Psychotherapy is the treatment of choice for adjustment disorder, but the type of psychotherapy varies depending on the stressor and specific symptoms. After all, the stressor that triggers adjustment disorder might be a single event, such as ending a relationship. It might be multiple stressors, such as losing your job and having marital problems. It might be a new transition, such as moving to a different city, having a baby or retiring. Or it might be a new diagnosis, such as learning you have a physical illness.
Plus, there are six types of adjustment disorder. For instance, one type consists of symptoms of depression, such as low mood, tearfulness and feelings of hopelessness. Another type features symptoms of anxiety, such as nervousness and worry. A third type features conduct disturbance, which might include anything from fighting to driving recklessly to skipping work to abusing drugs or alcohol.
The research on treatment for adjustment disorder has been scare. A recent review of psychological and pharmacological studies published between 1980 and 2016 concluded that the quality of evidence for positive effects was “low to very low.”
For some people, adjustment disorder may remit on its own (e.g., you find a job you love; your baby starts sleeping through the night). However, some research has found that adjustment disorder is a “gateway” to other disorders, such as major depressive disorder or anxiety disorders; and can increase the risk for suicide if untreated.
In general, because adjustment disorder is an excessive reaction to a stressful life event that impairs daily functioning, it’s best that therapy is brief and solution-focused. That is, therapy helps you to understand the meaning behind the stressor, and reframe it; remove or reduce the stressor; reduce symptoms; develop effective coping and problem-solving skills; and learn better ways to manage stress.
If you’re struggling with symptoms of anxiety, psychotherapy also might include learning relaxation techniques, shifting thoughts that perpetuate your anxiety and changing maladaptive behaviors (which is part of cognitive-behavioral therapy, or CBT).
If you’re struggling with symptoms of depression, therapy might include elements of CBT, as well, or interpersonal therapy. The latter focuses on helping you improve the quality of your current relationships.
If the stressor is related to a romantic relationship, or is somehow negatively affecting your relationship, couples therapy is important.
Adjustment disorder also is common in kids, and psychotherapy is equally as vital. In fact, it’s critical because an untreated adjustment disorder can progress into clinical depression, an anxiety disorder or substance abuse. Also, teens with adjustment disorder can have suicidal thoughts and even make attempts. Some research has found that girls with adjustment disorder may have higher levels of suicidal symptoms than boys with the disorder.
Like adults, treatment in kids and teens depends on the specific stressor and symptoms (an additional factor is age). As a whole, kids have more behavioral symptoms, so therapy will likely address impulse control, anger management and communication. Therapy also will help kids and teens develop strategies for problem solving, along with healthier ways to cope with stressful situations and transitions.
In addition, family therapy can be tremendously helpful in reducing and resolving conflict, improving communication skills and teaching caregivers the best ways to support their child through their symptoms.
Lastly, peer group therapy may help adolescents, as well. It provides a safe space for them to practice and sharpen their social, interpersonal and communication skills. Teens also learn to effectively express their emotions, and empathize with others. And group therapy reminds them that they’re not alone, and support is readily available.
Medication isn’t indicated for adjustment disorder, but it may be prescribed for specific debilitating symptoms. For instance, doctors might prescribe an antidepressant to reduce symptoms of depression or suicidal thoughts (called suicidal ideation by professionals). Some physicians prescribe benzodiazepines for reducing anxiety, even though they have the potential for dependency.
Several studies have found etifoxine, a medication with anxiolytic properties, to be helpful with anxiety symptoms in adjustment disorder. Etifoxine is not associated with dependence (and has fewer side effects than the commonly prescribed benzodiazepine alprazolam). Medication also may be prescribed to treat sleep issues.
Currently, there’s an ongoing systematic review examining the quality of evidence for using antidepressants, anxiolytics and other medication in treating adjustment disorder.
Support groups can be invaluable in helping you deal with your specific stressor, whether that’s a divorce, job loss or diagnosis. Support groups remind you that you’re absolutely not alone, provide an opportunity to express and process your own feelings and experiences, and can help you pick up additional coping strategies.
It’s also vital to have a strong support system, and surround yourself with compassionate, understanding individuals.
Some studies have found that herbal remedies may be effective. Specifically, most of the rigorous research (double-blind, randomized control studies) has been done with individuals with the anxiety subtype. They’ve have found kava-kava, Euphytose (which contains a combination of plant extracts), and ginkgo biloba to improve anxiety.
Several studies also have explored the effectiveness of a self-help manual and web-based self-help interventions. For instance, a 2016 study found that a manual based on CBT alleviated some symptoms of adjustment disorder.
Moreover, it’s important to engage in healthy habits, making sure you’re getting enough sleep, participating in physical activities you enjoy, and eating nutrient-rich foods. Think of these habits as forming the foundation for successfully navigating the day to day, and dealing with stress. Some research has suggested that practicing yoga might be beneficial for individuals with adjustment disorder with anxiety and depression.
Other nourishing habits might include journaling, meditating and listening to guided meditations.
To learn more about adjustment disorders, please see the symptoms of adjustment disorder.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bachem, R., Maercker, A. (2016). Self-help interventions for adjustment disorder problems: a randomized waiting-list controlled study in a sample of burglary victims. Cognitive Behaviour Therapy, 45 (5), 397–413.
Casey, Patricia. (2018). Treatment of adjustment disorder. In P. Casey (Ed.) Adjustment Disorder: From Controversy to Clinical Practice (1st ed.). New York: Oxford University Press.
Casey, P., Jabbar, F., O’Leary, E., Doherty, A.M., (2015). Suicidal behaviors in adjustment disorder and depressive episode. Journal of Affective Disorders, 174, 441–446.
Casey, P., Pillay, D., Wilson, L., Maercker, A., Rice, A., Kelly, B. (2013). Pharmacological interventions for adjustment disorders in adults (Protocol). Cochrane Database of Systematic Reviews, 1–12.
Ferrer L, Kirchner T. (2014). Suicidal tendency in a sample of adolescent outpatients with Adjustment Disorder: Gender differences. Comprehensive Psychiatry, 55(6), 1342-1349.
Fraser, M., Ballas, P., Turley, R.K. Adjustment Disorders in Children. University of Rochester Medical Center. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01573.
Hurley, K. (2018, November 25). Group therapy for kids: What it is, how they can benefit, and when not to send your child to group therapy. Retrieved from https://www.psycom.net/group-therapy-children.
IPT for Depression. International Society of Interpersonal Psychotherapy. Retrieved from https://www.interpersonalpsychotherapy.org/ipt-basics/adaptations-of-ipt-what-works-for-whom/ipt-for-depression/.
Kenardy, J. (2014). Treatment guidance for common mental health disorders: Adjustment disorder. InPsych, 36 (5). Retrieved from https://www.psychology.org.au/inpsych/2014/october/kenardy.
O’Donnell, M.L., Alkemade, N., Creamer, M., McFarlane, A.C., Silove, D., Bryant, R.A., Felmingham, K., Steel, Z., Forbes, D. (2016). A longitudinal study of adjustment disorder after trauma exposure. The American Journal of Psychiatry 173, 1231–1238.
O’Donnell, M. L., Metcalf, O., Watson, L., Phelps, A., & Varker, T. (2018). A systematic review of psychological and pharmacological treatments for adjustment disorder in adults. Journal of Traumatic Stress, 31(3), 321–331.
Stein, D.J., (2015). Etifoxine versus alprazolam for the treatment of adjustment disorder with anxiety: A randomized controlled trial. Advances in Therapy, 32 (1), 57-68.