Page 76 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 4
Abstract
Background: Individuals with mild intellectual disability (MID; IQ 50–70)
or borderline intellectual functioning (BIF; IQ 70–85) are at an elevated
risk of post-traumatic stress disorder (PTSD), with PTSD symptoms
possibly associated with behavioural problems. It is important to test
the effectiveness of trauma-focused treatments, such as eye movement
desensitisation and reprocessing (EMDR) therapy, for adults with MID–BIF,
PTSD, and severe behavioural problems.
Objective: To determine the safety and effectiveness of brief intensive
EMDR therapy carried out by a team of rotating therapists in adults with
MID-BIF, PTSD, and severe behavioural problems.
Methods: Using a randomised non-concurrent multiple baseline between-
subjects design, 11 adults with MID-BIF, PTSD, and severe behavioural
problems received a maximum of 16 intensive EMDR sessions twice daily
for a maximum of two weeks from six different EMDR therapists. Primary
outcome measurements included severity of PTSD symptoms, PTSD
diagnostic status, and adverse events. Secondary outcome measurements
included the frequency and severity of behavioural problems, presence of
adaptive behaviour, and the use of involuntary care. Outcome measurements
were assessed at baseline, during the intervention and post-intervention
phases, and at the follow-up phases, and subject to randomisation tests for
statistical significance.
Results: Intensive EMDR therapy carried out by a team of rotating
therapists resulted in significant decreases in PTSD symptoms
(Mdifference = 15.84, p < .001) with nine of 11 participants no longer meeting
the PTSD diagnostic criteria immediately following treatment and at the
9-week follow-up. Randomisation tests revealed no significant changes
in adaptive behaviour, frequency, and severity of behavioural problems.
Additionally, no decrease in the use of involuntary care measures was
observed. One participant dropped out; no adverse events were observed.
Conclusions: Brief intensive EMDR therapy for individuals with MID-BIF and
severe behavioural problems, conducted by a team of rotating therapists,
can be done safely and effectively to reduce PTSD symptoms.
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