Adjustment disorder is characterized by emotions and behaviors associated with a stressful event that lead to difficulties in work, school, and relationships. Seen as a temporary condition usually lasting about six months, treatment is focused upon helping a person cope with the stressful situation or making a transition in a more productive manner. Psychotherapy is the choice of treatment for this disorder, with an emphasis on the event or situation, its impact upon the person's life, and how the person can move on from the effects the event had.
The Treatment Process
The treatment process involves:
- A period of assessment
- Choosing a course of treatment that will help fulfill treatment goals
- Assessment to ensure there is a difference in thoughts, feelings, and behaviors after treatment
After the psychotherapist performs an assessment to gather information about the stressful event, how it's contributing to areas of difficulty in your life, how it compares with how you were doing before the stressful event, and any co-occurring disorders such as depression, the therapist will create a treatment plan containing specific goals to resolve the difficulties you are experiencing.
Psychotherapy treatments for adjustment disorder focus upon goal-oriented activities and psychoeducation about possible causes of stress, reframing stressful situations, and developing new coping strategies.
Medications are occasionally used to treat aspects of the disorder that mirror other symptoms of other disorders. Social support is often a focus of the therapy, along with group therapy, to treat adjustment disorder. Self-helping strategies are often overlooked and should be considered.
Short-term psychotherapy strategies are usually used for most cases of adjustment disorder. While treatment for adjustment disorder has not been widely studied, there are currently many different types of therapies used to treat adjustment disorder.
The American Psychiatric Publishing Textbook of Psychiatry found two types of therapies effective in the treatment of adjustment disorder.
- Mirror Therapy: Patients sit in front of a mirror and are asked to examine the image in the mirror. Acceptance of oneself as a whole person is encouraged. The results of this therapy when used for people who had heart attacks was superior when compared with Gestalt therapy and medical conversation in the treatment for adjustment disorder.
- Activating Therapy: This is a type of cognitive behavioral therapy that focuses on performing a set of activities to reclaim personal power over one's life or situation and to develop coping mechanisms. This therapy was effective for people experiencing long-term unemployment.
Psychiatric Advanced Practice Nursing: A Biopsychosocial Foundation for Practice described many different types of interventions used for adjustment disorder. Some of the treatments for adjustment disorder are dependent upon the situation of the client. Some example are:
- BICEPS: BICEPS stands for "brevity, immediacy, centrality, expectancy, proximity, and simplicity." Known as a "first aid" application for emotions, it is used to focus upon the problem and come up with solutions that will work right away so the person can resume a normal life after a stressful event. It helps the person learn the coping mechanisms that can be applied to bring the client relief with immediacy.
Psychotherapy: Psychotherapy is still the top choice for the treatment of adjustment disorder. Examples of psychotherapies include short-term therapies, such as Brief Dynamic Therapy, and Supportive Therapy.
- Brief Dynamic Therapy helps people identify what behaviors, thoughts, and feelings are contributing to their present difficulties in coping with their present situation. This has been found to help people with depressive symptoms with adjustment disorder.
- Supportive Therapy concentrates on helping people reason through their thoughts and emotions to get back control in their lives. Supportive Therapy focuses upon resolving feelings about the stressful situation or event, decreasing symptoms, and building the skills necessary to adapt and cope with the situation.
- Eye Movement Desensitization and Reprocessing Therapy (EMDR): Emotional turmoil, according to the principles of EMDR, is caused by past images and thoughts associated with a stressful event. When the stressful event is focused upon in therapy, the therapist has the client visually follow the therapist's finger across the client's "field of vision" and uses tapping and sounds in order to reprogram associations made with a painful past event. This therapy is effective with adjustment disorder with anxiety symptoms, but not as much with adjustment disorder with depressive symptoms.
Because the symptoms of adjustment disorder overlap with anxiety and mood disorders, sometimes medications that are used to treat the symptoms of other disorders will be used to treat the same symptoms within adjustment disorder. Using medications for the treatment of adjustment disorder should be done so with caution.
- Benzodiazepines are occasionally used to alleviate anxiety and insomnia associated with anxiety-related adjustment disorder. These should be used with caution, especially where addiction to other substances are an issue.
- Antidepressants are sometimes used when symptoms overlap with mood disorders.
- A trial using etifoxine and buspirone to treat adjustment disorder with anxiety were shown to be effective.
- Some herbal remedies were shown to be effective in treating anxiety in adjustment disorder. Euphitose (EUP) is a combination of six types of herbs, which include passion flower and valerian root, and was more effective than the placebo group in treating anxiety in adjustment disorder.
The course of medications usually lasts several weeks. The patient is weaned off the medications when the stressful event has passed and the patient develops new, healthy ways of handling stressful events in therapy.
Social Support and Group Support
Using your social support system can be very helpful in alleviating stress. Social support and group support are viewed as self-help strategies one can use to alleviate symptoms of adjustment disorder and are often used in conjunction with psychotherapy. For instance, if a person going through divorce has adjustment disorder, the person might find group therapy that is targeted for newly divorced people helpful.
Get the Help You Need
Since psychotherapy is the treatment most often used for adjustment disorder, it is important to gain the help of a mental health professional as soon as possible to treat adjustment disorder. Treatment outcomes are very positive; getting help as soon as possible will help you recover from the stressful event sooner rather than later.