Page 87 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Brief intensive EMDR therapy for PTSD
sessions during the intervention phase. These sessions involved reviewing
the video recordings and discussing the cases to ensure adherence to the
treatment protocol.
A week before therapy (baseline), the professional caregivers and, if
possible, the client’s relative received psychoeducation about PTSD and
EMDR therapy. Therapy sessions were conducted twice daily (morning
and afternoon) from Monday to Thursday, over a two-week period. During
the first therapy session (60 min), a case conceptualisation based on the
timeline of the DITS-ID was established. For this case conceptualisation, all
traumatic (meeting A-criterion) and stressful events (not meeting A-criterion)
on the timeline were assessed for distress using a scale for the Subjective
Units of Disturbance (SUD) 0 = no distress to 10 = extreme distress and
were ordered from high to low SUD. This resulted in a list of traumatic and
stressful events that could be treated (case conceptualisation). The first
therapy session included psychoeducation for participants about PTSD
and EMDR therapy. Participants were not trained in the use of coping skills
or emotion regulation techniques prior to treatment (De Jongh et al., 2016).
After the first session, all subsequent sessions consisted of 60 min of EMDR
therapy. We used the EMDR therapy protocol for children and adolescents
up to 18 years of age (De Roos et al., 2021). This protocol includes the
same eight phases as the standard protocol developed by Shapiro (2018)
but is adapted for individuals with lower language skills, such as individuals
with MID-BIF. If necessary, cognitive interweaves were applied as described
by Shapiro (2018). In line with the working memory theory (see De Jongh et
al., 2024, for a review), working memory taxation during EMDR therapy was
achieved using several tasks, specifically eye movements (following fingers
or a light bar), which were combined with pulsators. If the participant was
unable to perform eye movements, an additional distracting task, such as
tapping, counting, or a simple calculation task, was added. These tasks
were also added when the SUD score remained high (Matthijssen et
al., 2021). Once a memory was successfully processed, it was checked off
on the case conceptualisation with the participant, and the therapy moved
to the next traumatic event. Therapy was completed after all memories
of case conceptualisation were processed. The treatment duration varied
depending on the number of traumatic events and the time required for the
processing of traumatic memories.
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