Authors & year Design Sample % of sample with adjustment disorder (Diagnostic method), stressor Intervention type (Name) Key intervention components Intervention delivery method, frequency, duration, (delivered to) Outcomes (Measure(s)) Participants Arends et al. (2014) Clustered RCT with 3, 6 and 12 month follow-up Dutch workers who returned to work after sickness absence due to mental health disorders Intervention: Age: 41.3 Male: 27% Control: Age: 43.3 Male: 38% Intervention: 73% Control: 50% (ICD-10) Stressor: Not reported Problem solving intervention (SHARP) Intervention: 1. Create inventory of problems related to return to work 2. Develop solutions and an action plan 3. Evaluate action plan/implemented solutions Control: Care as usual (Guidelines around management of mental health problems in workers) Occupational therapist delivered 30 minute consultations (2 – 5 sessions) over 3 months Hospital Anxiety and Depression Symptom Return to work N = 153
Both groups improved on mental health functioning at all follow-up time points, with no significant differences between groups in level of improvement. Full return to work occurred 65 days earlier and partial return to work occurred 12 days earlier for the intervention group compared to controls. Hosaka et al. (2000) Single group pre-post with 6 month follow-up Japanese cancer patients Age: 51.3 (8.8) Male: Unknown 26% (DSM-IV) Stressor: Not reported Psychiatric intervention Cancer Psychological support Relaxation training Guided imagery Five weekly 90 minute group based sessions - Profile of Mood States (POMS) N = 47 There were no significant changes in individuals with adjustment disorder from pre to post treatment or at follow-up. Hosaka et al. (2001) Single group pre-post Japanese cancer patients 26% (DSM-IV) Psychiatric intervention Cancer Five weekly 90 minute group based sessions, followed - Profile of Mood States (POMS) N = 34
with 6 month follow-up Age: 50.2 (6.0) Male: Unknown Stressor: Not reported Psychological support Relaxation training Guided imagery by 3 further monthly free talk group session This study reported contradictory findings. Relaxation-based Bos et al. (2014) Pre-post Dutch psychiatric outpatients Age: 45.5 (10.5) Male 31% 10% adjustment disorder Stressor: Not reported Mindfulness training (MBSR + MBCT) Formal mindfulness exercises (Body scan, sitting meditation, yoga) Group therapy for 8 weekly session of 2.5 hours each - Short Symptom List (SSL) - World Health Organization Quality of Life N = 214
Group discussion of above experiences Psychoeducation Homework The adjustment disorder sub-analyses revealed a significant improvement to SSL and WHOQOL-Bref scores, with moderate to effect sizes of d = 0.59 and 0.87, respectively. Hsiao et al. (2014) RCT with 5, 8, and 14 month follow-up Taiwanese psychiatric outpatients Intervention: Age: 44.5 Male 32% Control: Age: 44.0 Male 27% 100% adjustment disorder with depression (DSM-IV) Stressor: Not reported Holistic/Eastern therapy Intervention: Treatment as (TAU) + 1. Cognitive restructuring 2. Meditation, relaxation and guided imagery 3. Emotion work 4. Physical exercises 5. Spiritual work Eight weekly sessions - Beck Depression Inventory (BDI) - State Trait Anxiety Inventory (STAI) - Suicidal ideation N = 71 trial
Age: 42.8 (18.5) Male 33% At the halfway point of treatment, BDI scores had reduced significantly for both intervention and controls. However, at the end of treatment, intervention had significantly lower BDI scores compared to controls. Quality of life also improved significantly in the intervention group compared to controls from the start of treatment to the end. CGI improved significantly in the intervention group but not in controls. Hirsh et al. (2009) Case study Male with an Implantable Cardioverter Defibrillator Age: mid 50’s 100% adjustment disorder with anxiety Stressor: Health Psychological therapy Cognitive behaviour stress management adapted from manual, including psychoeduction, stress and family therapy. Five session inpatient and five session outpatient over six weeks, with further sessions at one and three months - State Trait Anxiety Inventory (STAI) - Beck Depression Inventory (BDI) N = 1 Scores on STAI-State reduced from 72 at baseline to 24 at post treatment and STAI-Trait reduced from 62 at baseline to 22 at post treatment. BDI scores reducing from 18 at pre-treatment to 1 at follow-up (14 weeks).
Lagerveld et al. (2012) Clustered controlled with 12 month follow-up Dutch employees on sick leave due to psychological problems 67% adjustment disorder Stressor: Not reported Psychological therapy Intervention: Work-focused CBT, which was CBT with a work context, plus an additional module focusing on returning to work Control: Manualised CBT Intervention: Individual therapist delivered 12 sessions over 6 months Control: Individual therapist delivered 12 sessions over 6 months - Symptom Checklist (SCL-90) - Depression anxiety and stress (DASS-21) N = 208 While the intervention was more effective on return to work levels, it did not significantly differ from controls in the impact on mental health outcomes. Depression and anxiety levels significantly improved in both groups but there was no significant impact of either intervention or control stress levels. Powell & McCone (2004) Case study US military Age: 20 Male 100% adjustment disorder with anxiety Stressor: Terrorism Psychological therapy CBT with the following components: Cognitive impulse control Challenging irrational beliefs 13 sessions over 12 months Outcome 45 (OQ-45) N = 1
Stress management skills Relaxation training The individual participant showed a reduction from 66 on the OQ-45 at the first session to 11 at 12 month follow-up. van der Heiden & Melchior (2012) Pre post with month follow-up Dutch GP patients referred to an outpatient treatment centre Age: 43.6 Male 32% 100% adjustment disorder: 50% with depressed mood; 30% with anxiety; 20% other (DSM-IV) Stressor: Not reported Psychological therapy Manualised CBT consisting of psychoeducation, self-monitoring of stress, improving lifestyle and coping strategies, modifying negative thoughts Individual weekly 45 minute sessions - Symptom Checklist (SCL-90) N = 10 There were significant reductions in symptomatology as measured by the SCL-90 between pre and post treatment (d = 1.25) and from pre-treatment to follow-up (d = 1.37).
van der Klink et al. (2003) Cluster RCT with 12 month follow-up Dutch employees from a private company who were on 2 weeks sick leave for an adjustment disorder 100% adjustment disorder Stressor: Not reported Psychological therapy Intervention: Graded activity approach resembling stress inoculation training (a form of CBT) Control: Usual care (empathic counselling, stress and lifestyle advice, and work-related issue discussion) Four to five consultations over six weeks, 90 minutes in length, delivered by occupational therapists and a relapse prevention session - Symptom Checklist (SCL-90) - Symptom Questionnaire (4DSQ) N = 192 At 3 and 12 months, both groups improved significantly on outcomes with no significant differences between groups. Psychodynamic psychotherapy-related et al. (2012) RCT Israeli outpatients 100% adjustment disorder: 85% mixed depression and Psychological therapy Intervention: Manualised brief psychodynamic psychotherapy Intervention: Twelve sessions over 12 weeks - Symptom Checklist (SCL-90) N = 91
Intervention: Age: 46.7 (10.9) Male: 23% Control: Age: 40.6 (10.2) Male: 19% anxiety Stressor: interpersonal, occupational, economic, health Control: Intermediate psychotherapy Control: Approximately 48 sessions for 1 year Both groups improved significantly in SCL-90 scores from pre-treatment to 3 months with no significant differences between groups. The additional 9 months of therapy in the control group did not add any significant improvement to participants, and at post-treatment for the controls (12 months) compared to the same time point of 9 month follow-up for the intervention group, scores did not significantly differ. Hofer et al. (2010) Pre-post Outpatients with an acquired brain injury (ABI) Age: 51 (36 – 61) 100% adjustment disorder: depressed mood (80%); anxiety (20%) (DSM-IV-TR) Psychological therapy Resource activation Problem activation Clarification of meaning Problem mastery Unlimited psychotherapy sessions which lead to on average 23 sessions over 12 to 18 months - Beck Depression Inventory (BDI) N = 11
Pharmacotherapy – Depressive symptoms Amodeo et al. (2011) RCT Italian cancer patients with depressive disorders Intervention: Age: 59.9 (11.7) Male: 27% Control: Age: 61.8 (10.5) Male: 33% 50% with adjustment disorder with depressed mood Stressor: Health Intervention: titration of paroxetine (SSRI) Control: titration of paroxetine (SSRI) Intervention: 2.5 m/g day increasing by 2.5m/g each third day until 10m/g was reached day 8. Day 9 dose was increased to 15m/g day and on day 11 the full 20m/g day dose was reached Control: 10m/g day and increased to 20m/g day on day 8 Both treatments lasted 8 weeks Hospital Anxiety and Depression Scale (HADS) Montgomery Asberg Depression Rating Scale (MADRS) Hamilton Anxiety Rating Scale (HAM-A) Clinical Global Impression (CGI) N = 30
Etifoxine was found non-inferior (i.e. at least as effective) to the control, but a significantly higher percentage of the treatment group were classified as responders (72%) at the end of treatment compared to controls (56%). Both groups improved in CGI ratings, but etifoxine had a higher proportion of markedly improved individuals. SAS-SR and SDS scores improved comparably between groups with no significant differences. Stein (2015) RCT South African outpatients Intervention: Age: 40.0 (11.8) Male: 32% Control: Age: 38.9 (12.8) Male: 30% 100% adjustment disorder with anxiety Stressor: 39% interpersonal, (38%) work/school; economic (12%); other (11%) Intervention: Etifoxine anxiolytic) Control: Alprazolam (benzodiazepine) Intervention: Three capsules per day for 28 days (150mg/day) Control: Three capsules per day for 28 days (1.5mg/day) Hamilton Anxiety Rating Scale (HAM-A) Self-report for the Assessment of Adjustment Disorders N = 201 Alprazolam improved outcomes on HAM-A significantly more than etifoxine at day 7 but at day 35 (one week discontinuation), etifoxine demonstrated non-inferiority compared with alprazolam on HAM-A measures. There were no significant differences at day 35 for other measures. There were more adverse events reported in the alprazolam group.