Page 22 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 1
adults with PTSD be offered trauma-focused psychotherapy, with a choice
from a broader range of evidence-based interventions, including imaginal
exposure, prolonged exposure, cognitive therapy, cognitive processing
therapy, imagery rescripting, Brief Eclectic Psychotherapy for PTSD (BEPP),
Narrative Exposure Therapy (NET), and EMDR therapy. The guidelines
explicitly emphasise that no individual should be excluded from treatment
based on personal characteristics, such as (mild) ID, and that interventions
should be adapted, where necessary, to ensure they are appropriate and
feasible for the individual. However, the guidelines do not specify how such
adaptations should be implemented.
EMDR therapy is currently the most extensively studied PTSD treatment
among individuals with MID-BIF and research suggests that it is a safe,
feasible, and potentially effective therapy for adults with MID-BIF (e.g.,
Byrne et al., 2020; Penninx et al., 2021; Verhagen et al., 2023). Given these
promising findings and its increasing use in clinical practice, this dissertation
focuses specifically on EMDR therapy.
EMDR therapy
EMDR therapy is an eight-phase, structured therapy aimed at resolving
symptoms resulting from traumatic memories (De Jongh et al., 2024;
Shapiro, 2018). The first phase consists of taking a case history and
developing a case conceptualisation. Phase two involves preparing the
participant for therapy. Phase three focuses on determining the target
memory. Phases four, five, and six involve memory processing to achieve
an adaptive resolution. An important part of the procedure involves
performing tasks that demand working memory. For example, the therapist
moves their fingers back and forth in front of the participant and asks them
to follow the movements while focusing on the traumatic memory. The
client is repeatedly asked to report on any emotional, cognitive, somatic,
and/or imagistic experiences that arise until internal disturbances reach
a subjective unit of disturbance (SUD) score of zero (0 = no disturbance
at all, ten = the highest possible level of disturbance), and the client rates
an adaptive and positive statement about themselves as fully believable
on a Validity of Cognition (VOC) score of seven (7 = completely true, 1 =
not true at all). Phase seven involves closing the session and preparing the
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