment, by R. Novaco, 1975, Lexington, MA: Heath. Copyright 1975 by Heath. 1. Anger sometimes is a cover-up for feeling scared. You should ask yourself, “Am I angry or am I anxious (scared)?” 2. Don’t take insults personally. Stay on task. Do what you must to get what you want without getting sidetracked. People will sometimes insult you to bait you into a quarrel in order to get you off task. 3. Sometimes we get angry because we don’t know what to do. Once you learn other ways to act besides getting angry, you won’t have to get angry. 4. Learn to recognize the signs of anger, such as dry mouth, hot skin, or tense muscles, as soon as they start. It will be easier to relax these feelings away if you catch them early. 5. Use your anger to work for you. Like pain, anger is a signal that something is wrong. It could be that your thinking is wrong and needs changing. 6. Sometimes we get angry because we are afraid that we’re losing control. Remember, when you give in to your anger, you have already lost control. 7. It’s not what happens to you that makes you angry. It’s what you say to yourself about what happens that makes you angry. No one has the power to make you angry but you. No one has the power to get rid of your anger but you. 8. Be nice to yourself and others. Anger hurts.
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Figure 1.2: Anger Management Principles (Novaco)
Before teaching R. to relax, you need to teach him how to monitor the effects of relaxation strategies. The most practical approach is to teach R. to monitor his tension/relaxation states using the SUD level discussed above. First, have R. calibrate his SUD line (see figure 1.3) by collecting data on a regular basis and making notes in his anger journal (see figure 1.4).
Figure 1.3: SUD Line
Figure 1.4: Anger Control Journal
R. needs to a) identify beliefs that fuel his anger response, b) attempt to dispute them, c) generate fair-pair rational beliefs that don't make him angry, and d) internalize the rational beliefs. When R. has at least generated some rational self-talk, he will be ready for the next stage of stress inoculation.
This stage consists of everything R. says and/or does before, during, and after encountering the anger-provoking stress. Figure 1.1 is an example of a stress script R. might use to help him cope with anger provoked by peer teasing. R. writes the stress script in collaboration with his teacher.
Now R. actually gets to use the stress script in an anger-provoking situation. A preliminary step, called covert rehearsal, has R. imagining himself using his stress script successfully in an anger-provoking situation. He visualizes himself using the script before, during, and after the situation. And, most importantly, he always visualizes himself using the script successfully in dealing with his peers' provocations. Covert rehearsal helps R. memorize the script and gives him confidence in actually using it.
The next step, behavioral rehearsal, has R. actually using his script in a "safe" role-playing situation simulating the anger-provoking event. Assuming R. can keep his SUD level down during several of his role-plays, you can then give him the green light to use his script in a live situation. Figure 1.5 is an example of a hierarchy of anger-provoking situations that R. might be given to role play. Notice how each role-play is a successive approximation of the actual (real-life) event that R. is preparing for. In this sense, we may say that he is being inoculated against the stress of anger by getting stronger (i.e., more realistic) doses of the stressor in the same way that he might be inoculated against a disease or allergen; hence the name stress inoculation.
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First Situation: Students call me names but I get to choose the students and the names they call me. I write the names on a list and they can’t call me any names that aren’t on the list. They can’t do this for more than 1 minute; if I say “stop” before the minute is up, they must stop. Second Situation: Students call me names; teacher chooses the students and the names they call me. I write the names on a list and they can’t call me any names that aren’t on the list. They can’t do this for more than 1 minute; they don’t have to stop before the minute is up even if I tell them to. Third Situation: Students call me names; teacher chooses the students and they get to choose the names they call me. They write the names on a list and clear them with the teacher; they can’t call me any names that aren’t on the list. Fourth Situation: Students call me names; teacher chooses the students and they get to choose the names they call me. They don’t have to clear them with the teacher ahead of time. Fifth Situation: Same as the fourth but lasts longer.
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Figure 1.5: Hierarchy of Anger-Provoking Situations