Self-Instruction Training and the Stress Inoculation Technique

Two of the main Behavior Modification Techniques used in cognitive-behavioral therapy.

Behavior Modification Techniques have been one of the central elements on which cognitive-behavioral intervention has traditionally been based. At their birth, the Learning Theories proposed by Thorndike, Watson, Pavlov or Skinner emphasized the role played by the stimulus that accompanies the learning situation (by association or by contingency).

Subsequently, after the rise of Cognitive Theories, it seems to have been demonstrated that the psychological change in the individual is deeper and more complete when the modification of cognition is also worked on. when the modification of cognitions and deep beliefs is also worked on, and not only the most conducive part.and not only the behavioral part.

Accordingly, let us look at two of the techniques that attempt to illustrate what it consists of and how such change is effected on a more internal and mental level: Self-Instruction Training and Stress Inoculation..

Self-Instruction Training (SIT)

Self-Instruction Training emphasizes the role of the person's own internal verbalizations about his or her future performance when carrying out a given behavior.

An internal verbalization (or self-verbalization) could be defined as a set of orders or instructions that the person gives himself to guide the management of his behavior during his performance. during his or her performance. Depending on how this instruction is, the person will feel more or less able to perform the behavior effectively.

This technique can be applied as a therapeutic element in itself or it can also be considered as a a component of Stress Inoculation Therapy, as will be discussed later.as will be discussed later.

Components of Self-Instruction Training

EA is composed of several elements: modeling, behavioral rehearsal, and cognitive restructuring.. Let us detail what each of them consists of:

1. Modeling (M)

Modeling is a behavioral technique that is based on the idea that all behavior can be learned by observation and imitation (Social Learning). (Social Learning). It is used in order to acquire or strengthen new, more adaptive response patterns, weaken inadequate ones or facilitate those that the person already possesses but does not put into practice for various reasons (performance anxiety, for example).

To carry out the procedure, it is necessary that a model performs the successful behavior in the presence of the person and that the person practices it in a way that gradually increases his or her autonomy as the help received by the model decreases. In addition, the model informs the person about the adequacy of the execution of the behavior and indicates possible aspects to be improved.

2. Behavioral rehearsal (BT)

This technique is similar to the previous one, since it also serves for learning new behavioral skills, especially social or interpersonal ones. It consists of staging a potentially anxiogenic behavioral repertoire in the context of the professional's consultation. in the context of the professional's consultation, in such a way that the subject can feel more secure as the reproductions are artificial and easily manipulated.

Therefore, CE allows the reduction of the subject's level of anxiety before the performance and a greater predisposition to "train" his/her behavior without fear of suffering the consequences that would occur if the situation were in the real context. At first, the proposed representations are very much guided by the professional and gradually by the professional and gradually become more flexible and natural.

3. Cognitive Restructuring (CR)

It is based on the idea that psychological problems are caused and maintained by the way a person interprets his or her environment and circumstances. That is, that an event by itself does not have positive or negative emotional valueRather, it is the evaluation that is made of this event that provokes one type of emotion or another. If the event is conceptually interpreted as something positive, the derived emotional state will also be pleasant. On the other hand, if a negative cognitive appraisal is made, a state of emotional distress will result.

The idea of a negative interpretation of the event is usually immediately followed by a series of thoughts known as irrational beliefs. thoughts that are known as irrational beliefsThese are expressed in an absolutist and dogmatic (all-or-nothing) manner and do not take into account other possible alternative explanations. Such as, for example, overemphasizing the negative, exaggerating the unbearable or condemning people or the world if they do not provide the person with what he/she believes he/she deserves.

Cognitive Restructuring is the main element of Albert Ellis' Rational Emotive Behavioral Therapy, which aims to modify this inadequate belief system and provide the individual with a new, more adaptive and realistic philosophy of life.

The core practice of CR is the realization of an exercise (mental or written) in which the initial irrational cognitions derived from the situation, the emotions they have generated and finally a set of objective and rational reflections which should include the initial irrational cognitions derived from the situation that has occurred, the emotions that these have generated and finally, a set of objective and rational reflections that question the negative thoughts mentioned. This record is known as the ABC Model.

Procedure

The AE procedure begins with self-observation and the recording of the verbalizations that the person makes about him/herself with the aim of eliminating those that are inadequate or irrelevant and that are interfering in the successful execution of the behavior (e.g.: everything goes wrong, I am to blame for everything that has happened, etc.). Subsequently, the establishment and new, more correct self-verbalizations are carried out (e.g.: making a mistake sometimes is normal, I will succeed, I am calm, I feel capable, etc.).

More concretely, EA consists of five phases:

Stress Inoculation Techniques (EI)

Stress Inoculation Techniques aim to facilitate the subject's acquisition of certain skills that will allow him/her to both to diminish or cancel the tension and physiological activation and to eliminate the previous cognitions (often pessimistic and negative in nature) for more optimistic assertions (often of a pessimistic and negative nature) by more optimistic assertions that facilitate an adaptive coping of the stressful situation that the subject has to face.

One of the theories on which this technique is based is the Stress Coping Model of Lazarus and Folkman. This procedure has proven its efficacy especially in Generalized Anxiety Disorders.

Procedure

The development of the Stress Inoculation is divided into three phases: an educational phase, a three phases: an educational phase, a training phase and an application phase.. This intervention acts both in the cognitive area, as well as in the area of self-control and behavioral adaptation to the environment.

In the educational phase information is provided to the patient about the way in which anxiogenic emotions are generatedemphasizing the role of cognitions.

Subsequently, an operational definition of the person's specific problem is made by means of different data collection instruments such as an interview, a questionnaire or direct observation.

Finally, a series of strategies a series of strategies are implemented to encourage and facilitate the subject's adherence to the treatment.. For example, establishing an adequate therapeutic alliance based on the transmission of trust.

In the training phase, the person is shown a series of procedures with the aim of integrating skills related to four major blocks: cognitive, emotional activation control, behavioral and palliative coping. The following techniques are used to work on each of these blocks:

In the application phase the person is exposed to anxiogenic situations (real and/or imagined) in a gradual way.putting into action everything learned in the training phase. In addition, the effectiveness of the application of the techniques is checked and evaluated, and doubts or difficulties are resolved during their execution. The procedures used are the following:

Finally, to complement the intervention in Stress Inoculation some more sessions are programmed in order to achieve a maintenance of the achievements and prevent possible relapses. In this last component we worked on aspects such as the conceptual differentiation between fall -punctual- and relapse -more sustained over time- or the scheduling of follow-up sessions (mainly continuing with a form of indirect contact with the therapist).

By way of conclusion

Throughout the text it has been possible to observe how, as initially suggested, psychological intervention that addresses different components (cognitions and behaviors, in this case) can increase its effectiveness in achieving the psychological change proposed by a person. Thus, as demonstrated by the principles upheld by the Psychology of Language, the messages that a person sends to himself tend to shape his perception of reality and, therefore, his capacity for rationality. and therefore, the capacity of reasoning.

Therefore, an intervention focused also on this component will allow a greater probability in the maintenance of the psychological change obtained in the individual.

• External guidance aloud: the person copes with the negative situation by following the therapist's instructions.
• Self instructions out loud: the person faces the negative situation while self-directing out loud.
• Self instructions in a low voice: the person faces the aversive situation while self-directing but this time in a very low voice.
• Covert self instructions: the person faces the negative situation by guiding his/her behavior through internal verbalizations.
1. Educational phase2. Training phase
• • HCognitive skillsin this block Cognitive restructuring strategies, problem solving techniques and practice of self-instructional exercises accompanied by subsequent positive reinforcement.
  • Cctivation controlThis deals with training in relaxation techniques focused on the sensation of muscular tension-distension.
  • Behavioral skillstechniques such as behavioral exposure, modeling and behavioral rehearsal are addressed here.
  • Coping skillsfinally, this block is composed of resources to enhance attentional control, change of expectation, appropriate expression of affect and emotions, as well as the correct management of perceived social support.
3. Application phase
• • Imagined rehearsalThe individual performs a visualization as vivid as possible of the coping with the anxiogenic situation.
  • Behavioral rehearsalThe individual stages the situation in a safe environment.
  • Graded in vivo exposureThe individual is in the real situation in a natural way.
Bibliographical references:
• • Labrador, F. J. (2008). Técnicas de Modificación de Conducta. Madrid: Pirámide.
  • Marín, J. (2001) Psicología Social de la Salud. Madrid: Síntesis Psicología.
  • Olivares, J. and Méndez, F. X. (2008). Técnicas de Modificación de Conducta. Madrid: Biblioteca nueva.