"Learning to Be Brave": Cognitive-Behavioral Therapy in a Case with Severe Anxiety, Developmental Disorder and Intellectual Disabilities

Abstract

Objectives: Psychotherapy in children and adolescents with intellectual disabilities is hampered by a variety of barriers. Case Description: This case illustrates the successful cognitive-behavioral therapy (CBT) in a 10-yearold girl with anxiety, developmental disorder and intellectual disabilities. Severe anxiety symptoms and behavioral problems manifested after a medically inevitable examination. Because of a known epilepsy, administration of exposure-based techniques was questionable. The CBT comprised 64 therapy sessions. Interventions on selfmonitoring, introducing the treatment rationale and anxiety coping were oriented towards observable behaviors rather than towards self-reflection. Sessions were first conducted at the patient's home, including involvement of family members. With increasing maturation of the patient, cognitive techniques were applied as well. After 38 sessions, the patient was able to manage anxiety-provoking situations without avoidance behaviors, according to her developmental age. A medical examination, similar to the situation of anxiety onset, was trained in advance and was then successfully managed. Finally, competences of daily living have substantially increased. Conclusions: Only minor adaptations to the treatment setting and techniques were needed, as compared to treatments in cases with similar anxiety but without intellectual disabilities. Here, psychotherapy most likely prevented the escalation of problem behaviors in the long term. Dealing with "being different"due to intellectual disabilities and limited competences in daily living implies developmental risks and chances, which both can be successfully mastered with psychotherapeutic support.