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

Abstract

Purpose Emerging evidence indicates that adapted eye movement desensitisation and reprocessing (EMDR) can be useful for people with intellectual disabilities in treating post-traumatic stress disorder (PTSD). However, the required adaptations are not described in enough detail across the literature, making it difficult for therapists to easily adapt EMDR for people with intellectual disabilities. This paper aims to address this by describing 14 clinical cases, along with outcome data for six people, and the views of five people with intellectual disabilities about EMDR. Design/methodology/approach A total of 14 people with mild or moderate intellectual disabilities and varied experiences of trauma were offered EMDR by one clinical psychologist in a UK NHS setting; nine people completed EMDR therapy, six people provided outcome data with pre-post measures and five people were asked two questions about EMDR therapy. Findings Adaptations are described. The outcome data indicate reductions in symptoms of PTSD following EMDR intervention. EMDR was liked and perceived as useful. Originality/value This paper provides details about adaptations that can be made to the standard EMDR protocol, reports the views of service users about EMDR and adds evidence that EMDR reduces symptoms of PTSD in people who have intellectual disabilities.

Some observations on remote delivery of eye‐movement desensitisation and reprocessing to people with intellectual disabilities

“…From the responses of clients, carers and therapists, the PES-EMDR intervention appears to be acceptable to the majority of clients, albeit that some may choose to stop treatment after the PES phase and not progress to engagement with trauma confrontation. There are a number of previous publications reporting outcomes of EMDR for people with intellectual disabilities, suggesting that the procedures used were acceptable (Gilderthorp, 2015;Jowett et al, 2016;Karatzias et al, 2019;Mevissen et al, 2011Mevissen et al, , 2017Porter, 2022). Those studies did not comment on whether there were also clients who did not complete the full course of therapy.…”

“…Adaptations to the standard EMDR protocol that were found to be effective were the use of visual supports, frequent return to target and a focus on emotions and physical sensation rather than mental images or cognitions. Rigid adherence to the standard protocol is likely to result in less effective processing and engagement for this client group (Porter, 2022).…”

“…However, the procedure can be made more accessible to people with intellectual disabilities and acceptable to therapists by expanding the introductory PES phase in order to increase engagement and to ensure that participants have sufficient understanding of what they need to do and why, and by using some of the techniques developed for use with traumatised children (but adapted so as to be appropriate for adults (Barol & Seubert, 2010)). Some case study reports suggest that adapted EMDR protocols can be used to treat PTSD in people with intellectual disabilities (Gilderthorp, 2015;Jowett et al, 2016;Mevissen et al, 2011Mevissen et al, , 2017Porter, 2022), and a small-scale controlled trial concluded that EMDR was 'feasible, acceptable and potentially effective' for people with intellectual disabilities (Karatzias et al, 2019). However, a recent review concluded that while EMDR appears acceptable and feasible 'no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardised assessment, and a paucity of methodological rigorous treatment designs' (Byrne, 2022).…”

Clinicians' experiences of learning to use eye movement desensitisation and reprocessing therapy with people with intellectual disabilities: A qualitative study

“…Further efforts are being made to assess EMDR quantitatively through the Trauma‐AID trial, a multi‐site RCT study (described further in Unwin et al, 2023). In addition to this, a recent study by Porter (2022) provided detailed descriptions of the adaptations made to the EMDR protocol. This not only benefits the progression of research but also provides clinicians with tangible information to potentially inform their own practice.…”

“…For bilateral stimulation, clients often opted for butterfly or tapping techniques rather than the eye movements; this was a common adaptation observed across studies in Smith et al (2021)'s review. In Unwin et al (2019)'s case series, clinicians also used prompts to support an individual's focus during sessions.Making such adaptations can feel uncomfortable for clinicians as they worry about departing too far from the set protocol(Unwin et al, 2019) Porter (2022). provide an example of clear and detailed descriptions of how the EMDR protocol has been adapted for use within the intellectual disability population.…”