Adjustment Disorders Treatment & Management

Updated: Nov 01, 2016
  • Author: Julia B Frank, MD; Chief Editor: David Bienenfeld, MD  more...
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Treatment

Approach Considerations

Clinical treatments may substantially alleviate symptoms of adjustment disorder. In the absence of controlled trials comparing different modalities of treatment, selection of treatments remains a clinical decision, influenced by consensus and common practice. No particular treatment may be considered “optimal” or the “treatment of choice.” [14]

The predominant mood accompanying adjustment disorder (eg, depression or anxiety) is a major consideration for both pharmacologic and supportive treatments. For instance, clinicians should consider both psychotherapy and pharmacotherapy for patients who have adjustment disorder with depressed anxious mood. [14, 45, 46, 47]

Treatments that are effective for other stress-related disorders also may contribute to relief of adjustment disorder. According to Strain et al, treatment relies on the specificity of the diagnosis, the construct of stressor-related disorders, and whether the stressors are involved as causes, develop concomitantly, or are essentially unrelated. [14]

Newcorn and Strain report that age affects treatment outcome for adjustment disorders. [14, 48] Clinical symptoms in children and adolescents differ from those in adults and elderly persons. [49] Andreasen and Hoenk reported that in children and adolescents, more serious mental illnesses were present at 5 years’ follow-up. [50] In contrast, adults without prior mental disorders remain generally free of future disorders after suffering from adjustment disorder.

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Psychotherapy

Most studies acknowledge that brief, rather than long-term, psychotherapy is most appropriate for persons with adjustment disorder because this disorder tends to be time-limited. [25, 37, 51, 52]

Psychotherapy begins with the identification of the stressor, as consciously recognized or acknowledged by the patient. The person’s nonadaptive responses may be diminished if the stress can be eliminated, reduced, or accommodated. [27] Strain et al suggest that the goals of psychotherapy should include the following [14] :

  • Analyze the stressors affecting the patient and determine whether they can be eliminated or minimized

  • Clarify and interpret the meaning of the stressor for the patient

  • Reframe the meaning of the stressor

  • Illuminate the concerns and conflicts the patient experiences

  • Identify a means of reducing the stressor

  • Teach or reinforce coping skills

  • Help patients gain perspective on the stressor, establish relationships, attend support groups, and manage themselves and the stressor

Accordingly, treatment of adjustment disorders entails psychotherapeutic counseling aimed at reducing the stressor, improving the ability to cope with stressors that cannot be reduced or removed, and developing emotional states and support systems that enhance adaptation and coping. Generic (brief “psychodynamic”) psychotherapy, crisis intervention, family and group therapies, cognitive-behavioral therapy (CBT), and interpersonal psychotherapy all may encompass these elements. The recommendation that any therapy be time-limited communicates the expectation of recovery to the patient and may contribute to a favorable outcome.

Few randomized, controlled trials (RCTs) of the effectiveness of treatment for adjustment disorder have been conducted. [14, 43] In one, Gonzalez-Jaimes and Turnbull-Plaza showed that “mirror psychotherapy” was both efficient and effective in treating adjustment disorder. [53]

In another RCT, 192 employees diagnosed with adjustment disorder were randomized to receive either care as usual or an intervention consisting of an individual cognitive-behavioral approach to a graded activity, similar to stress inoculation training. The intervention group returned to work sooner than the control group did; both groups showed similar symptom reduction. [43, 54]

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Pharmacologic Therapy

Typically, the goal of pharmacologic agents for individuals with adjustment disorder is the amelioration of debilitating symptoms (insomnia, anxiety, and panic attacks) rather than treatment of the disorder itself. The agents most commonly prescribed for individuals with this disorder are benzodiazepines and antidepressants. [25, 46, 55, 56, 57] Antidepressants may be tried in patients with minor or major depressive disorders who have not responded to psychotherapy or other supportive interventions for 3 months. [56] The advisability of waiting that long to initiate antidepressants when a full-blown depressive syndrome develops is a matter of clinical judgement, based on the expectation that the person will recover substantially over time, with other kinds of supportive care.

Other agents have been investigated for the treatment of adjustment disorder. A randomized, double-blind study compared lorazepam with etifoxine, a nonbenzodiazepine anxiolytic. Although patients responded to both agents, more responded to etifoxine. [7] In a separate randomized, double-blind study, a higher rate of successful response to treatment (91%) was achieved in patients who received trazodone than in those who received clorazepate, though the results were not statistically significant. [58]

Two additional studies investigated the use of plant-based remedies for adjustment disorder. [59, 60] In these studies, patients received either a plant extract preparation or placebo. Extracts included either kava-kava or valerian and other extracts among outpatients with adjustment disorder with anxious mood. Individuals who took the experimental plant extract in either study showed significant improvement in comparison with those who took the placebo.

Further studies are required to investigate the effectiveness of these agents and additional novel agents in treating adjustment disorder.

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Activity

For many people, aerobic exercise stabilizes the autonomic nervous system and may be associated with the release of endogenous neurotransmitters (dopamine and endogenous opioids) that induce positive mood states. Encouraging activity of any kind, but especially vigorous exercise, may contribute to recovery from a disabling stress reaction.

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