The Gentling Approach to Stress Inoculation in PTSD Children

The Gentling Approach to Stress Inoculation

Stress Inoculation is a strategy that is used in treating children with Post Traumatic Stress Disorder. The idea is to help the child to cope with situations and stimulus that has been identified as triggering stress behaviors, reactions, or stress episodes. Inoculation is process of “de-sensitization”. The child should be exposed to these known triggers in small amounts of time that increase gradually over time. This is paired with supportive measures from caregivers, like coaching, reassurance, and close proximity. There is no formula as to how big of a “dose” should be presented, or how fast the “dose” should get bigger. In the Gentling Approach to treating PTSD in children, the key is to only apply as much added stress that the child can handle without having a severe stress episode. This necessitates that the caregiver applying the Stress Inoculation efforts know the child quite well, so as not to overstep the child’s tolerance. It is important to note that a child’s tolerance is not consistent; it may change from day to day and week to week. Below is a list of stress inoculation areas that caregivers can use to direct their efforts. When the list is used as part of treatment, the caregiver should carefully note: 1.) the day and time of the effort 2.) the response of the child 3.) the conditions that the inoculation effort took place.

Age normal expectations: social behavior with peers and adults in one on one or group situations, school behavior sets, self care, following directives for pleasant, neutral, and unpleasant tasks, ability to self regulate emotions and behaviors when placed under stressful directives.

Novel situations: presentations of new, novel activities, encouragement to participate independently or cooperatively in novel activities, presentation of attractive problems, such a puzzles or games, situational set up to encourage creative solutions.

Self initiated protection: opportunities to exercise learned self protection skills, such as being cautious of strangers, and use of other skill sets to avoid becoming a victim of abuse, increase in reliability of healthy reflexive response and reactions to danger (as opposed to panic, disorganization and decompensation).

Attachment and bonding: ability to manage the normal stress of temporary separation from significant others, ability to adequately function for short periods of time while alone (like in another room, or in the yard), ability to not over react when significant adults place expectations or sanctions on the child, ability for the child to get needs met without use of manipulation of significant others.

Cue and trigger management: ability for the child to experience known cues and triggers and apply learned self regulating behavior and emotions measures, including self comforting, demonstrating cognitive restructuring, and accepting / seeking support and assistance from adults.

EXAMPLE:

Tyler was directed to go out to the yard in the early afternoon on Sunday the 11^th, to play alone in the sandbox. It was made clear to him that I would not be going outside with him, and he was given reassurance that I could see him through the kitchen window, and that he could come inside if he got frightened. I saw him to the door, and watched as he went to the sandbox. I left the door and returned to the kitchen. Tyler appeared to play happily in the sandbox alone for nine minutes as I kept checking on him at the kitchen window. At the end of the nine minutes, he came to the back door and called my name through the screen. I answered with “yes?” and Tyler then turned around and went back to the sandbox for another ten minutes before coming inside. This represents progress over the last inoculation effort that Tyler was able to only tolerate without stress for four minutes.