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Abstract
BackgroundDiagnostic overshadowing can prevent the treatment of comfort eating in people with intellectual disabilities, and the published literature contains few therapeutic examples. This case study reports a relatively novel, promising, and accessible, remote cognitive behavioural intervention.Case presentationThis case study documents a therapeutic intervention for comfort eating with a client, Sarah, in a National Health Service adult Community Learning Disabilities Service. Sarah is a white, British woman in her late thirties, with a diagnosis of Down syndrome who experienced significant problems with comfort eating and subsequent weight management. Despite dieting and exercising, Sarah was clinically obese and experienced weight related pain and psychological distress. Systemic intervention between Sarah, her mother, and the therapist formulated Sarah’s eating difficulties using a cognitive behavioural framework. This hypothesised how comfort-eating met her emotional needs and maintained her health difficulties. Remote cognitive behavioural therapy interventions included collaborative behavioural experiments, coping strategies, and homework tasks.ConclusionsThe Maslow Assessment of Needs Scale-Learning Disabilities, Glasgow Depression Scale for people with a Learning Disability, Glasgow Anxiety Scale for people with an Intellectual Disability, qualitative feedback from family, as well as frequency data showed significant improvement. Additionally, the case considers the evidence base, assessment, formulation and intervention, before reflecting on its various strengths and limitations. It reflects on the intersectionality of sexuality and intellectual disabilities, and the desire for romantic attachment, which was additionally complicated by the context of coronavirus and social isolation. The environmental influences on comfort eating regarding this case, and in general, the experiences of people with intellectual disabilities are also considered. The potential clinical impact of this case study includes exemplifying an effective comfort eating therapeutic intervention in an often overlooked client group.
Highlights
Diagnostic overshadowing can prevent the treatment of comfort eating in people with intellectual disabilities, and the published literature contains few therapeutic examples
The case considers the evidence base, assessment, formulation and intervention, before reflecting on its various strengths and limitations. It reflects on the intersectionality of sexuality and intellectual disabilities, and the desire for romantic attachment, which was complicated by the context of coronavirus and social isolation
Cognitive behavioural therapy with people with intellectual disabilities (PWID) Evidence suggests that adapted cognitive behavioural therapy (CBT) can help PIWD manage anxiety [45], bereavement [46], depression [69], and a range of other presenting difficulties [32]
Summary
The Maslow Assessment of Needs Scale-Learning Disabilities, Glasgow Depression Scale for people with a Learning Disability, Glasgow Anxiety Scale for people with an Intellectual Disability, qualitative feedback from family, as well as frequency data showed significant improvement. Cognitive behavioural therapy with PWID Evidence suggests that adapted CBT can help PIWD manage anxiety [45], bereavement [46], depression [69], and a range of other presenting difficulties [32]. Collaboration In line with the manual of CBT for PWID and common mental health difficulties by Hassiotis et al [32], the first stage of intervention focussed on collaboration between Sarah, Gill, and the therapist. When Sarah opted to discuss her gemstones this initially seemed unrelated; the topic gave a better understanding of her spiritual beliefs, something which was later used as part of the intervention This was in line with the person-centred approach recommended by Abbott and Howarth [1], incorporating clients’ unique interests, spiritual beliefs, and goals. These were posted to Sarah and Gill to facilitate meaningful discussion in the following session, subsequently using some in the formulation
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