Page 112 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 5
stop... Then I tried it [EMDR therapy] once more, and then I did
not do it anymore.”
Therapist three (after therapy): “He is too afraid of his reaction
when he gets therapy... That he has no control over it.”
During the first EMDR therapy session, participant one cried intensely while
thinking of a traumatic memory. He later reported feeling overwhelmed
by sadness and anger, finding it difficult to experience these emotions.
According to the therapist, he was particularly afraid of his own intense
reaction, which he felt unable to control. Participant one struggled to cope
with this and did everything he could to avoid feeling emotions. For example,
he avoided thinking about the traumatic memory during the session and was
unable to select the most distressing image from the traumatic memory.
Despite this, participant one continued to attend the therapy sessions.
During subsequent sessions, he exhibited seemingly threatening behaviour,
such as placing his feet on a table and saying that he could kick very hard
with them. Although he said he wanted to continue therapy, he repeatedly
left the sessions. Therapists interpreted his behaviour as a way of avoiding
confronting traumatic memories and accompanying emotions. Throughout
the sessions, the therapists attempted various strategies to break the
avoidance behaviour, including psychoeducation, offering a flashforward
(i.e. a technique in which the patient is confronted with a future situation
reflecting their anxiety about therapy) and applying EMDR 2.0, that is,
activation of the trauma memory combined with intensive distracting tasks
and enhancing motivation to counter avoidance (Matthijssen et al., 2021).
Despite these efforts, the therapy process could not be resumed, and the
therapy was terminated after six sessions, in joint decision with participant
one. His strong emotional reactions and withdrawal may reflect a lack of
perceived safety during therapy but seemed to be primarily driven by fear of
being overwhelmed by his own emotions in the first therapy session.
Participant two
Participant two (before therapy): “[Things that get better after
therapy] just in everyday life, like when you go to the shop,
especially in the evening... Sleeping better.”
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