Page 141 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

General discussion
After each session, processed memories were checked off with the client,
providing continuous insight into the progress of treatment and supporting
a sense of safety, predictability, and involvement for individuals with MID-
BIF. The EMDR therapy protocol and case conceptualisation made the
treatment easily transferable between therapists. These elements likely
facilitated agreement between client and therapist on treatment goals
and tasks, aligning with key components of the therapeutic alliance, even
though a strong emotional bond might not have been established.
Study 3 (Chapter 4) examined the effectiveness of brief intensive EMDR
therapy in reducing PTSD symptoms and diagnostic status. In addition,
changes in adaptive behaviour, behavioural problems, and the use of
involuntary care were assessed as secondary outcomes. These outcomes
were included to explore whether successful reduction in PTSD symptoms
would translate into improvements in functioning in other areas. In Study
3 (Chapter 4), we hypothesised that if PTSD symptoms were effectively
reduced, behavioural problems would decline, adaptive behaviour would
improve, and the use of involuntary care would decrease. For adaptive
behaviour, an individual goal was formulated for each participant, such
as ‘participant independently walks home from work’. Some participants
showed small improvements in adaptive behaviour after brief intensive
EMDR therapy, whereas others exhibited medium changes. Improvements
were not systematic across participants, suggesting that improvements
in adaptive behaviour do not automatically occur following an overall
reduction in PTSD symptoms after trauma treatment.
Changes in adaptive behaviour may require interventions aimed at learning
new skills and adapting the environment. Although a reduction in PTSD
symptoms may enable a participant to walk home from work independently
because avoidance symptoms have decreased, the continued involvement
of professional caregivers, for example, accompanying the participant out
of habit or caution, may have inadvertently prevented actual improvements
in this adaptive skill. Although participants were supported by their regular
caregivers between therapy sessions, the qualitative study in Study 4
(Chapter 5), which involved three participants from Study 3, indicated
that caregiver involvement in the therapeutic process itself was limited.
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