STRESS INOCULATION TRAINING II

Principal Investigator: Mark S. Kiselica

Level of Intervention: Selective

Target Population: Adolescents with elevated self-reported anxiety symptoms.

References: Kiselica, Baker, Thomas, & Reedy (1994)

Theory (Risk & Protective Factors Targeted):
Research has shown that high levels of anxiety can be maladaptive and negatively impact psychological functioning. Elevated anxiety is the primary feature of anxiety disorders in childhood but it is also associated with depression, oppositional behavior, poor peer relations, and poor academic performance. Teaching children strategies for managing anxiety could prevent maladaptive outcomes (Suinn, 1990). Stress Inoculation Training (SIT; Deffenbacher, 1988; Huebner, 1988; Meichenbaum, 1985; Meichenbaum & Deffenbacher, 1988) has been used as an anxiety management strategy to teach youth cognitive-behavioral coping skills to control anxiety reactions.

Description of Intervention:
The authors utilized Meichenbaum’s (1985) stress inoculation training model (Meichenbaum & Deffenbacher, 1988) to create an 8-session preventive intervention for adolescents with elevated self-reported anxiety. An assertiveness training component was added to the program. Participants learned about the process of anxiety arousal and both instrumental and cognitive-palliative (emotion-regulation) coping skills (Meichenbaum & Deffenbacher, 1988) such as progressive relaxation, cue-controlled relaxation, cognitive restructuring. The program was administered by two trainers (one Ph.D. level counseling student, and one master’s level professional counselor). The control group was also administered an 8-session program that was held once a week. This program consisted of "guidance" classes held in a traditional classroom setting. The format was similar to the intervention in that the first sessions were used to establish trusting relationships with the adolescents.

Research Subjects:
The sample (N = 48) was entirely Caucasian and drawn from a rural, public high school (total population = 7,000) in a midde-class to lower middle-class community. Ninth grade students enrolled in four required sections of a class taught by the two trainers completed the State-Trait Anxiety Inventory Trait Anxiety Scale (STAI A-TRAIT; Spielberger, Gorsuch, & Lushene, 1970). Students with the highest scores on the STAI A-TRAIT were rank ordered and paired. The final sample consisted of 24 treatment (13 boys, 11 girls) and 24 control subjects (13 boys, 11 girls). All subjects remained in the study though they were informed of their right to refuse participation.

Research Design:
After students were rank ordered and paired, each pair of subjects was randomly assigned to the intervention or the control condition.

Outcomes:
MANCOVA was used to test for an overall group effect while controling for preintervention differences. Univariate ANCOVAs (Group x Level) were conducted on each of the dependent measures using the pre-assessment score as a covariate.

Participants in both the intervention and control groups were administered two measures as a manipulation check. Early in the program students were asked about their expectations for success in their program. Following the intervention they were asked about their attitude toward the program they received. Intervention and control participants had similar expectations and attitudes towards their respective programs. All participants also completed a knowledge acquisition measure that assessed the degree to which they learned concepts presented in the intervention training sessions. Overall, participants in the SIT intervention scored significantly higher than control participants (p<.001) and female participants scored higher than male participants (p<.01). A three-way interaction (treatment condition x gender x time) indicated that female participants in the SIT intervention scored significantly higher than male participants on this measures (p<.05).

Post-intervention & Follow-Up
Results indicated that intervention subjects reported significantly less anxiety on the STAI A-TRAIT (p<.001) and less stress (p<.01) on the Symptoms of Stress Inventory (SOSI; Leckie & Thompson, 1979) at post-test and follow-up. There were no group differences on the student’s quarterly grade point average (GPA). Scores for SIT participant’s on the knowledge acquisition measure were correlated with these three adjustment measures but no significant relationships were found.

Strengths and Limitations:
Kiselica, Baker, Thomas, and Reedy (1994) developed a stress inoculation training program for adolescents that was successful in reducing self-reported anxiety and stress by training participants in cognitive coping skills and providing assertiveness training. The design of the evaluation was good (i.e. random assignment to condition), but the short-term follow-up assessment (4 weeks after post-test) and the small sample size limit the generalizability of the findings. A unique aspect of this program was that the authors included measures of the participant’s expectations and attitudes towards the intervention to confirm group equality. No other specific measures of program implementation were included and no independent replication has been done.

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