Until "divorce" do us part: A mixed-method study of the experience and treatment of adjustment disorder stemming from romantic partner betrayal

Although mounting evidence indicates that some individuals betrayed by a romantic partner may develop an adjustment disorder, a trauma-and stressor-related disorder characterized by intrusions, avoidance, and failure to adapt, there currently exists no systematic individualized treatment. Considering trauma-and stressor-related disorders as etiologically rooted in the emotional memory of a distressing life event, reducing the salience of this memory may provide a positive therapeutic outcome. Pre-clinical evidence has demonstrated that administering propranolol, a noradrenergic beta-blocker, prior to the reactivation of an emotional memory can interfere with its reconsolidation, i.e., the restabilization of memory to long-term storage. In clinical populations with posttraumatic stress disorder, this procedure, referred to as reconsolidation therapy, attenuates symptoms of traumatic stress. However, no research to date has investigated whether reconsolidation therapy can be extended to other stressor-related disorders. The first two manuscripts of this dissertation present the rationale, methods, and results of a clinical trial aimed at investigating the effectiveness of reconsolidation therapy to treat adjustment disorders stemming from romantic partner betrayal. Results from ANCOVAs revealed that compared to a no-treatment waitlist control condition (n = 29), reconsolidation therapy (n = 30) produced a significant reduction in event-related stress symptoms, including intrusions, avoidance, and increased vigilance, as well as general psychological distress, including symptoms of depression and anxiety, as measured with the Impact of Event Scale-Revised and the Hopkins Symptom Checklist-25, respectively. The final manuscript presents a qualitative investigation of the meaning and experience of romantic betrayal among individuals with an adjustment disorder. Thirteen participants who completed the larger trial were interviewed using the McGill Illness Narrative Interview. Findings revealed that romantically betrayed individuals often use the trauma metaphors and prototypes to make sense of their experience with betrayal. Yet almost all participants did not identify their reaction as traumatic stress and were hesitant to use that idiom. However, framing the experience of betrayal as an emotional memory of the event, that can be attenuated, provided participants with a plausible framework for explaining their symptoms, as well as a treatment solution, which led to a sense of validation and relief. This thesis is the first to investigate the broader application of reconsolidation therapy to treat psychiatric disturbances rooted in a painful life-experience.

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