Building Psychological Flexibility to Mitigate Adjustment Disorder

Abstract

Clients who present to psychotherapy reporting diffuse and/or sub-clinical concerns may provide a puzzling treatment decision for providers of evidence-based practice. The current case study illustrates the implementation of an evidence-based treatment, Acceptance and Commitment Therapy (ACT), for a client diagnosed with adjustment disorder with mixed anxiety and depressive symptoms. ACT targets a dimensional, transdiagnostic construct known as psychological flexibility, currently conceptualized as involving six inter-related behavioral repertoires. The client was a Caucasian woman in her 30s who self-referred to therapy. She reported feeling anxious and depressed, especially in regard to interpersonal difficulties with her mother and her ex-husband. Fourteen sessions of an ACT protocol emphasizing a modular approach to the repertoires emphasized by the psychological flexibility model were provided. Each modular session consisted of psychoeducation, metaphors, experiential exercises, and daily practice assignments for one of the repertoires. The client completed pre-treatment, post-treatment, and 6-month follow-up outcome measures and weekly process measures to track change throughout treatment. One process measure assessed each of the six repertoires. The client’s data revealed substantial increases in psychological flexibility and decreases in psychological distress from pre- to post-treatment, which remained stable at follow-up. This case report suggests that ACT may be a desirable treatment option for clients bearing ambiguous or sub-clinical presentations, including interpersonal conflicts. The report also provides a model for monitoring change with individual psychological flexibility repertoires with respect to a modular approach to teaching those repertoires.