Self-help interventions for adjustment disorder problems: a randomized waiting-list controlled study in a sample of burglary victims

Abstract

Adjustment disorders (AjD) are among the most frequent mental disorders yet often remain untreated. The high prevalence, comparatively mild symptom impairment, and transient nature make AjD a promising target for low-threshold self-help interventions. Bibliotherapy represents a potential treatment for AjD problems. This study investigates the effectiveness of a cognitive behavioral self-help manual specifically directed at alleviating AjD symptoms in a homogenous sample of burglary victims. Participants with clinical or subclinical AjD symptoms following experience of burglary were randomized to an intervention group (n = 30) or waiting-list control group (n = 24). The new explicit stress response syndrome model for diagnosing AjD was applied. Participants received no therapist support and assessments took place at baseline, after the one-month intervention, and at three-month follow-up. Based on completer analyses, group by time interactions indicated that the intervention group showed more improvement in AjD symptoms of preoccupation and in post-traumatic stress symptoms. Post-intervention between-group effect sizes ranged from Cohen's d = .17 to .67 and the proportion of participants showing reliable change was consistently higher in the intervention group than in the control group. Engagement with the self-help manual was high: 87% of participants had worked through at least half the manual. This is the first published RCT of a bibliotherapeutic self-help intervention for AjD problems. The findings provide evidence that a low-threshold self-help intervention without therapist contact is a feasible and effective treatment for symptoms of AjD.

A scoping review of ICD-11 adjustment disorder research

“…The stressor list of the ADNM was used in nine reviewed studies. However, the number of stressors in the first part of the ADNM ranged considerably across different studies: 10 stressors (Bachem & Maercker, 2016; Bachem, Perkonigg, Stein, & Maercker, 2016), 13 stressors (Horn & Maercker, 2016), 15 stressors (Zelviene, Kazlauskas, Eimontas, & Maercker, 2017), 16 stressors (Glaesmer, Romppel, Brähler, Hinz, & Maercker, 2015), 17 stressors (Eimontas et al, 2017), and 19 stressors (Lorenz, Bachem, & Maercker, 2016). …”

“…Three studies reported outcomes of cognitive behavioural (CBT) self-help interventions for ICD-11 AjD (Bachem & Maercker, 2016; Kazlauskas, Zelviene, & Eimontas, 2017; Maercker et al, 2015). One of the reviewed studies included a sample of patients in psychopharmacological treatment (Bachem et al, 2016).…”

“…A group at the University of Zurich developed a self-help printed manual for burglary victims which could be delivered without therapist support (Bachem & Maercker, 2016; Maercker et al, 2015). This low-intensity intervention has a specific focus on the ICD-11 AjD core symptoms: preoccupation and failure to adapt.…”

“…A case study indicated feasibility of this approach with a significant decline of AjD symptoms at the three-month follow-up (Maercker et al, 2015). A waiting list RCT study with three-month follow-up (intervention group n  = 30, waiting list n  = 25) revealed promising findings, with between-group effect size of d  = 0.67 for preoccupation, and d  = 0.34 for failure to adapt symptoms (Bachem & Maercker, 2016). The authors of the intervention proposed that an e-health self-help approach might be suitable for an AjD (Maercker et al, 2015).…”

“…After the ICD-11 proposals (Maercker et al, 2013), there is still very limited data available on treatment of ICD-11 AjD. Two RCT studies indicated promising effects of the specialized CBT-based self-help interventions targeted towards symptoms of ICD-11 AjD (Bachem & Maercker, 2016; Eimontas et al, 2017). An internet-delivered approach might be suitable for treatment of AjD (Eimontas et al, 2017; Maercker et al, 2015).…”