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.
Literatur
Bailey NM, Andrews TM (2003) Diagnostic criteria for psychiatric disorders for use with adults with leaning disabilities/mental retardation (D-LD) and the diagnosis of anxiety disorders: a review. J Intellect Disabil Res 47(1):50–61
Bandelow B (1997) Panik- und Agoraphobie-Skala (PAS). Hogrefe, Göttingen
Beail N (1998) Psychoanalytic psychotherapy with men with intellectual disabilities: a preliminary outcome study. Br J Med Psychol 71:1–11
Beail N (2003) What works for people with mental retardation? Critical commentary on cognitive-behavioral and psychodynamic psychotherapy research. Ment Retard 41(6):468–472
Beail N (2005) Evidence base for behavioural Interventions: Critical commentary. Ment Retard 43:442–445
Chambless DL, Baker MJ, Baucom DH et al (1998) Update on empirically validated therapies, II. Clin Psychol 51:3–16
Chidester L, Menninger KA (1936) The application of psychoanalytic methods to the study of mental retardation. Am J Orthopsychiatry 6:616–625
Cooper SA, Smiley E, Morrison J et al (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry 190:27–35
Deb S, Thomas M, Bright C (2001) Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. J Intellect Disabil Res 45(6):495–505
Didden R, Duker PC, Korzilius H (1997) Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation. Am J Ment Retard 101(4):387–399
Didden R, Korzilius H, Oorsouw W, Sturmey P (2006) Behavioral treatment of challenging behaviors in individuals with mild mental retardation: Meta-analysis of single-subject research. Am J Ment Ret 4:290–298
Dorn TA, Prout HT (1993) Service delivery pattern for adults with mild mental retardation at community mental health centers. Ment Retard 31:292–296
Emerson E (2003) Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. J Intellect Disabil Res 47:51–58
Gaudette G, Boisvert JM, Sabourin G (1983) Treatment of phobia of medical equipment in a mentally retarded patient with Hodgkin’s disease. Union Med Can 112:164–166
Grawe K, Donati R, Bernauer F (1994) Psychotherapie im Wandel. Von der Konfession zur Profession. Hogrefe, Göttingen
Hagopian LP, Crockett JL, Keeney KM (2001) Multicomponent treatment for blood-injury-injection phobia in a young man with mental retardation. Res Dev Dis 21:141–149
Hamilton Anxiety Scale (HAMA) (2005) In: Collegium Internationale Psychiatriae Scalarum. 5. Aufl
Hamilton Depression Scale (HAMD) (2005) Collegium Internationale Psychiatriae Scalarum. 5. Aufl
Herzinger CV, Campbell JM (2007) Comparing functional assessment methodologies: A quantitative synthesis. J Autism Dev Disord 37:1430–1445
Hurley A (1989) Individual psychotherapy with mentally retarded individuals: A review and call for research. Res Dev Disabil 10:261–275
Hurley AD (2005) Psychotherapy is an essential tool in the treatment of psychiatric disorders for people with mental retardation. Ment Retard 43:445–448
International Classification of Functioning, Disability, and Health (ICF) der WHO (2001) http://www.who.int/classifications/icf/en/
Jennett HK, Hagopian LP (2008) Identifying empirically supported treatments for phobic avoidance in individuals with intellectual disabilities. Behav Ther 39(2):151–161
Kazdin AE, Wilcoxon LA (1976) Systematic desensitization and nonspecific treatment effects: a methodological evaluation. Psychol Bull 83:729–758
Kessler RC, Aguilar-Gaxiola S, Alonso J et al (2009) The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 18:23–33
King R (2005) Proceeding with compassion while awaiting the evidence: Psychotherapy and Individuals with mental retardation. Ment Retard 43:448–450
Klinkhammer G (2009) Zeit zum Hinhören, Hinschauen, und Mitfühlen. Medizinische Versorgung von Menschen mit schwerer geistiger Behinderung. Dtsch Ärztebl 106(8):288–291
Kwok H, Cheung PW (2007) Co-morbidity of psychiatric disorder and medical illness in people with intellectual disabilities. Curr Opin Psychiatry 20:443–449
Leitenberg H, Callahan EJ (1973) Reinforced practice and reduction of different kinds of fears in adults and children. Behav Res Ther 11:19–30
Leitlinien der DGPPN, siehe dazu: http://media.dgppn.de
Lennox DB, Miltenberger RG, Spengler P, Erfanian N (1988) Decelerative treatment practices with persons who have mental retardation: a review of five years of the literature. Am J Ment Retard 92:492–501
Liebeck H (1991) New elements in behavior therapy of a case of dog phobia in an adolescent patient with Down’s syndrome. A critical study of the method. Prax Kinderpsychol Kinderpsychiatr 40:289–292
Lindsay WR, Michie AM, Baty FJ et al (1994) The consistency of reports about feelings and emotions from people with intellectual disability. J Intellect Disabil Res 38:61–66
Lott GM (1966) Psychotherapy of the mentally retarded. JAMA 196(3):139–142
Luiselli JK (1977) Case report: an attendant-administered contingency management programme for the treatment of a toileting phobia. J Ment Defic Res 21:283–288
Lynch C (2004) Psychotherapy for persons with mental retardation. Ment Retard 42:399–405
Martorell A, Tsakanikos E, Pereda A et al (2009) Mental health in adults with mild and moderate intellectual disabilities: the role of recent life events and traumatic experiences across the life span. J Nerv Ment Dis 197(3):182–186
Matson JL (1981) A controlled outcome study of phobias in mentally retarded adults. Behav Res Ther 9:101–107
Meyer EA, Hagopian LP, Paclawskyj TR (1999) A function-based treatment for school refusal behavior using shaping and fading. Res Dev Dis 20(6):401–410
Mindham J, Espie CA (2003) Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability. J Intellect Disabil Res 47:22–30
Neham S (1951) Psychotherapy in relation to mental deficiency. Am J Ment Defic 55:557–572
Nota L, Soresi S, Perry J (2006) Quality of life in adults with an intellectual disability: the evaluation of quality of life instrument. J Intellect Disabil Res 50:371–385
Ost LG (1987) Applied relaxation: description of a coping technique and review of controlled studies. Behav Res Ther 25:397–409
Peck CL (1977) Desensitization for the treatment of fear in the high level adult retardate. Behav Res Ther 15:137–148
Prout HT, Nowak-Drabik KM (2003) Psychotherapy with persons who have mental retardation: an evaluation of effectiveness. Am J Ment Retard 108(2):82–93
Ricciardi JN, Luiselli JK, Camare M (2006) Shaping approach responses as intervention for specific phobia in a child with autism. J Appl Behav Anal 39:445–448
Runyan MC, Stevens DH, Reeves R (1985) Reduction of avoidance behavior of institutionalized mentally retarded adults through contact desensitization. Am J Ment Defic 90:222–225
Spencer CR, Conrad PL (1989) Treatment of acrophobia of an institutionalized adult with mental retardation. Ment Retard 27:1–4
Stavrakaki C, Lunsky Y (2007) Depression, anxiety and adjustment disorders in people with intellectual disabilities. In: Bouras N, Holt G (eds) Psychiatric and Behavioural Disorders in Intellectual and Developmental Disabilities. Cambridge Univ Press, Cambridge, pp 113–130
Stenfert-Kroese B (1997) Cognitive-behaviour therapy for people with learning disabilities: conceptual and contextual issues. In: Stenfert-Kroese B, Dagnan D, Loumidis K (eds) Cognitive-behavioral therapy for people with lerning disabilites. Routledge, London, pp 1–15
Sturmey P (2005) Against psychotherapy with people who have mental retardation. Mental Retard 43:55–57
Taylor JL (2005) In support of psychotherapy for people who have mental retardation. Ment Retard 43:450–453
United Nation-Behindertenrechtskonvention vom 13.12.2006, http://www.un.org/esa/socdev/enable/rights/adhoccom.htm
Aster M von, Neubauer A, Horn R (2006) Wechsler-Intelligenztest für Erwachsene (WIE), deutschsprachige Bearbeitung und Adaptation des WAIS-III von David Wechsler. Harcourt, New York
Waranch HR, Iwata BA, Wohl MK (1981) Treatment of a retarded adults’s mannequin phobia through in vivo desensitization and shaping approach responses. J Behav Ther Exp Psychiatry 12(4):359–362
WHO (1992) In: Dilling H, Mombour W, Schmidt MH (eds) Internationale Klassifikation psychischer Störungen (ICD-10). Huber, Bern Göttingen Toronto
WHO (2001) The world health report 2001 – Mental Health: New Understanding, New Hope, siehe: http://www.who.int/whr/2001/media_centre
Willner P (2005) The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical overview. J Intellect Disabil Res 49:73–85
01.01.2009: Innerstaatliches Inkrafttreten und Abschluss der Ratifizierung des am 30. März 2007 von der Bundesrepublik Deutschland unterzeichneten Übereinkommens der Vereinten Nationen über die Rechte von Menschen mit Behinderungen und das dazugehörige Fakultativprotokoll, siehe dazu http://www.behindertenbeauftragte.de
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.
Interessenskonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00115-009-2917-8