Stress- grafting therapy ( English stress-inoculation training ) is one of the methods of behavior modification [1] used in cognitive-behavioral psychotherapy . This method was developed in 1974-1985 by the Canadian psychologist Donald Meichenbaum ( born Donald Meichenbaum , born in 1940) [2] In Russian-language literature, this technique is also sometimes called “stress vaccination” [3] or “stress vaccination training ” " [4] . The method is called the “vaccination” method, because it has a certain similarity with the technique of biological immunization : just as medical immunization helps the body prepare for protection against severe infections, psychological immunization is designed to prepare for dealing with stress loads of increasing intensity and complexity [5] . This method allows the client to transition from a state of " learned helplessness " to a state of "learned competence" [1] .
Meichenbaum’s method is to teach self-control techniques to help deal with stressful situations. This technique can also be used to develop optimal behavior in problem situations that cause anger, physical pain, or other negative emotions and discomfort [6] . According to Meichenbaum,
A detailed training program for coping with stress, followed by applied training in using these skills for various stressors, is the exact opposite of the random, ill-conceived ways of mastering such skills that our contemporaries often have to resort to. Studies on stress have revealed the skills necessary for coping with stress, and the method of cognitive modification of behavior, in our opinion, is a promising means of teaching these skills [7] .
The procedure of stress-vaccination therapy is usually clearly structured, focused on the task and in most cases does not take much time. This technique has been successfully applied to prepare the patient for the upcoming operation, to prepare athletes for the competition, in the professional sphere - to educate employees on more effective strategies for behavior in a difficult situation [4] (in relation to people who often find themselves in stressful situations, - for example, military, law enforcement officers, managers) [8] . The model can be applied both in individual and in group psychological counseling [4] .
Content
The theoretical basis of the method
Stress-vaccination therapy is based on a cognitive model of stress : it is assumed that the degree of negative impact of stress depends to a large extent on how this particular situation is perceived by each individual person (i.e., on the appearance of rational and adaptive or irrational, destructive and distracting thoughts about a problem situations). It should also be noted that in stressful situations, anxious, irrational, and destructive thoughts associated with past negative experiences are usually updated. For this reason, objectively identical events can be completely differently perceived by different people (depending on their personal characteristics and life experience), which leads to different styles of behavior in a given situation and, accordingly, to different consequences. A non-adaptive reaction to stress, from the point of view of Meichenbaum, occurs if
- occurring or expected events are perceived as threatening;
- the individual lowly assesses his chances of preventing this threat [4] or feels himself a victim of circumstances over which he has no control. The individual also believes that he cannot control his behavior and emotions that arise in a stressful situation [9] .
Such beliefs have a pronounced negative effect according to the “ self-fulfilling prophecy” scheme: disturbing expectations in a stressful situation lead to the emergence of maladaptive behavior and a painful reaction to stress, which, in turn, convinces the individual of the truth of his negative attitudes [4] .
By changing the beliefs associated with the problem situation [4] and the content of the internal dialogue, one can prepare a person for the difficulties he or she is experiencing. This is exactly what “stress vaccination training" is [8] . If the therapist manages to change the client’s internal monologue (using the auto-instruction method ), then the physiological component of the emotions undergoes a positive change in the stressful situation, which reduces the individual’s anxiety, improves the possibility of self-control and allows one to behave more rationally and adaptively.
Although Meichenbaum’s technique is primarily based on changing beliefs and internal dialogue, it is assumed that to some extent the effectiveness of this method is associated with the phenomenon of getting used to the stressor (which brings this method closer to the technique of systematic desensitization ) [3] . Although stress-vaccination training is based primarily on changing the internal monologue, this technique also uses relaxation techniques, as well as strategies designed to solve problems .
Stress-Vaccine Therapy Scheme
Training is carried out individually or in a group, with the active participation of the client [8] . It consists of the following steps:
“Conceptual Phase" [9]
This phase is also sometimes called the “clarification phase” [4] . At this stage, the psychological and biological mechanisms of reaction to stress are explained to the client [6] . The therapist helps the client distinguish adaptive and effective responses from maladaptive or painful ones [8] . It is emphasized that negative emotions can lead to non-adaptive behavior in a stressful situation [5] . The therapist explains to the client that high anxiety usually occurs when the individual focuses on his unpleasant sensations and on his own inadequacy, as well as thoughts that lower self-esteem and self-confidence (for example, thoughts such as “it’s hard to do something take "or" I can not do anything with my thoughts or the situation "). Accordingly, low anxiety is associated with focusing attention on the external situation, which increases the ability to self-control and helps to solve the problem [1] .
The therapist also helps the client realize that any person himself is the source of his negative thoughts, feelings and actions and therefore he can change them to more positive ones [9] . The therapist explains that behavior can be modified by revising one's attitude to a problem situation and developing self-control skills [5] .
It should be emphasized that a person may not notice that in a stressful situation they automatically have automatic negative thoughts , or not realize what negative consequences these thoughts lead to. Therefore, it is necessary to teach self-observation techniques that help “hear” your own internal monologue and notice how negative attitudes affect emotions, well-being and behavior [4] . Meichenbaum provides various diagnostic methods for detecting automatic thoughts in stressful situations: examination of a patient, diagnostic study of behavior, group discussion, analysis of situations, homework (self-observation and keeping diary entries) [3] .
In addition, clients are taught strategies for solving problems (for example, how to identify a problem, develop possible alternative methods of action, weigh the pros and cons of each possible solution to a problem and find a way to implement the best of all possible solutions) [4] .
The client is also taught how to use self-hypnosis , which helps to improve self-control and reduce anxiety, using, for example, the following phrases: “I can do this”, “We must act calmly, and I will succeed”, “Focus on the present: what exactly is needed to do? "," Do not give up efforts; do not expect perfection and immediate success ” [3] ,“ You can develop a plan on how to cope with this ”,“ Better just think what you can do about it. This is better than worrying, "" Relax: you control yourself. Take a slow, deep breath ” [10] ,“ You are able to develop a coping strategy! ”,“ It is useless to get nervous and worried: this will not help. Think about what can be done in this situation ” [3] .
This phase also explains how to timely recognize signs of increasing emotional stress, which will allow the client to quickly apply the necessary techniques and prevent loss of self-control in a stressful situation [3] .
Finally, at this stage, the client determines which stressors are most problematic for him and identifies his expectations regarding the results of the training. Based on this, the therapist and client develop a collaboration plan [8] .
"The phase of the formation of new skills" [9]
At this stage, the client is invited to try in practice various strategies ( coping skills) that can reduce the negative impact of stressful situations [6] . These strategies are worked out in imaginary stressful situations, and the client is advised not to deny, but to fix the negative, non-adaptive and disturbing thoughts that arise when confronted with a problem situation, and replace them with rational positive thoughts leading to adaptive forms of behavior (“coping strategies”) [5] .
"The phase of the application of new skills" [9]
This phase is sometimes also called the “confrontation phase" [3] . At this stage, the acquired skills are consolidated and these skills are transferred to real life [9] . The client "tests" new techniques in specific situations and makes sure of their effectiveness. This stage also requires the participation of a therapist, but to a much lesser extent (control and minor correction) [8] . If we are talking about developing communication skills, this stage is often carried out as part of group therapy, which allows us to simulate a communication situation that is close to real [5] . This step includes a variety of practical exercises, such as role-playing games . In addition, real actions are worked out in real situations [4] .
At the stage of confrontation with stress, the client uses the following cognitive-behavioral scheme:
- Timely recognize the emotions and sensations preceding the stress response [3] .
- Recall the techniques that should be used in a stressful situation: relax (use breathing and relaxation techniques), use a positive internal monologue (positive self-suggestions, such as “I can solve this problem”, “I can manage to take control of the situation”, “Do one thing after another - the situation can be dealt with! ”,“ Even if I cannot suppress fear, I know how I should behave ”,“ Soon it will pass, it happened worse ”) [3] .
- The way out of a stressful situation should be accompanied by methods of “self-affirmation” (for example: “Hurray! I did it! It worked!”, “Every time I train, it becomes easier for me to overcome stress”, “I can be proud of my success in overcoming such situations” , “I can be satisfied with what I managed to do”). In this case, the client uses self-hypnosis, which is a positive reinforcement, that is, a kind of "reward" for the fact that the client was able to use adaptive ways to overcome a stressful situation. In addition, “self-affirmation” enhances the client’s self-confidence and reinforces adaptive behavior skills [3]
At the final stage of the training, if necessary, the therapist gives the patient a card with instructions ( English coping card ), which indicates what should be done in a problem situation (for example, in the event of a panic attack). The patient can carry such a card with him, put it on the desktop or hang at home in a conspicuous place. The need to use such cards is due to the fact that in a stressful situation the patient may get confused and forget what the therapist recommended to him to do (especially if it comes to a complex scheme of actions). In addition, the mere presence of a card often has a calming effect on the patient. Finally, constantly looking at the card, the patient “internalizes” the program of actions that he must perform: he is rehearsing in his mind what he has to do in a problem situation. This helps to better perform actions at the moment when it is necessary. It is noted that even after the problem has disappeared, many patients periodically re-read the instruction card, and this reduces their fear that they will not be able to cope with the problem if it reappears in the future [6] .
See also
- Self-efficacy
- Stress analysis
Notes
- ↑ 1 2 3 Patterson C., Watkins E. Theories of Psychotherapy Publisher: Peter, 2003
- ↑ In some sources, his surname is transcribed as “Meichenbaum”
- ↑ 1 2 3 4 5 6 7 8 9 10 “ Psychotherapeutic Encyclopedia ”
- ↑ 1 2 3 4 5 6 7 8 9 10 Lawrence A. Oliver P. Psychology of personality. Theory and research . - M., 2001
- ↑ 1 2 3 4 5 Fedorov A.P. Cognitive-behavioral psychotherapy . - St. Petersburg: Peter, 2002
- ↑ 1 2 3 4 Chaloult, L. La thérapie cognitivo-comportementale: théorie et pratique . Montréal: Gaëtan Morin, 2008
- ↑ Meichenbaum D., Cognitive-behavior modification: An integrative approach . New York: Plenumı 1977 (translated from Patterson C., Watkins E. Psychotherapy Theories . Publisher: Peter, 2003)
- ↑ 1 2 3 4 5 6 Romek V.G., Don Meichenbaum stress vaccination training
- ↑ 1 2 3 4 5 6 V. Shabalina, G. Ternovskaya. Meichenbaum's “vaccination against stress” model as a psychological “vaccination against addiction”
- ↑ Komer R. Pathopsychology of behavior: disorders and pathology of the psyche . SPb .: Prime-EUROSNAK; M .: OLMA-press, 2005