A Systematic Review of Treatment Interventions for Individuals With Intellectual Disability and Trauma Symptoms: A Review of the Recent Literature

Abstract

Individuals with intellectual disabilities (IDs) are at increased susceptibility to adverse life experiences and trauma sequelae. There is a disparate range of therapeutic interventions for post-traumatic stress disorder (PTSD) and associated symptoms. This systematic review aimed to appraise the effectiveness of both cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay. A systematic search, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of the PsychInfo, PubMed, Cochrane Database of Systematic Reviews, and MEDLINE databases were performed, and all relevant articles published between 2010 and March 2020 were included. A total of 11 articles were included, eight that focused on EMDR and three on CBT. The methodological quality of many of these articles was generally weak. Tentative findings suggest that EMDR and CBT are both acceptable and feasible treatment options among adults and children with varying levels of intellectual delay, but no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardized assessment, and a paucity of methodological rigorous treatment designs. This review highlights the continued use of therapeutic approaches with clients presenting with IDs and PTSD. It adds to the extant literature by providing an expansive and broad overview of the current effectiveness of both EMDR and CBT. Further high-quality research is needed to provide more conclusive findings regarding treatment effectiveness and modifications to treatment needed with this population.

EMDR therapy with people who have intellectual disabilities: process, adaptations and outcomes

“…In spite of the current understanding of trauma and PTSD in the intellectually disabled population, and in spite of the evidence base for the effectiveness of EMDR for the treatment of PTSD in the general population, a lack of methodologically sound research means less is known about EMDR for the treatment of people with intellectual disabilities and PTSD (Byrne, 2020), including how to adapt the standard protocol for this clinical group.…”

“…The population of people with intellectual disabilities are known to be more likely to experience trauma (Beail et al , 2021 ; Hatton and Emerson, 2004; Mason-Roberts et al , 2018; Mevissen and de Jongh, 2010; Tsakanikos et al , 2007), and to experience environmental stressors that place them at higher risk of developing post-traumatic stress disorder (PTSD) and co-morbid mental health conditions (Wigham and Emerson, 2015). In spite of this, PTSD is not as frequently diagnosed in this population, and less is known about the application of psychological therapies for treatment of PTSD in people who have intellectual disabilities (Byrne, 2020).…”

“…In recent years, the efficacy of trauma-informed CBT (Stenfert Kroese et al , 2016; Stenfert Kroese, 2021) has been explored, but there remains a dearth of literature describing EMDR with people with intellectual disabilities (Byrne, 2020). Tentative evidence from 11 case studies describes effective outcomes for people who have intellectual disabilities where symptoms of PTSD were reduced using the EMDR standard protocol with some adaptations (Jowett et al , 2016; Byrne, 2020; Smith et al , 2021). In the context of using EMDR in a clinical setting with people with intellectual disabilities, a review of the literature carried out by this author found little specific information about the ways the standard EMDR protocol had been adapted.…”

Lost voices part 2: Modifying psychological therapies for two young men with complex learning disabilities following alleged sexual and physical abuse: A case study in trauma recovery

“…Recent evidence for eye movement desensitisation and reprocessing (EMDR) for people with learning disabilities and PTSD has suggested that this may be effective (Byrne, 2020). At the time of these events, this intervention was not available in the MHLDT.…”

“…At the time of these events, this intervention was not available in the MHLDT. Cognitive behaviour therapy (CBT) was considered but required a level of language and abstract processing that was not possible for James and George (Byrne, 2020; Whitehouse et al., 2006).…”