Page 24 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 1
Intensive trauma-focused treatment
Evidence suggests that intensive trauma-focused treatment can be an
effective alternative to weekly trauma-focused treatment (Gahnfelt et al.,
2025; Hoppen et al., 2023; Hurley, 2018). The multidisciplinary guidelines
for PTSD (Federatie Medisch Specialisten, 2025) support this view and
explicitly recommend considering intensive trauma-focused treatment.
Intensive treatment can consist of various therapies, such as a combination
of prolonged exposure (PE) and EMDR therapy (e.g., Voorendonk et al.,
2023), or one type of therapy such as EMDR therapy alone (Hurley et
al., 2018). A common element in intensive trauma-focused treatment
is therapist rotation, meaning that different therapists deliver therapy
sessions throughout the treatment process. Intensive trauma-focused
treatments appear to offer a promising solution to the high dropout rates
often seen in traditional weekly trauma-focused treatments. Studies
indicate that between one-quarter and one-third of participants in weekly
trauma-focused therapy discontinue treatment, with some reporting even
higher dropout rates (e.g., Niles et al., 2018). These high dropout rates may
be due to a worsening of symptoms, which can be difficult to distinguish
from the temporary distress that is an inherent part of trauma-focused
therapy (Bongaerts et al., 2022; Van Woudenberg et al., 2018). In contrast,
intensive trauma- focused treatments have demonstrated considerably
lower dropout rates than other treatments. For example, Van Woudenberg
et al. (2018) reported a dropout rate of less than 3%, whereas Bongaerts et
al. (2022) reported no dropouts.
Intensive trauma focused-treatment with rotating therapists has shown
promising results in individuals with MID-BIF. A pilot study by Ooms-Evers
et al. (2021) investigated the effects of EMDR therapy and prolonged
exposure therapy in 33 children and adolescents with MID-BIF. The study
demonstrated a significant reduction in PTSD symptoms and in most
participants, the PTSD diagnostic criteria were no longer fulfilled after
treatment. Mevissen et al. (2020b) evaluated intensive trauma-focused
treatment consisting of intensive EMDR therapy for both children and their
parents, combined with parental skills training and two weeks of follow-
up parent support at home. The study involved six families, including nine
parents (six with MID-BIF) and ten children (all with MID-BIF). Significant
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