Adjustment Disorder

Treatment


Phillip W. Long, M.D.
1990

Contents


Medical Treatment

Basic Principles

Therapists usually do not treat Adjustment Disorder with medication.

Antianxiety Drugs

Sometimes a few days or weeks of antianxiety medication, (e.g. lorazepam 1 mg three times a day, or clonazepam 0.5-1.5 mg at bedtime), is prescribed to control anxiety and insomnia.

Antidepressant Or Antipsychotic Medications

Usually antidepressant or antipsychotic medications aren't used for Adjustment Disorder. These medications should not be prescribed merely for their sedating effect, since antianxiety drugs are much better in this regard, and have far fewer side-effects. If antidepressant or antipsychotic medication is indicated, it is more likely that the diagnosis is a more serious mood or psychotic disorder, rather than just Adjustment Disorder.

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Psychosocial Treatment

Basic Principles

Adjustment Disorder (by definition) lasts less than 6 months, thus supportive psychotherapy is usually all that is necessary.

This supportive pschotherapy should emphasize that full recovery usually occurs within a few months, and that this natural recovery is hastened by a psychotherapy which focuses on stress-reduction. Thus the problem triggering the Adjustment Disorder should be clarified, and alternative solutions explored. Finally, some plan for stress-reduction should be agreed upon. It is important that the therapist not dictate what changes the patient must make.

Brief environmental change may be helpful; however, simplistic advice such as "take a few days of vacation" is usually insufficient.

For the anxious and depressed patient:
Psychotherapy should fight against the patient's attempts to withdraw and "just give up". The patient should be encouraged, perhaps by "prescription," to increase contact with others. Likewise, the family should adopt a kind but firm pressure aimed at overcoming the patient's desire to withdraw and "give up".

Other, more serious mental disorders are frequently misdiagnosed as "Adjustment Disorders". Thus, if long-term therapy is needed, the patient probably has something else (e.g., Major Depressive Disorder, or Generalized Anxiety Disorder).

For the irresponsible or aggressive patient:
If the patient's socially unacceptable behavior has caused trouble with the law, authorities, or school, the therapist should caution the family against "rescuing" the patient from the consequences of this behavior. Too often, such "rescuing" only reinforces the patient's socially unacceptable behavior and prevents any subsequent emotional growth.

For the adolescent patient:
The therapy of an adolescent with an Adjustment Disorder should usually involve the family. Adolescents in conflict are actively asking for help, although their pleas may be misunderstood because of their aggressive behavior.

Individual Psychotherapy

Formal psychotherapy is seldom necessary in the isolated stress response or Adjustment Disorder. Supportive psychotherapy, with an emphasis on the here and now, is usually sufficient. Usually all that is required is crisis intervention, brief counselling, and education.

Family Therapy

While much of treatment usually is individual psychotherapy, family members can benefit from a family session after the start of individual psychotherapy. During the family session, the therapist should reassure the family that the Adjustment Disorder usually is short-lived and should respond to their understanding and support.

Behavior Therapy

Behavior therapy usually focuses on having the patient to keep a daily log of what triggers the stress, how the patient responds to the stress, and what helps reduce the stress. Techniques for general tension reduction are also helpful in reducing the reaction to stressful events.

Group Therapy

Many patients with Adjustment Disorder (e.g., following a diagnosis of cancer or AIDS, or breakup of a relationship) often benefit from attending support groups with others who have also experienced the same stressor. Within the group, members exchange advice, share coping strategies, and provide support and encouragement. Some support groups also provide new social networks to replace those lost through events such as death or divorce.

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Internet Mental Health (www.mentalhealth.com) copyright 1995-2011 by Phillip W. Long, M.D.