Post-Traumatic Stress Disorder Treatment in Intellectually Disabled Patients: The Promise of Eye Movement Desensitization and Reprocessing Therapy

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Table of Contents

Findings
Limitations
Use and Application of Findings
Conclusion
References

Findings

Nowadays, multiple individuals in the United States develop mental disorders, such as post-traumatic stress disorder, in response to traumatic events, including participation in military conflicts, accidents, or sexual and physical violence. According to the National Comorbidity Survey Replication, which is a general population survey, around 5.7% of adult Americans face increased risks of developing PTSD after exposure to traumatic events (Kessler, 2018).

Such risks are specifically high for the survivors of kidnapping, rape, and intimate partner violence (Kessler, 2018). Eye movement desensitization and reprocessing therapy (EMDR) belongs to the number of relatively recent approaches to treatment that reduce the distressing symptoms of PTSD in patients. The approach has been found rather effective in general PTSD populations in the previously conducted randomized controlled trials, which is a common and reliable study design (Jowett et al., 2016; Jacobsen, 2016). However, capitalizing on the wave of success, diverse institutions may apply EMDR to treat any patient with PTSD without giving proper consideration to limitations and research gaps surrounding its use in intellectually disabled adults.

Limitations

The main limitation of the present study is that it is based on information from methodologically diverse sources. Not all of the research articles testing EMDR in PTSD patients with disabilities document the features of EMDR sessions in a consistent manner (Jowett et al., 2016). Moreover, high-quality studies on EMDR in populations with PTSD and IDs are still scarce (Karatzias et al., 2019). The existing experimental studies greatly vary in terms of sample size. Because of that, the provided recommendations mainly point to the remaining research gaps.

Use and Application of Findings

The use and application of findings that shed light on current research gaps related to the effectiveness of EMDR in PTSD patients with IDs may contribute to improvements in this population’s quality of life and treatment outcomes. They can do so by attracting the attention of the scientific community to the sources of potential adverse effects of EMDR that disproportionately affect PTSD patients with generalized neurodevelopmental disorders. To start with, it is supposed that the presence of IDs may contribute to the risks of developing PTSD and symptoms’ severity in those exposed to traumatic events (Jowett et al., 2016).

In general, eight-phase EMDR sessions using standard protocols for adults show relatively good results in intellectually disabled patients with PTSD by causing a 20% increase in the number of diagnosis-free participants twelve weeks after treatment (Karatzias et al., 2019). In spite of potential extra challenges resulting from the overlapping of the two conditions, treatment guidelines for PTSD patients developed with reference to intellectually disabled people’s unique struggles and psycho-emotional characteristics are still lacking, which is a huge problem (Jowett et al., 2016). The recommendations below refer to specific goals to pursue in order to address the problem.

Recommendation 1

To start with, it will be impossible to maximize the benefits of EMDR for intellectually disabled patients without addressing research gaps surrounding differences between people with and without ID in terms of PTSD symptoms. Patients with disabilities are harmfully affected by diagnostic overshadowing, but this phenomenon is not well-researched in the context of PTSD therapy. Limited knowledge concerning disability-related differences in PTSD manifestations may lead to inaccurate assessments of disease severity before and after EMDR treatment.

Considering this, to some extent, the aforementioned research gap brings the said effectiveness of EMDR in PTSD patients with IDs into question. Consequently, studies addressing the unique symptoms of PTSD in ID patients would speed up the development of PTSD treatment guidelines adapted to such patients’ needs.

Recommendation 2

The second recommendation for the scientific community is to support research that would draw comparisons between different adaptations of the standard EMDR protocol in terms of their effectiveness in intellectually disabled patients diagnosed with PTSD. In 2007, Tomasulo and Razza presented evidence that suggested resemblances between the manifestations of PTSD in typically developing children and adults with ID (Jowett et al., 2016). After that, a few research groups attempted to integrate the elements of the child-adjusted EMDR protocol into protocols to be used with adults having IDs, with quite positive results (Jowett et al., 2016).

However, as of now, there are no projects to compare different approaches to protocol adaptation and address the issue of methodological diversity. Therefore, studies comparing the outcomes of three promising approaches to EMDR sessions (the standard protocol, the child-adjusted protocol, and the standard protocol with the storytelling method) in the discussed population would be of benefit.

Recommendation 3

Finally, future researchers and mental health specialists working with the population in question are recommended to avoid over-relying on EMDR. Bae, Kim, and Park (2016) report that high dissociation (depersonalization and derealisation) scores are negatively related to response to EMDR therapy. At the same time, dissociation is quite common in PTSD patients with disabilities. Taking this into account, the potential benefits of EMDR for such patients should not be overestimated despite the reported positive results. Probably, future studies will shed light on the role of IDs as a barrier to PTSD treatment using EMDR.

Conclusion

To sum up, it is widely accepted that a person’s ability to deal with stress and maintain social functioning despite distressing events of different types is a prerequisite to proper mental health and living a full-fledged life. PTSD profoundly affects an individual’s psychological well-being and daily life by resulting in frequent flashbacks. It also causes poorly controlled thoughts about distressing events of the past, the impaired ability to engage in everyday affairs, nightmares and sleep disorders, severe anxiety and phobias, and similar unwanted symptoms (Kessler, 2018).

Despite suggestions that people with IDs are more susceptible to PTSD, there are still no universally approved treatment recommendations developed for this specific subgroup of patients (Jowett et al., 2016). In particular, there is solid evidence to support the effectiveness of standard EMDR protocols in general populations, but its use in people with ID is only regarded as potentially beneficial (Jowett et al., 2016; Karatzias et al., 2019).

The review of the existing literature suggests that the scientific community should work towards filling a range of research gaps to unleash the true potential of EMDR in PTSD patients with IDs. To start with, there are some factors to suggest that people with IDs may experience more severe PTSD (specific characteristics of memory processing, communication challenges, less social support, etc.). Nevertheless, there is still no solid research on differences between people with and without IDs in terms of PTSD manifestations (Jowett et al., 2016; Karatzias et al., 2019). New research is specifically important given that response to EMDR is weaker in patients with high dissociation scores, and disabilities are likely to be a risk factor for developing depersonalization/derealization (Bae et al., 2016).

Next, there is no consensus on the best EMDR protocol to treat PTSD patients with IDs despite attempts to create new protocols by combining EMDR-related recommendations for children and adults (Bae et al., 2016). Taking these gaps into account, it is too early to say that PTSD patients with IDs enjoy the benefits of EMDR just like other populations.

References

Bae, H., Kim, D., & Park, Y. C. (2016). Dissociation predicts treatment response in eye-movement desensitization and reprocessing for posttraumatic stress disorder. Journal of Trauma & Dissociation, 17(1), 112-130.

Jacobsen, K. H. (2016). Introduction to health research methods (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Jowett, S., Karatzias, T., Brown, M., Grieve, A., Paterson, D., & Walley, R. (2016). Eye movement desensitization and reprocessing (EMDR) for DSM–5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities: A case study review. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), 709–719.

Kessler, R. C. (2018). Trauma and PTSD in the United States. In C. B. Nemeroff & C. R. Marmar (Eds.), Post-traumatic stress disorder (pp.109-131). New York, NY: Oxford University Press.

Karatzias, T., Brown, M., Taggart, L., Truesdale, M., Sirisena, C., Walley, R.,… Paterson, D. (2019). A mixed-methods, randomized controlled feasibility trial of eye movement desensitization and reprocessing (EMDR) plus standard care (SC) versus SC alone for DSM-5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 32(4), 806-818.

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