A cognitive behavioral model for Adjustment Disorder: Conceptualization, empirical evidence and clinical implications
(2025) Annales médico-psychologiques — p. 1-7 (2025)
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- (en) Introduction and background.-Adjustment Disorder (AjD) is a highly prevalent mental health condition, currently ranked as the 11th most commonly used diagnosis. Prevalence rates vary by population, ranging from 12.4% in oncology aftercare to 27.3% among individuals experiencing involuntary job loss. AjD is also linked to increased suicide risk, underlining the need for targeted clinical interventions. Despite its prevalence, AjD has long been understudied and often confused with normal stress reactions or other disorders like depression and anxiety. The ICD-11 has provided a clearer diagnostic framework, identifying two main symptom clusters: (1) preoccupation with the stressor and (2) failure to adapt. The development of the International Adjustment Disorder Questionnaire has improved diagnosis, but theoretical models to guide interventions remain limited. Previous conceptualizations.-Earlier models of AjD were based on PTSD theories, assuming AjD shared similar symptomatology, though less intense. These models emphasized intrusive memories, avoidance, and negative appraisals. However, newer approaches have shifted focus. Eberle and Maercker proposed that preoccupations, persistent, stressor-related thoughts, are central to AjD, though they did not provide concrete clinical applications. Empirical findings have since supported this shift, highlighting the need for a model grounded in cognitive-behavioral therapy (CBT). Proposed CBT-based model for AjD.-This paper presents a preliminary CBT conceptualization of AjD, which incorporates empirical findings and aims to guide therapeutic intervention. The model identifies six core components: (1) nature of the event-includes the event's severity, duration, and consequences, (2) predisposing factors-environmental, psychological, and demographic vulnerabilities, (3) preoccupation with the event-negative, repetitive thoughts linked to maladaptive appraisals, (4) emotional response-emotions like sadness, fear, guilt, and hopelessness triggered by appraisal, (5) experiential avoidance-strategies such as distraction, rumination, or substance use aimed at avoiding the event or its consequences, (6) failure to adapt-impairment in daily functioning, such as sleep, work, or concentration. The model posits that a stressful event, combined with predisposing vulnerabilities, leads to negative appraisals. These appraisals trigger emotional distress and preoccupations. Avoidance strategies reinforce these thoughts and emotions, leading to functional impairments, which in turn reinforce the cycle. Clinical illustration.-The case of Victor, a 40-year-old man who experienced a disabling car accident, illustrates the model. Victor's preoccupations about his lost job and role as a father, combined with emotional struggles and avoidance, led to impaired functioning, despite not meeting criteria for PTSD or major depression. This supports the specificity and relevance of the AjD model. Empirical support for model components.-Empirical studies support the model's components: (1) nature of event: job-and health-related stressors are strongly linked to AjD, (2) predisposing factors:
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Vancappel, A., & Leroy, A. (2025). A cognitive behavioral model for Adjustment Disorder: Conceptualization, empirical evidence and clinical implications. Annales médico-psychologiques, 1-7. https://doi.org/10.1016/j.amp.2025.06.004 (Original work published 2025)