Cognitive behaviour therapy with a woman in her twenties with a mild intellectual disability presenting with psychogenic non‐epileptic seizures

Abstract

Purpose -This case report aims to describe the treatment of a woman (Rachel) in her twenties who was referred to the community team for people with an intellectual disability by her neurologist as she wanted help with reducing the frequency of psychogenic non-epileptic seizures (PNES). Design/methodology/approach -CBT was used as the therapeutic approach. The first stage of intervention focussed on reducing the frequency of PNES through relaxation and distraction techniques. Graded exposure was then used to enable Rachel to achieve her goal of going on the bus alone. The intervention process was completed over 12 sessions. Findings -Outcome was measured using self-report of seizure frequency. Rachel has successfully reduced the frequency of PNES from seven to two-three per week, and has managed to successfully complete several bus journeys on her own, working through the hierarchy the authors had developed. The authors also completed pre and post therapy measures for anxiety and depression. Her scores on the Glasgow Anxiety Scale for Intellectual Disability reduced from 23 to 19 whilst she scored sub-clinically on the Glasgow Depression Scale for Intellectual Disability. Originality/value -This case report seeks to add to the evidence base of CBT as a viable treatment for PNES whilst also demonstrating that the approach can be adapted to meet the needs of clients with intellectual disabilities.

A review of the frequency and nature of adaptations to cognitive behavioural therapy for adults with Intellectual Disabilities

“…Consideration of developmental level was reported in 15 out of 23 studies. Studies included information on adaptive skills (Atnas & Lippold, ), receptive language ability (Rose, O'Brien, & Rose, ) and assessment of the cognitive skills necessary to undertake CBT (Bishop & Henry, ). Studies considered developmental level when selecting outcome measures.…”

“…Using the clients own language was reported by Kirkland (). Studies also reported simplification of written and verbal language, for example by using accessible information sheets (Atnas & Lippold, ; Wright, ) and reducing the need for written psycho‐educational materials (Kellett et al., ). Studies also noted the need for specific questions at times (Hurley, ), as well as the need for simple words and short sentences (Willner & Goodey, ).…”

“…People with intellectual disabilities are a heterogeneous group in terms of ability and it is reasonable to expect that this might result in a degree of heterogeneity in reported adaptations. Indeed, some studies reported that clients had good levels of functioning and understanding and so techniques did not require much adaptation (Atnas & Lippold, ). It is also important to consider the likelihood that studies used adaptations that were not reported.…”

Cognitive behavioural therapy for psychogenic non-epileptic seizures in the context of mild intellectual disability: a case study

“…To the authors' knowledge, there is only one published case study describing the use of CBT to treat PNES in an individual with ID (Atnas and Lippold, 2013). Atnas and Lippold based their intervention on the CBT treatment protocol for PNES outlined by Goldstein et al (2004), with the client experiencing a reduction in the number of seizures by the end of the treatment.…”

“…At present, there is no literature describing the delivery of a CBT-based intervention adapted for individuals with ID that involves caregivers in the treatment of PNES. It will also describe an adapted approach to the cognitive restructuring element of Goldstein et al's (2004) protocol, not included in Atnas and Lippold's (2013) case report. Given the success of CBT to treat PNES in the general population, it is important to further develop the literature describing how evidence-based treatment protocols for PNES can be adapted for individuals with ID and to help provide a framework to approach treatment in this significant population of patients presenting with PNES.…”