Adjustment Disorder and Stress Treatment in Sycamore and North Aurora ILIf you are interested in counseling for Depression and Major Depressive Disorder (MDD), call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
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What is Adjustment Disorder?Stressors and chronic stressors can impact all of us in different ways. Sometimes, stress impacts us emotionally, creating anxiety or depression. Sometimes, stress impacts us behaviorally, creating challenges with work performance or increases in unhealthy coping, such as using more alcohol to cope with stress. For others, stress can create more irritability and impact interpersonal functioning. When someone seeks treatment because they are struggling to adjust to and manage stress or stressors in their lives, they are typically diagnosed with what is called Adjustment Disorder, a disorder that falls under the Trauma- and Stressor-Related Disorder category. Many are struggling with coping with stressors currently, in a rapidly changing world with heightened economic and political tensions (regardless of your political affiliation).
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Adjustment disorder, specifically, is diagnosed when someone develops emotional or behavioral symptoms in response to a stressor or stressors. These symptoms will become clear within 3 months after the stressful event(s). We provide this diagnosis when the stressor is causing intense distress “that is out of proportion to the severity or intensity of the stressor” (American Psychiatric Association [APA], 2013, p. 286) or “significant impairment in social, occupational, or other important areas of functioning” (APA, 2013, p. 286). How do we know if stress is impacting someone’s functioning? Well, we consider how their functioning was before and after the stressor. Sometimes clients report a single event has taken place, such as a breakup or death of a parent, whereas other times, they may report many stressors, such as current events, work challenges, or difficulties with their relationships). Stressors sometimes re-occur, such as having seasonal business crises, whereas others are continuous, such as having a painful illness, living in an unsafe neighborhood, or being impacted by an ongoing politically induced stressor (APA, 213). Developmental transitions sometimes represent these stressors, such as leaving for college, becoming a new parent, or failing to accomplish an occupational goal (APA, 213). Adjustment disorder can be diagnosed after the death of a loved one if the grief is intense and persistent beyond normative grief.
Adjustment disorder has many variations as follows:
Adjustment Disorders are time limited (6 months in duration, typically). Therefore, if you are impacted by stressors for an extended period of time beyond that, then the symptoms may be better accounted for by another diagnosis at that time. For example, after 6 months, a depressive disorder, other trauma disorder, or anxiety disorder may better explain the continuation of symptoms. However, the treatment goals would remain similar: To help cope with and heal from the impact of the stressor to remit the depression, anxiety, etc.
How common are adjustment disorders? Very. We are seeing more and more clients here at Oakheart who are being impacted by stressors. Per the Diagnostic and Statistical Manual of Mental Disorders 5-20% of clients in an outpatient mental health setting will receive a diagnosis of Adjustment Disorder (APA, 2013). This makes sense. Coping with stressors can be challenging, exhausting, and destabilizing in nearly every aspect of one’s life and we often need support and new coping skills to navigate the most challenging parts of life.
Adjustment disorder has many variations as follows:
- Adjustment Disorder with Depressed Mood: Clients present with mood challenges, increased tearfulness, or increased hopelessness following the stressor. They may struggle to stay motivated, struggle to enjoy what they used to, and feel more negative about the future as a result of the stressor.
- Adjustment Disorder with Anxiety: Client reports feeling more nervous, more worried, jittery, or may have experience unusual separation anxiety. They may feel an overall sense of impending doom. We are seeing a rise in this presentation.
- Adjustment Disorder with Anxiety and Depressed Mood: Clients report feeling both increased anxiety and mood disturbance following the stressor.
- Adjustment Disorder with Disturbance of Conduct: Client presents with increased behavioral changes, such as more aggressive behavior, substance use, terminating relationships or jobs without enough forethought, or increase in illegal behavior.
- Adjustment Disorder with Mixed Disturbance of Emotions and Conduct: Client reports anxiety, mood, and behavioral disturbances after stressors.
- Adjustment Disorder Unspecified: Clients who do not fit in one of the above categories.
Adjustment Disorders are time limited (6 months in duration, typically). Therefore, if you are impacted by stressors for an extended period of time beyond that, then the symptoms may be better accounted for by another diagnosis at that time. For example, after 6 months, a depressive disorder, other trauma disorder, or anxiety disorder may better explain the continuation of symptoms. However, the treatment goals would remain similar: To help cope with and heal from the impact of the stressor to remit the depression, anxiety, etc.
How common are adjustment disorders? Very. We are seeing more and more clients here at Oakheart who are being impacted by stressors. Per the Diagnostic and Statistical Manual of Mental Disorders 5-20% of clients in an outpatient mental health setting will receive a diagnosis of Adjustment Disorder (APA, 2013). This makes sense. Coping with stressors can be challenging, exhausting, and destabilizing in nearly every aspect of one’s life and we often need support and new coping skills to navigate the most challenging parts of life.
How is Adjustment Disorder Treated?
Luckily, Adjustment Disorder can be treated with psychotherapy. Medication management can also be helpful in combination with therapy. There are a number of evidence-based therapies we provide at Oakheart to address Adjustment Disorder symptoms which include (but are not limited to): Cognitive-Behavioral Therapy (CBT), Cognitive-Processing Therapy (CPT), and Acceptance and Commitment Therapy (ACT). Sometimes an integration of therapies can be helpful, depending on the needs of the client.
Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy (CBT): Cognitive Behavioral Therapy includes many components and is based on the principle that thoughts/beliefs (Cognitions), emotions, physical symptoms, and behaviors are all intricately related. Helping someone feel better in CBT will typically involve changing unhelpful thoughts/beliefs (Cognitions), emotions, and behaviors via a variety of tools such as cognitive restructuring, emotion regulation and distress tolerance skills, mindfulness, behavioral activation, coping skill development, interpersonal effectiveness skill refinement, stressful event processing, etc. CBT is considered an Evidence-Based Practice (EBP)/ an Empirically Supported Treatment and is the gold-standard treatment approach across many client concerns, including Adjustment Disorder. In Adjustment Disorder, the main beliefs targeted for change can involve beliefs regarding the self, others, and the world that tend to reflect inability to cope with the future, loss of worth following a stressor, hopelessness following stressor, and/ or extreme shifts in trusting others or self. Behavioral targets for change tend to involve developing alternative coping skills to substances, isolation, anger management techniques, and identifying solution focused behavior, rather than harmful or destructive behavior.
Cognitive-Processing Therapy (CPT): CPT, a treatment for PTSD, is often utilized for varying trauma disorders, including Adjustment Disorder (which technically falls under the diagnostic umbrella of trauma disorders). CPT first encourages processing of memories of stressful or traumatic experiences, with the goal of processing related natural emotions that the client may be avoiding. CPT also focuses on how emotional responses to stressors impact one’s interpretation or view of the event. This part of therapy targets the content of cognitions, especially cognitive distortions. In an attempt to make sense of stressful experiences, individuals may assimilate, accommodate, or over-accommodate the experience into their world views. Assimilation involves fitting the event into one’s prior held beliefs. For example, if a client believes that good things happen to good people and bad things should happen to bad people, a stressful event may be falsely interpreted as evidence of being a bad person. In other words, in order for the client to maintain their prior beliefs, they may blame themselves and assume they must have been bad in order for this bad thing to happen to them. Therapy would attempt to correct this attempt at assimilation. Over-accommodation is when the individual drastically changes his/her beliefs about the self and the world to achieve control and safety. The goal of therapy is to facilitate accommodation, which consists of changing one’s beliefs enough to integrate the event in a balanced, healthy, and realistic way (Resick, et al., 2008). Treatment focuses on several areas that are thought to be most impacted by stressors and traumatic events: Safety, Trust, Power/Control, Esteem, Intimacy.
Acceptance and Commitment Therapy (ACT): ACT is considered a mindfulness-based Cognitive Behavioral Therapy and one of the goals of ACT is to achieve psychological flexibility. Psychological flexibility is achieved via various key concepts such as Defusion, Expansion, Connection (Mindfulness Principles), Valued Identification, and Committed Action (Behavioral Principles). Defusion refers to the way in which an individual relates to their thoughts. In ACT, the goal is to not "stick" to your thoughts, including painful and distressing thoughts, and to take a more observing approach. Expansion refers to making room for all kinds of emotional and physiological experiences, including unpleasant and distressing ones, as opposed to trying to push them away, avoid them, or run from them. The concept of connection represents being fully present and connected in the moment as opposed to being stuck in the past (e.g., ruminating), or the future (e.g., worrying). Values identification involves working closely with your therapist on clarifying what is most important to you in your life and what gives your life meaning, and then committing (Committed Action) to living your life in a way that is consistent with what you value. ACT typically uses many metaphors as a way to help clients relate to and understand concepts (e.g., the quicksand analogy - stopping the struggle, regardless of how instinctive it is, and trying something different or even opposite).
Our clinicians at OakHeart are proud to offer evidence-based treatment options for depression. Call 630-570-0050 to schedule an appointment today.
Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy (CBT): Cognitive Behavioral Therapy includes many components and is based on the principle that thoughts/beliefs (Cognitions), emotions, physical symptoms, and behaviors are all intricately related. Helping someone feel better in CBT will typically involve changing unhelpful thoughts/beliefs (Cognitions), emotions, and behaviors via a variety of tools such as cognitive restructuring, emotion regulation and distress tolerance skills, mindfulness, behavioral activation, coping skill development, interpersonal effectiveness skill refinement, stressful event processing, etc. CBT is considered an Evidence-Based Practice (EBP)/ an Empirically Supported Treatment and is the gold-standard treatment approach across many client concerns, including Adjustment Disorder. In Adjustment Disorder, the main beliefs targeted for change can involve beliefs regarding the self, others, and the world that tend to reflect inability to cope with the future, loss of worth following a stressor, hopelessness following stressor, and/ or extreme shifts in trusting others or self. Behavioral targets for change tend to involve developing alternative coping skills to substances, isolation, anger management techniques, and identifying solution focused behavior, rather than harmful or destructive behavior.
Cognitive-Processing Therapy (CPT): CPT, a treatment for PTSD, is often utilized for varying trauma disorders, including Adjustment Disorder (which technically falls under the diagnostic umbrella of trauma disorders). CPT first encourages processing of memories of stressful or traumatic experiences, with the goal of processing related natural emotions that the client may be avoiding. CPT also focuses on how emotional responses to stressors impact one’s interpretation or view of the event. This part of therapy targets the content of cognitions, especially cognitive distortions. In an attempt to make sense of stressful experiences, individuals may assimilate, accommodate, or over-accommodate the experience into their world views. Assimilation involves fitting the event into one’s prior held beliefs. For example, if a client believes that good things happen to good people and bad things should happen to bad people, a stressful event may be falsely interpreted as evidence of being a bad person. In other words, in order for the client to maintain their prior beliefs, they may blame themselves and assume they must have been bad in order for this bad thing to happen to them. Therapy would attempt to correct this attempt at assimilation. Over-accommodation is when the individual drastically changes his/her beliefs about the self and the world to achieve control and safety. The goal of therapy is to facilitate accommodation, which consists of changing one’s beliefs enough to integrate the event in a balanced, healthy, and realistic way (Resick, et al., 2008). Treatment focuses on several areas that are thought to be most impacted by stressors and traumatic events: Safety, Trust, Power/Control, Esteem, Intimacy.
Acceptance and Commitment Therapy (ACT): ACT is considered a mindfulness-based Cognitive Behavioral Therapy and one of the goals of ACT is to achieve psychological flexibility. Psychological flexibility is achieved via various key concepts such as Defusion, Expansion, Connection (Mindfulness Principles), Valued Identification, and Committed Action (Behavioral Principles). Defusion refers to the way in which an individual relates to their thoughts. In ACT, the goal is to not "stick" to your thoughts, including painful and distressing thoughts, and to take a more observing approach. Expansion refers to making room for all kinds of emotional and physiological experiences, including unpleasant and distressing ones, as opposed to trying to push them away, avoid them, or run from them. The concept of connection represents being fully present and connected in the moment as opposed to being stuck in the past (e.g., ruminating), or the future (e.g., worrying). Values identification involves working closely with your therapist on clarifying what is most important to you in your life and what gives your life meaning, and then committing (Committed Action) to living your life in a way that is consistent with what you value. ACT typically uses many metaphors as a way to help clients relate to and understand concepts (e.g., the quicksand analogy - stopping the struggle, regardless of how instinctive it is, and trying something different or even opposite).
Our clinicians at OakHeart are proud to offer evidence-based treatment options for depression. Call 630-570-0050 to schedule an appointment today.
OakHeart Adjustment Disorder Counselors, Psychologists, and Social Workers
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD. The Guilford Press.
