Training in Self-Instructions and Stress Inoculation

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

Later, after the rise of Cognitive Theories, it seems to have been shown that the psychological change in the individual is deeper and more complete when working on the modification of deep cognitions and beliefs, and not just the most behavioral part.

According to this, let's see two of the techniques that try to illustrate what it consists of and how this change is made at a more internal and mental level: Self-Instruction Training and Stress Inoculation.

Self-Instruction Training (EA)

Self-Instruction Training highlights the role of internal verbalizations made by the person himself about his future execution when carrying out a behavior determined.

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. Depending on how this instruction is, the person will feel more or less able to carry out the behavior effectively.

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

Components of Self-Instruction Training

The EA is made up of several elements: modeling, behavior rehearsal and cognitive restructuring. Let's detail what each of them consist 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). It is used in order to acquire or strengthen new, more adaptive response patterns, weaken those inadequate or facilitate those that the person already has but that they do not put into reasonsanxiety in execution, 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 this Practice it in a way that gradually increases your autonomy as the help received by the model decreases. In addition, this informs the person about the adequacy of the execution of the behavior and indicates possible aspects to improve.

2. Behavioral test (EC)

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

Therefore, the CS allows the reduction of the level of anxiety of the subject before the execution and a greater predisposition to "train" their behavior without fear of suffering the consequences it would have if the situation were in context real. At first the representations that are proposed are very guided 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 environment and his circumstances. That is an event by itself has no positive or negative emotional valueRather, the evaluation that is made of this event is the one that causes one type of emotion or another. If the event is conceptually interpreted as positive, the derived emotional state will also be pleasant. On the other hand, if a negative cognitive assessment is made, a state of emotional distress will result.

The idea of ​​negative interpretation of the event is usually immediately followed by a series of thoughts that are known as irrational beliefs, since they are expressed in an absolutist and dogmatic way (all or nothing) and do not take into account other possible alternative explanations. How, for example, to highlight the negative excessively, exaggerate what is unbearable or condemn people or the world if they do not provide the person what they believe they deserve.

Cognitive Restructuring is the main element of the Rational Emotive Behavioral Therapy by Albert Ellis, which has the objective of modifying this inappropriate belief system and providing the individual with a new, more adaptive and realistic philosophy of life.

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

Process

The EA procedure begins with self-observation and recording of the verbalizations that the person makes about himself with the aim of eliminate those that are inappropriate or irrelevant and that they are interfering in the successful execution of the behavior (For example: everything goes wrong, I am to blame for everything that happened, etc.). Subsequently, the establishment and new more correct self-verbalizations are carried out (For example: sometimes making a mistake is normal, I will achieve it, I am calm, I feel capable, etc.).

More specifically, the EA is made up of five phases:

1. Modeling: the person observes how the model deals with the negative situation and learns how he can carry it out.
2. External guidance in loud voice: the person copes with the negative situation following the instructions of the therapist.
3. Loud Self-Instructions: The person copes with the negative situation while self-directing out loud.
4. Self-instructions in a quiet voice: the person faces the aversive situation at the same time that he / she directs himself but this time in a very low voice.
5. Covert self-instructions: the person faces the negative situation by guiding her behavior through internal verbalizations.

Stress Inoculation Techniques (IE)

The Stress Inoculation Techniques have the objective of facilitating the acquisition of certain skills that allow both decrease or cancel physiological tension and activation and eliminate previous cognitions (of a pessimistic and negative nature, frequently) by more optimistic assertions that facilitate an adaptive coping with the stressful situation that the subject must carry out.

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

Process

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

1. Educational phase

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

Subsequently, an operational definition of the specific problem of the person is carried out, through different data collection instruments such as an interview, a questionnaire or observation direct.

Finally, A series of strategies are put in place that favor and facilitate the adherence of the subject to the treatment. For example, establishing an adequate therapeutic alliance based on trust transmission.

2. Training phase

In the training phase, the person is shown a series of procedures in order to integrate skills related to four large blocks: cognitive, control of emotional activation, behavioral and coping palliative. To work on each of these blocks, the following techniques are put into practice:

• Hcognitive abilities: in this block, cognitive restructuring strategies, problem solving techniques and practice of self-instruction exercises accompanied by subsequent positive reinforcement are worked on.

• Cactivation control: This is about training in relaxation techniques focused on the sensation of muscle tension-strain.

• Behavioral skills: Techniques such as behavioral exposure, modeling, and behavior rehearsal are covered here.

• Coping skills: finally, this block is made up of resources to enhance attentional control, change of expectation, the adequate expression of affection and emotions, as well as the correct management of social support perceived.

3. Application phase

In the application phase the person is intended to gradually expose himself to anxiety situations (real and / or imagined), putting into motion everything learned in the training phase. In addition, the effectiveness of the application of the techniques is verified and valued and doubts or difficulties are resolved during their execution. The procedures used are the following:

• Imagined essay: the individual makes a visualization as vivid as possible of the coping with the anxious situation.
• Behavioral essay: the individual stages the situation in a safe environment.
• Graduated in vivo exposure: the individual finds himself in the real situation naturally.

Finally, to finish complementing the intervention in Stress Inoculation a few more sessions are scheduled in order to get maintenance of the achievements obtained and prevent possible relapses. In this last component, aspects such as the conceptual differentiation between fall - punctual - and relapse - more maintained in the time- or the scheduling of follow-up sessions where continuing with a form of indirect contact with the therapist, mainly).

In conclusion

Throughout the text it has been possible to observe how, as it was initially proposed, the psychological intervention that addresses different components (cognitions and behaviors, in this case) can increase its effectiveness in achieving the psychological change posed by a person. Thus, as demonstrated by the principles supported by the Psychology of Language, the messages that a person gives himself tend to configure his perception of reality and therefore, the ability to reason.

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

Bibliographic references:

• Labrador, F. J. (2008). Behavior Modification Techniques. Madrid: Pyramid.

• Marín, J. (2001) Social Psychology of Health. Madrid: Synthesis of Psychology.

• Olivares, J. And Méndez, F. X. (2008). Behavior Modification Techniques. Madrid: New Library.