Cognitive behaviour therapy with a woman in her twenties with a mild intellectual disability presenting with psychogenic non‐epileptic seizures
| DOI | https://doi.org/10.1108/AMHID-03-2013-0023 |
| Date | 12 July 2013 |
| Pages | 245-250 |
| Published date | 12 July 2013 |
| Author | Catherine I. Atnas,Tessa Lippold |
| Subject Matter | Education,Health & social care |
Cognitive behaviour therapy with a woman
in her twenties with a mild intellectual
disability presenting with psychogenic
non-epileptic seizures
Catherine I. Atnas and Tessa Lippold
Catherine I. Atnas is a trainee
clinical psychologist at the
Psychology Department,
University of Surrey,
Guildford, UK.
Tessa Lippold is a consultant
clinical psychologist at Surrey
and Borders Partnership NHS
Foundation Trust,
Leatherhead, UK.
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.
Keywords PNES, Intellectual disability, CBT, Anxiety, Epilepsy, Disabilities, Psychology
Paper type Case study
Introduction
Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures due to the episodes of
altered movement, sensation or experience that can occur. However, they do not involve
abnormal electrical discharges in the brain, rather are associated with psychological and
emotional processes (Reuber, 2005).
Considering the aetiology of PNES, it has been suggested that trauma such as sexual or
physical abuse, epilepsy, intellectual disability and stressful life events may contribute to the
development of PNES (Reuber, 2005). There is currently no widely accepted psychological
model for PNES, however, Goldstein et al. (2004) suggest that, due to a lack of self-report of
anxiety during seizures, alongside the experience of somatic symptoms of anxiety, PNES may
provide a coping mechanism for avoidance of unpleasant feelings or thoughts by dissociating.
They liken PNES to somatoform disorders due to the high levels of distress experienced
by individuals, as well as holding strong physical illness attributions and the avoidance of
The authors would like to thank
Rachel and her family for consent to
publish this case report, as well as
Dr Karen Dodd for her advice. They
would also like to thank Dr Paul
Davies and Professor Arlene Vetere
for all their support, time and help.
DOI 10.1108/AMHID-03-2013-0023 VOL.7 N O. 4 2013, pp. 245-250, CEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISA BILITIES
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