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CBT of a Person Living in a Situation of Mental Handicap and Presenting an Anxiety Disorder Coupled with a Specific Phobia

The prevalence of anxiety disorders within a population presenting an intellectual deficiency is 43%. The integrated multimodal approach highlights different predisposing risk factors: vulnerability and its consequences on adaptive behaviors and deficits in the learning process; interactions with the environment. Negative experiences and a weak perception of control lead to a higher failure expectation, resulting in an increase in anxiety for the handicapped person. On the other hand, environment, family and professionals may induce responses of dependency, fear and avoidance, and consequently, a decrease of opportunities to develop social and emotional skills. The cognitive-behavioral therapy was adapted to the patient. The therapeutic alliance with the patient, as well as with his family and professionals, was the keystone and the required condition for the therapy procedure. The functional analysis underlined three therapeutic axes: 1) a work on the physiological reactions of anxiety and the train phobia, using the reaction management techniques 2) A work on cognitive restructuration. 3) A work on the behavior during exposure to the anxiety-inducing situation. Simultaneously, the patient received an antidepressant and anti-anxiety medication. Other skills and techniques were used: eye tracking (ASL mobile) to point out the patient resources; the psycho-educative approach using the "heart mat" (cardiac coherence) as a mediator to share the understanding of the situation; a motivational approach for the exposure planning; and the PEUR model, used in group therapies to divide the therapy into sequences, thus fostering self-control. Measurements at frequent and regular intervals have shown the rapid evolution of the patient and the pertinence of the cognitive-behavioral approach during therapies for persons living in a situation of mental handicap and presenting concomitant mental disorders.


Pierre El korh and Fabienne Giuliani

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