STRESS INOCULATION TRAINING I

Principal Investigator: Anthony Hains & Michael Szyjakowski

Level of Intervention: Selective

Target Population: Male students in 11th or 12th grade.

References: Hains & Szyjakowski (1990)

Theory (Risk & Protective Factors Targeted):
Research has shown that stress negatively impacts different aspects of psychological functioning. Consequences of stress include elevated anxiety, depression, suicidal behavior, poor academic performance, and delinquent behavior. Cognitive and behavioral coping skills provide individuals with a strategy to manage stress. As a result, they have the potential to serve a protective function and reduce the negative impact of stressful events.

Description of Intervention:
The authors adapted a Stress Inoculation Training program (Meichenbaum & Deffenbacher, 1988) into a school-based prevention program for high school students that included cognitive coping skills and relaxation training. The 13-session program consisted of three phases: a conceptualization phase, a skill acquisition phase, and a skill application phase. The sessions used both group and individual formats but group sessions were used to introduce the component skills of cognitive restructuring, problem solving, and anxiety management. The two authors served as the therapists for the intervention.

Research Subjects:
Students from an all-male, parochial school in the Midwest responded to an announcement describing a school-based program on stress management. Out of the 30 youth that attended the orientation, 24 participated in the program. All of the participants were Caucasian except for one subject who was African-American.

Research Design:
Subjects were randomly assigned to an intervention group (N = 12), or a wait-list control group (N = 12). Three subjects in the treatment condition dropped out prior to the end of the intervention.

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.

Post-intervention
Results indicated that intervention subjects reported significantly less trait anxiety on the State-Trait Anxiety Inventory (STAI; Spielberger, 1983) compared to controls (p<.05). They also reported significantly less anger and higher self-esteem. No group differences were found on the State Anxiety subscale or on depressive symptomatology.

VERSION 2
Hains (1992)

Target Population: Male students in 10th and 11th grade.

Theory (Risk & Protective Factors Targeted):
Research has shown that stress negatively impacts different aspects of psychological functioning. Consequences of stress include elevated anxiety, depression, suicidal behavior, poor academic performance, and delinquent behavior. Cognitive and behavioral coping skills provide individuals with a strategy to manage stress and thus, have the potential to serve a protective function and reduce the negative impact of stressful events.

Description of Intervention:

Stress Inoculation Training
See description above.

Anxiety Management Training
Students assigned to this intervention group learned self-controlled relaxation skills through anxiety management training (Suinn & Deffenbacher, 1988). The intervention was based on a manual developed by Suinn (1986) but the structure of the intervention was modified slightly to parallel the cognitive intervention group. Youth were taught to recognize cues that trigger anxiety reactions and then to respond with behaviors that promote relaxation (e.g. visualization, progressive muscle relaxation).

Research Subjects:
Students from an all-male, parochial school in the Midwest responded to an announcement describing a school-based program on stress management. Out of the 30 youth that attended the orientation, 25 participated in the program. All of the participants were Caucasian except for one subject in the cognitive intervention who was Asian.

Research Design:
Subjects were randomly assigned to the cognitive intervention group (N = 9), the anxiety management training group (N = 8), or a wait-list control group (N = 8). Three subjects in the treatment condition dropped out prior to the end of the intervention.

Outcomes:
A MANOVA conducted on pre-assessment measures established the equivalence of the intervention and control groups prior to intervention. MANCOVA was used to test for an overall group effect while controling for pre-intervention differences. Univariate ANCOVAs (Group x Level) were conducted on each of the dependent measures using the pre-assessment score as a covariate.

Post-Intervention
Results indicated that intervention subjects reported significantly less state anxiety (p<.001) and less trait anxiety (p<.01) on the State-Trait Anxiety Inventory (STAI; Spielberger, 1983) compared to controls. They also reported less depression (p<.055) on the Reynolds Adolescent Depression Inventory (RADS; Reynolds, 1987) compared to controls. Group differences were not found on a measure of anxious self-statements.

Significant differences from the ANCOVAs were followed by orthogonal comparisons to compare the two interventions to the control group. A similar pattern of results were found when youth in either intervention group were compared to controls but no significant differences were found between the two intervention groups.

Follow-Up
There was no follow-up data available for the control group due to the design of the intervention. A MANOVA was used to determine whether there was any change in the dependent variables from post-treatment to follow-up for either of the intervention groups. There were no significant differences suggesting a maintenance of treatment gains.

VERSION 3
Hains & Ellmann (1994)

Target Population: High school students (9th – 12th grade)

Description of Intervention:
See description above. Two therapists (one Ph.D. and one doctoral student) facilitated the treatment groups.

Research Subjects:
Students from a suburban high school in the Midwest responded to an announcement describing a school-based program on stress management. Out of the 25-30 youth that attended the orientation, 21 participated in the program (16 girls, 5 boys). All of the participants were Caucasian except for one subject who was Asian-American. Based on pre-assessments, subjects were classified as being either high emotional arousal or low emotional arousal. In order to be classified as high arousal, the student needed a score that was 1 SD above the normative mean or above the cutoff on two of four measure of trait anxiety, trait anger, anger expression, or depression. The measures included in the assessment were the State-Trait Anxiety Inventory (STAI; Spielberger, 1983), the Stait-Trait Anger Expression Inventory (STAXI; Spielberger, 1988), and Reynolds Adolescent Depression Inventory (RADS; Reynolds, 1987).

Research Design:
Subjects were randomly assigned to the treatment (7 girls, 4 boys) or a wait-list control group (9 girls, 1 boy). The groups were not equated on gender or age.

Outcomes:
As described previously, youth in both the intervention and control groups were divided into high and low emotional arousal. Univariate ANCOVAs (Group x Level) were conducted on each of the dependent measures using the pre-assessment score as a covariate to control for any pretraining differences. One-tailed comparisons were used to interpret interactions.

Post-Intervention:
Main effects for group were found on trait anger (p<.04) and anger expression (p<.04) with the treatment subjects having lower post-assessment scores than controls regardless of arousal level. Group x Level interactions on trait anxiety (p<.08), depression (p<.08) were marginally significant but follow up tests indicated that high emotional arousal subjects in the treatment group obtained significantly lower scores that high arousal subjects in the wait-list group on trait anxiety (p<.03) and depression (p<.03).

High arousal subjects in both the treatment and control groups were in the clinical range prior to the intervention. After participating in the program, the scores of all of the high arousal subjects who participated in the intervention were within the non-clinical range.

Strengths & Limitations:
The Stress Inoculation Training Program is a brief intervention designed to prevent psychological symptoms related to stress. The program targets adolescents and attempts to teach them cognitive-behavioral coping skills and relaxation training. The results from three evaluations suggest that the program is effective in reducing self-reported internalizing symptoms (i.e. anxiety, depression) in youth. In the most recent evaluation, positive outcomes (that were also clinically significant) were only found in youth that reported higher levels of distress prior to participation (i.e. high arousal group). Although the authors utilized a randomized trial design in all three studies, the sample sizes were extremely small and two of the three samples were all boys. There was only a brief period before the wait-list control group was given the intervention, which prevented an examination the extended effects of the program. In addition there was significant attrition in the intervention group in the first evaluation. A treatment manual was used consistently, and in one evaluation regular therapist meetings were held to review the program and address problems. No measures of program fidelity were included and the program has not been independently replicated.

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