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.

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).

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.

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 studies support the model's components: (1) nature of event: job- and health-related stressors are strongly linked to AjD, (2) predisposing factors: risk factors include being female, unemployed, young, having low income/support, or a history of mental illness; (3) preoccupations: four types have been identified, related to Negative Views of Self and Future, Indignation, Perceived Change, and Injustice and Incomprehensibility; measured using the Event-focused Repetitive Thoughts Questionnaire (ERTQ); (4) experiential avoidance: denial and disengagement worsen symptoms, while acceptance and cognitive reappraisal are protective; (5) failure to adapt: associated with disrupted routines and lower psychological functioning.

This CBT model informs the development of Adjustment-Focused CBT (AF-CBT), which includes: (1) restructuring preoccupations – using cognitive restructuring to challenge negative thoughts, address guilt, and promote hope, (2) developing acceptance – techniques such as writing an “acceptance letter” to the event help patients face the reality of the stressor and reduce avoidance, (3) increasing adaptation – problem-solving strategies and motivational tools encourage functional adaptation and reduce emotional burden. These interventions draw on evidence-based CBT techniques and align with core principles originally developed for depression treatment.

This model enhances prior conceptualizations by introducing predisposing factors and experiential avoidance as core mechanisms. It also operationalizes preoccupations through a validated assessment tool and integrates CBT strategies, offering a clear clinical application.

While promising, the model is still preliminary. Most supporting studies are cross-sectional or qualitative, and causal relationships remain to be empirically tested. The model currently focuses on a single-event framework and would benefit from expansion to multi-event or crisis contexts.

This paper presents a preliminary cognitive-behavioral model of AjD, centered on preoccupation, experiential avoidance, and failure to adapt. The model not only deepens theoretical understanding but also provides structured therapeutic guidance. Future clinical trials are essential to test and refine this model, with the goal of developing effective, evidence-based treatments for individuals suffering from Adjustment Disorder.

Le trouble de l’adaptation est une condition largement répandue mais sous-étudiée depuis des décennies, bien qu’il soit associé à un risque élevé de suicide. Il se caractérise par des réactions émotionnelles anormales après un événement stressant (par exemple, un divorce, une maladie, un licenciement). Il existe actuellement un manque de conceptualisation théorique du trouble de l’adaptation. Pour combler cette lacune, nous proposons un modèle cognitivo-comportemental du trouble de l’adaptation. Nous suggérons que la nature de l’événement stressant et les facteurs prédisposants contribuent à des préoccupations initiales liées à cet événement. Ces préoccupations peuvent déclencher une réaction émotionnelle. Les patients peuvent alors s’engager dans un évitement expérientiel de ces expériences, refusant de reconnaître l’existence de l’événement. Cette stratégie maintient les préoccupations et conduit à un échec de l’adaptation. Nous présentons ensuite des preuves empiriques soutenant ce modèle. Sur la base de cette conceptualisation, nous proposons trois interventions thérapeutiques clés : (1) cibler les préoccupations à l’aide de techniques de restructuration cognitive, (2) traiter l’évitement expérientiel par l’écriture d’une lettre d’acceptation, et (3) remédier à l’échec d’adaptation en utilisant des approches motivationnelles et de résolution de problèmes.