Page 23 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

General introduction
participant for the period between sessions. Phase eight consists of re-
evaluation and integration.
The EMDR procedure is based on the adaptive information processing (AIP)
model, which suggests that it creates a physiological condition in which
unprocessed memories of traumatic events become linked to networks
that include adaptive information and skills (Shapiro, 2007). Retrieving a
traumatic memory is assumed to place a demand on the limited capacity
of the working memory. If another task is performed while retrieving a
traumatic memory, less capacity is available for recalling it. Consequently,
the memory is perceived as less intense and emotional; this theory is
known as the working memory theory (see De Jongh et al., 2024, for an
overview of the theoretical background of EMDR therapy). Research within
the general population shows that, in cases of persistently high subjective
unit of distress (SUD) scores, this may be reduced by performing additional
tasks that utilise working memory in addition to the original task. These
include activities such as tapping, counting, or solving a simple arithmetic
problem alongside the original task (Matthijssen et al., 2021).
There is an EMDR protocol for children and adolescents up to 18 years of
age (De Roos et al., 2025). This protocol includes the same eight phases
as the standard protocol developed by Shapiro (2018). It is adapted
for individuals with lower language skills, which seems to be suitable
and potentially effective for individuals with MID-BIF (Byrne et al., 2020;
Mevissen et al., 2011; Penninx et al., 2021; Schippers-Eindhoven et al.,
2024; Verhagen et al., 2023). Schipper-Eindhoven et al. (2024) conducted
a systematic review of 13 studies to identify and categorise the difficulties
therapists face when applying EMDR therapy to individuals with MID-BIF
and the adaptations used to overcome these difficulties. They divided the
adaptations made into three main categories: EMDR delivery (e.g., tuning
to the developmental level of the client, simplifying language, decreasing
pace), involvement of others (e.g., involving family or support staff during
or in between sessions), and the therapeutic relationship (e.g., taking more
time, adopting a supportive attitude).
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