Related Case Studies
Adjustment Disorder Case Study: Helping a High School Teacher with Life Stress
Patient Information
- Age: 34
- Gender: Female
- Background: High school English teacher, recently divorced, residing in a medium-sized town in Nasik.
History or Cause
Aditi (name changed due to confidentiality), 34, a secondary school teacher, began experiencing intense emotional anguish after a series of life incidents within a short span of time. In the course of six months, she divorced her tormented spouse legally, had to vacate her residence, and transitioned to an administrative position at work. At the same time, her father also had a stroke that demanded full-time care and necessitated her finding various providers for care management.
Prior to this, Aditi had always been a peace-loving and gentle person with a love for literature and viewed herself as a caring teacher. Her classroom was a 'haven' for both of them. The early fall semester had commenced, and her coworkers had already begun noticing some changes; her attendance was not regular, she would arrive late, and there was an apparent decline in her emotional well-being. She cried at lunchtime, lost her place in her classes, and limited her interactions with other staff and friends.
What began as anxiety and stress became something different for Aditi. She was bingeing, not sleeping, and experiencing symptoms that were akin to panic attacks at staff meetings. Aditi started attending therapy sessions in spite of her resistance after she told her mom that "every day feels like I am trying to swim with cement shoes that are dragging me down."
Diagnosis
Aditi was assessed by a board-certified clinical psychologist who conducted a thorough intake that included a mental status examination, clinical interviews, and standardized psychological tests.
Diagnostic Tool Utilized:
- Adjustment Disorder New Module (ADNM-20)
- Beck Depression Inventory (BDI)
- GAD-7 (anxiety)
- Sleep Quality Assessment Scale
Results:
ADNM-20 showed clinically significant distress in relation to current stressors (divorce, caregiving duties, new job responsibilities).
BDI indicated mild to moderate depressive symptoms
GAD-7 indicated moderate anxiety
The sleep scale indicated chronic insomnia
Final Diagnosis
Adjustment Disorder with Mixed Anxiety and Depressed Mood (according to the DSM-5 diagnostic criteria).
The diagnosis is an acknowledgment of being unable to deal with an abundance of changes in life throughout the span of time. It is not an indication of a major depressive disorder or generalised anxiety disorder, but an overreaction within a period of being overwhelmed by an overload of external stresses.
Treatment
The intervention strategy sought to re-establish the feeling of power and emotional balance of Aditi through the integration of cognitive-behavioural therapies, mindfulness, and reorganisation of social supports. The therapy did not seek to eliminate the stressors but to establish her resilience and coping skills.
Program:
1. Psychoeducation:
- Educated Aditi about her adjustment disorder, how it is time-limited, the mechanisms of operation, and its distinction from major psychiatric illnesses.
- This had a participatory outcome of reducing her self-stigma and creating hope, as Aditi stated, "I’m not broken. I’m overwhelmed, and that’s okay."
2. Cognitive Behavioural Therapy (CBT):
- Weekly meetings with a licensed psychologist on a one-on-one basis.
- The focus was on identifying unhelpful thinking styles like catastrophising ("I am failing at everything") and moving to a more balanced and grounded belief system.
- Structured journaling was introduced to find and track thoughts, feelings, and behavioural responses.
3. Stress Inoculation Training (SIT):
- Aditi was paced through progressive exposure to stress-inducing situations under controlled exposure.
- She practised (and was supported with feedback) response strategies (e.g., breathing strategies, reframing, progressive muscle relaxation).
4. Mindfulness-Based Stress Reduction (MBSR):
- Enrolled in an 8-week MBSR group course.
- Learnt body scans, meditation, and non-judgmental awareness.
- Practised 10-minute mindfulness sessions every morning and evening.
5. Behavioural Activation:
- Re-introduced activities that she enjoyed back into her routine (e.g., reading novels, walking her dog, gardening).
- Planned a weekly social time with friends or family to help reduce isolation.
6. Family Counselling:
- Monthly joint meetings with her mother to set boundaries for caregiving and clarify responsibilities for Erica's father.
7. Pharmacological Intervention (optional):
- After collaboration with a psychiatrist, Aditi began a low-dose SSRI (sertraline, 25mg) to help with anxiety and sleep.
- She was monitored biweekly for side effects and to adjust dosages.
Therapy:
CBT in Practice:
- Aditi identified core beliefs about perfectionism and having too much responsibility.
- Reframed some of the thoughts like, "If I am not holding it together, I am a failure," to "It's ok to ask for help."
- She was given homework assignments like role-playing stressful conversations (e.g., asking her principal if she could delegate some of the paperwork).
Mindfulness Sessions:
- Aditi was sceptical at first, but would later call them "a mental shower".
- She learnt to sit with discomfort rather than act immediately or suppress her feelings.
- It was instrumental in helping her regulate emotional spikes, especially anxiety before her monthly school meetings or panic as soon as she woke up.
Group Therapy Participation:
- Aditi participated in a support group for carers and professionals experiencing burnout.
- She found a community of other stressed-out professionals (educators, daughters, and divorcées).
Improvements/Recovery Timeline:
Week 1-2:
- Started therapy, started medication.
- Slight improvement in sleep quality.
- She started using thought logs and stress diaries.
Week 3-4:
- Mood fluctuations began to stabilise.
- She reported no longer having as many mid-workday breakdowns.
- She successfully asked for reduced administrative work at school.
Week 5-6:
- More self-confidence, reconnected to two of her best friends, and
- reported her first uninterrupted sleep for months!
- Went on a lovely weekend road trip with her sister.
Week 7-8:
- Improvement in both mood and functioning overall
- Began to engage in group therapy more
- Resumed the hobby of creative writing; had written two short stories
Month 3:
- Completed a taper of sertraline, with the psychiatrist overseeing the process
- had mild rebound anxiety and continued to access mindfulness tools without incident
- She was able to attend her father's specialist appointment without having an emotional breakdown.
Months 4-6:
- Returned to full-time teaching with excitement
- Began to mentor a younger teacher in her school district
- Wrote a local magazine op-ed about teacher burnout prevention strategies
- She described herself as "Not only survived, but I started to grow!"
Jagruti Rehab Treatment’s Impact on Erica’s Life:
Erica's recovery was progressive and durable. By recognising the cause of her distress and developing new mental strategies, she regained awareness of her emotions and ability to respond to her routine. She no longer saw herself in terms of someone “not coping” because she was an admirable woman responding gracefully in extraordinary circumstances.
Her empowered agency was restored. She now occupies her employment, her familial responsibilities, and her greatest responsibilities to herself with reason as opposed to an expectation of perfection. Her creative spark returned, and she continues to send out short stories to literary journals.
Family and Community Impact:
Erica's improved mental health raised the emotional tone of her family. Her mother noted that, as she had breached her caregiving responsibilities to a point of overload, she now distinctly found herself in a connected and supported place. In a more involved way, Aditi identified and expressed boundaries and created a shared calendar of obligations and appointments to maintain a lower count of last-minute situations.
At work, her colleagues identified and reacted. She became the advocate for staff wellness, successfully lobbying colleagues for a biannual mental health awareness workshop with participation from teachers across the region. Students reported that “Ms E” had returned to her animated, storytelling self while educating specifically in English, leaving joy and energy in the classroom.
The Final Thought
This Adjustment Disorder case study has reminded us that mental health difficulties are not only determined by a catastrophic event or a chemical imbalance within the brain. At times, life occurs on its terms at a pace, with costs and expectations that are unfathomable.
Adjustment Disorder is commonly regarded as "just stress", but, as demonstrated in Erica's case, it can obliterate a life if left untreated. The good news is that if the right tools are employed and prioritising interventions, and someone has the bravery to seek help, people can recover from adjustment disorder more resiliently and wisely.
Aditi did not erase stress. She learnt to dance.
And perhaps THAT is the biggest indicator of post-traumatic growth.
Dr. Amar Shinde, founder of Jagruti Rehab, is a renowned psychiatrist in India with over two decades of experience in mental health, addiction recovery, and neuropsychiatry, dedicated to holistic, compassionate patient care.