A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults

Abstract

Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.

Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report

“…Psychotherapeutic and psychopharmacological treatment options for AD have recently been summarized in three review articles (Domhardt and Baumeister, 2018;O'Donnell et al, 2018;Stein, 2018). They found that the quality of evidence has been ranked low to very low (O'Donnell et al, 2018).…”

“…Psychotherapeutic and psychopharmacological treatment options for AD have recently been summarized in three review articles (Domhardt and Baumeister, 2018;O'Donnell et al, 2018;Stein, 2018). They found that the quality of evidence has been ranked low to very low (O'Donnell et al, 2018). McPhillips et al (2018) provide qualitative data on why MCT might be more effective than cognitive behavioral therapy (CBT) in the treatment of emotional distress in cardiac patients, although the validity of this hypothesis still needs to be shown.…”

“…Increased levels of anxiety and depression symptoms, and decreased quality of life have been observed in PAH, although AD has not been described so far (Larisch et al, 2014;Somaini et al, 2016). Divergent treatments such as cognitive behavioral therapy and low-intensity psychological interventions (self-help therapy, bibliotherapy, support groups, behavioral activation, mindfulness, meditation, relaxation, and e-mental health interventions) have been proposed for the treatment of AD, and three broader common components of these divergent strategies have been identified: (1) the enabling of individuals to reduce or remove the stressor, (2) interventions to improve coping with the stressor, and (3) stress reduction strategies (O'Donnell et al, 2018). However, to date there is only limited empirical evidence for these treatments in AD and a need for further studies and replication studies evaluating the efficacy of specific interventions in patients with AD have been proposed (O'Donnell et al, 2018).…”

Adjustment Disorder: Current Developments and Future Directions

“…To date, there is only one published systematic review of treatments available for adjustment disorder. A 2018 review examined 29 treatment trials investigating current options for psychological and pharmacological intervention [52]. They found that the quality of evidence in these studies was “low” to “very low” according to Grading of Recommendations Assessment, Development and Evaluation (GRADE; [53]) guidelines.…”

Social status and modern‐type depression: A review

“…Individuals who cannot accept their own social status on the basis of the Japanese traditional hierarchal order can exhibit depression-like behaviors, such as learned helplessness and social withdrawal, which is considered to indicate the presence of MTD (Kato, Hashimoto, et al, 2016;Kato & Kanba, 2017). Given that MTD is a subtype of adjustment disorders that are F I G U R E 2 Changes of social rank and depression-like symptoms resistant to psychotropic drugs (O'Donnell, Metcalf, Watson, Phelps, & Varker, 2018), medication is likely to be ineffective. In this article, we have reviewed the potential mechanisms of MTD from the standpoint of social status using knowledge gained mainly from captive animals and humans and have proposed that a shared pathobiology mechanism underlies social status and MTD.…”