Psychotherapy of adjustment disorders: Current state and future directions

Figures & data

Table 1. Included studies on psychological and psychotherapeutic interventions to AD.

Study	Country	Type of intervention and control group	Design	Setting/sample/diagnosis	Stressors	Age range; mean age (SD)	Gender (females)	N	Outcome +/o/–
Altenhöfer et al. (2007)	Germany	Client-centred psychotherapy vs wait list	Clinical study (no randomisation)	Secondary care outpatients with AD	Loss of a significant person or a severe negative experience at work or university	18–65	Both (40 females)	50	+
Andreu-Mateu et al. (2012)	Spain	Virtual reality components combined with face-to-face therapy	Case study	Secondary care outpatients with AD and comorbid depression/PTSD	–	35–42	Only females	2	+
Bachem and Maercker (2016)	Switzerland	CBT-oriented unguided self-help manual vs wait list	RCT	Participants with clinical or subclinical AD were recruited via media reports or referral of police units	Domestic burglary	19–80	Both (47 females)	53	+
Bakker et al. (2007)	The Netherlands	MISS vs usual care	Cluster-RCT	Primary care patients with symptoms of stress-related mental disorders and sick leave from a paid job	–	Intervention: 41.97 (8.8), control: 39.50 (9.6)	Both (intervention: 67%, control: 65%)	483	o
Ben-Itzhak et al. (2012)	Israel	Brief psychodynamic vs intermediate psychodynamic psychotherapy	RCT	Secondary care outpatients with AD	Interpersonal, occupational, or economic difficulties; experiencing a loss; health problems	20–65; 43.6 (11.02)	Both (52)	66	+
Blonk et al. (2006)	The Netherlands	CBT vs CBT combined with a graded activity approach vs two sessions with a GP	RCT	Self-employees with AD who had applied for sickness benefit from an insurance company	Work-related psychological complaints	42 (7.9)	Both (19%)	122	+ (combined intervention)
Bos et al. (2014)	The Netherlands	Mindfulness training (MBSR/MBCT)	Clinical study	Secondary care outpatients with depressive, bipolar or anxiety disorder and AD	–	21–66; 45.5 (10.5)	Both (69%)	143	+
Brouwers et al. (2006)	The Netherlands	Problem solving using a graded activity approach vs GPs’ usual care	RCT	Primary care outpatients with emotional distress or minor mental disorders	–	Intervention: 39.4 (9.1), control: 40.1 (9.3)	Both (intervention: 58%, control: 60%)	194	o
Cvetek (2008)	Slovenia	EMDR vs active listening vs wait list	RCT	Undergraduate & postgraduate students without a psychiatric disorder	Various distressful experiences	19–32; 23.4 (3.7)	Both (60)	90	+
Frankel (2001)	USA	Ego enhancing treatment	Single case study	Secondary care outpatient with AD with depressed mood	Difficulty in adjusting to assisted living and other stressors	88	Male	1	+
Gorschenek et al. (2008)	Germany	Client-centred psychotherapy vs wait list	Two-year-follow-up to the study of Altenhöfer et al. (2007)	Secondary care outpatients with AD	Loss of a significant person or a severe negative experience at work or university	18–65	Both (40 females)	50	+
Hsiao et al. (2014)	Taiwan	BMS group psychotherapy vs control (one-session psychoeducation)	RCT	Secondary care outpatients with AD with depressed mood	–	44.5 & 44.0 (median)	Both (BMS: 67.6%, control: 73.0%)	71	o/+ (diurnal cortisol patterns & suicidal ideation)
Jojic and Leposavic (2005a)	Serbia	Autogenic training	Clinical study	Secondary care patients with AD	–	17.3 (0.2)	Both	31	+
Jojic and Leposavic (2005b)	Serbia	Autogenic training	Clinical study	Secondary care patients with AD	–	39.3 (1.6)	Both	35	+
Kramer et al. (2010)	Switzerland	Short-term dynamic psychotherapy (STDP)	Process-outcome study	Self-referred university students with AD with anxious or depressed mood	–	20–39; 24 (3.86)	Both (82%)	32	+
Kramer et al. (2015)	Switzerland	Short-term dynamic psychotherapy (STDP)	Process-outcome study	Self-referred university students with AD with depressed mood	–	19–39; 24.7 (3.8)	Both (75%)	32	+
Maercker et al. (2015)	Switzerland	CBT-oriented unguided self-help manual for AD	Single case study	Participant with clinical AD, recruited via media report/referral of police	Burglary	68	Male	1	+
Maina et al. (2005)	Italy	BDT vs BSP vs wait list	RCT	Secondary care outpatients with dysthymic disorder, depressive disorder not otherwise specified or AD with depressed mood	Precipitant life event not specified	WL: 30.2 (7.8), BDT: 40.7 (15.3), BSP: 39.5 (0.5)	Both (WL: 50%, BDT: 80%, BSP: 60%)	30	+
Markowitz et al. (1992)	USA	Interpersonal therapy	Pilot study	Outpatients with HIV-infection and depression	HIV-infection	17–61; 37.3 (13.1)	Both (22%)	23	+
Mihelich (2000)	USA	Two sessions of EMDR compared to two sessions of exposure	Serial case study	Patients with AD	–	–	–	9	+ (in patients with anxious or mixed symptoms)
Nardi et al. (1994)	Israel	CBT	Case study	Soldiers with AD	Conscription	18–20	Male	3	+
Quero et al. (2012)	Spain	Online emotional therapy web-based system for homework assignments for AD	Single case study	University student with AD/complicated grief	Death of her sister 8 months ago	21	Female	1	+
Rebergen et al. (2009)	The Netherlands	GBC by occupational physicians vs TAU (minimal involvement of the OP with easy referral to psychologists)	RCT	Dutch police force with mental health problems	–	GBC: 38.8 (8.4), TAU: 40.0 (9.5)	GBC: 48.8%, TAU: 39.5%	240	o/+ (small effect for worker with administrative functions/minor stress-related symptoms)
Ruesch et al. (2015)	Germany	CBT group programme vs wait-list control group	RCT-study protocol	Secondary care outpatients with chronic somatic disease and comorbid depression or AD	–	–	–	128	N/A
Schuyler (2004) & Cluver et al. (2005)	USA	Brief CBT via face-to-face and analogue videophone	Feasibility study	Primary care for terminally ill cancer patients with AD or depression	Cancer	–	Both (7)	10	+
Skruibis et al. (2016)	Lithuania	Web-based brief AD intervention (CBT + MBCT) vs wait-list control group	RCT-study protocol	Individuals with adjustment difficulties	–	–	–	–	N/A
Srivastava et al. (2011)	India	Meditation vs control group	Pre-test / post-test control group design	Individuals with AD with mixed anxiety and depressed mood	–	30–40; 35	Both (21)	30	+
Stenlund et al. (2009)	Sweden	CBR + Qigong vs Qigong only	RCT	Secondary care patients on sick leave for burnout	–	41.6 (7.4)	Both (96)	136	+
Sundquist et al. (2015)	Sweden	Mindfulness-based group therapy vs CBT	RCT	Primary care patients with depressive, anxiety or stress and ADs	–	42 (11), 41 (11)	Both (184)	215	+
Van der Klink et al. (2003)	The Netherlands	Activating intervention by trained physicians vs TAU by untrained physicians	Cluster randomised trail	Primary care for individuals on first sickness leave for AD	–	39 (8.0), 42 (8.8)	Both (71)	192	+
Van Oostrom et al. (2010)	The Netherlands	Participatory workplace intervention vs usual care	RCT	Sick-listed employees with distress	–	48.6 (7.7), 49.2 (8.6)	Both (31)	145	o/+ (for employees who at baseline intended to return to work despite symptoms)
Vente et al. (2008)	The Netherlands	SMT-I vs SMT-G vs TAU	RCT	Patients with sickness leave recruited through occupational health services, GP & advertisements	Work related stress	SMT-I: 41.64 (9.41), SMT-G: 41.50 (10.33), CAU: 40.92 (9.64)	Both (SMT-I: 61%, SMT-G: 57%, CAU: 65%)	82	o
Willert et al. (2011)	Denmark	CBT vs wait-list control group	RCT	Employees with absenteeism	–	24–61	Both (84)	102	+

BDT: brief dynamic therapy; BMS: body-mind-spirit therapy; BSP: brief supportive psychotherapy; CBR: cognitively oriented behavioural rehabilitation; CBT: cognitive behavioural therapy; EMDR: eye movement desensitisation and reprocessing; GBC: guideline-based care with an activating approach, time contingent process evaluation and cognitive behavioural principles; GP: general practitioner; MBCT: mindfulness-based cognitive therapy; MBSR: mindfulness-based stress reduction; MISS: minimal intervention for stress-related mental disorders with sick leave; N: number of participants; N/A: not available; OP: occupational physician; PTSD: posttraumatic stress disorder; RCT: randomised controlled trial; SD: standard deviation; SMT-I/G: CBT-based stress management training on individual or group level; STDP: short-term dynamic psychotherapy; TAU: treatment as usual.

Figure 1. Stepped care approach for adjustment disorders (psychological intervention parts highlighted).

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