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Psychotherapie bei Menschen mit Intelligenzminderung

Theoretischer Hintergrund und praktische Umsetzung

Psychotherapy in intellectual disability

Theoretical background and implementation

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Zusammenfassung

Hintergrund

Jeder dritte Mensch mit Intelligenzminderung (IM) leidet zusätzlich an einer psychischen Störung, u. a. an spezifischen Phobien. Es ist unklar, ob die in der Normalbevölkerung wirksamen psychotherapeutischen Verfahren auch bei Menschen mit IM anwendbar sind.

Patienten und Methoden

Wir geben einen Überblick über die historische Entwicklung und den aktuellen Kenntnisstand zur Psychotherapie insbesondere von phobischen Störungen bei Menschen mit IM. Anhand eines Fallbeispiels wird überprüft, wie sich in der Literatur beschriebene Therapieempfehlungen in der Praxis bewähren.

Ergebnisse

Auch bei Menschen mit IM ist die Konfrontation mit dem angstauslösenden Reiz die Basis der verhaltenstherapeutischen Behandlung. Dennoch sind in der Behandlungsstrategie einige Modifikatoren zu beachten, um den spezifischen Besonderheiten dieser Menschen gerecht zu werden. Neben allgemeinen Grundregeln wie einfacher Sprache und anschaulichem Arbeitsmaterial erwiesen sich einige Behandlungselemente als besonders wirkungsvoll, z. B. gestufte In-vivo-Exposition, Einbeziehung des sozialen Umfelds, Kontingenzmanagement und Coping-Strategien.

Schlussfolgerung

Spezifische Phobien sind auch bei Menschen mit IM verhaltenstherapeutisch behandelbar. Dabei sind die speziellen Bedürfnisse dieser Menschen zu berücksichtigen.

Summary

Background

Every third person with intellectual disability suffers from additional mental health problems, among others phobic disorders. Yet we do not know whether psychotherapeutic methods that are effective in the normal population are applicable to people with intellectual disabilities.

Patients and methods

We give a survey of the development and the present state of the art of psychotherapy, particularly with regard to phobic disorders in intellectual disability. Therapeutic recommendations described in the literature will be evaluated in a case study of one patient.

Results

The confrontation with the phobic stimulus is the basis of behavior therapy for people with intellectual disability as well. However, with respect to the special needs of these people, some modifications need to be considered in the treatment strategy. In addition to some general rules like simple language or the use of visual materials, some techniques of intervention turned out to be particularly effective, e.g., graduated in vivo exposure, involving significant others, contingency management, and coping strategies.

Conclusion

Specific phobias in intellectual disability can be treated with behavior therapy as well. However, the special needs of these people need to be considered.

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Danksagung

Wir danken Frau Liane Schemmel (examinierte Krankenschwester) für ihre aktive Begleitung und Unterstützung während der Expositionsstunden und Herrn Jorka Schweitzer (http://www.sozialehunde.de) für die Bereitstellung und Anleitung der Therapiehunde. Darüber hinaus danken wir Herrn Dr. Hübner für die Überarbeitung der englischen Zusammenfassung.

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  1. Behandlungszentrum für psychisch kranke Erwachsene mit geistiger Behinderung, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik , Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Deutschland

    T. Sappok, T. Voß, E. Millauer, C. Schade & A. Diefenbacher

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  1. T. Sappok
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  2. T. Voß
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  3. E. Millauer
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Correspondence to T. Sappok.

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Sappok, T., Voß, T., Millauer, E. et al. Psychotherapie bei Menschen mit Intelligenzminderung. Nervenarzt 81, 827–836 (2010). https://doi.org/10.1007/s00115-009-2917-8

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