People with intellectual disabilities who suffer post-traumatic stress disorder will receive an adapted form of eye movement desensitisation and reprocessing (EMDR) therapy in a randomised controlled trial involving 144 patients across four NHS trusts. This matters because adults with intellectual disabilities are at high risk of abuse and trauma, yet no controlled trials have tested any psychological therapy for PTSD in this group. Standard EMDR is difficult to use with them—the eye movement exercises are unfamiliar and hard to explain—so the protocol has been adapted with an expanded introductory phase and techniques borrowed from child therapy. If the adapted EMDR proves effective and cost-effective, it could become a standard NHS treatment pathway for this vulnerable population. The trial will also raise awareness that PTSD in people with intellectual disabilities is both common and treatable, potentially reducing hospital admissions and improving quality of life. The study runs for 48 months, with primary outcomes measured at eight months after treatment begins.
View original technical description
Research question: Is an adapted eye movement desensitization and reprogramming (EMDR) protocol effective and cost-effective for people with intellectual disabilities (PwID) and post-traumatic stress disorder (PTSD)? Background: PTSD is a common mental disorder that may develop following exposure to traumatic events. PwID are a vulnerable group who are at increased risk of all types of abuse. Common presenting problems for PwID exposed to traumatic events, particularly abuse, include typical symptoms of PTSD (re-experiencing, avoidance and hyper-arousal), and further symptoms characteristic of more complex presentations of PTSD (e.g. difficulty in regulating emotions and sustaining relationships; feelings of shame, guilt and worthlessness), as well as challenging behaviours. These patients are extremely complex and challenging, requiring highly specialist NHS ID services, and are at risk of admission to hospital. There have been no controlled trials of psychological therapies for PTSD in PwID. EMDR is an effective treatment in the general adult population. It includes an initial phase of psycho-education and emotional stabilisation (PES), before the main treatment phase in which the patient focusses on memories of past traumatic events while making controlled eye movements (EMDR). The standard EMDR protocol is difficult to use with PwID because the eye movement exercises are unfamiliar, and their purpose is difficult to explain. However, it can be made more accessible to PwID and acceptable to therapists by expanding the introductory PES phase and using some techniques developed for use with traumatised children, appropriately adapted for adults). Aims and objectives: This study is a randomized controlled trial of an adapted EMDR protocol for PwID, compared with treatment as usual (TAU), which will be as defined by the therapist, and could include any non-trauma-focussed intervention. We aim to determine whether EMDR improves the mental health and quality of life of PwID who suffer PTSD; whether the EMDR protocol is cost-effective; and whether the outcomes are influenced by the complexity of the PTSD presentation. Methods: Within 4 large NHS Trusts, a total of 144 patients with ID referred for treatment, and who are confirmed using ICD-11 criteria as having PTSD, will be allocated randomly to receive either PES+EMDR or TAU. Specialist ID clinicians will be trained and supervised to deliver the protocol. Patients will be assessed for PTSD, mental health, quality of life and challenging behaviour, before treatment and at 4 (after PES), 8 (after EMDR), and 14 month follow-up. The primary outcome is a measure of PTSD at the 8-month follow-up. Health economic data will be collected before treatment and at 14-month follow-up. A process evaluation will include, inter alia, a description of TAU, assessment of fidelity of treatment delivery, and interviews with samples of patients, therapists and carers. Timelines for delivery: 48 months overall duration, including nested feasibility (to m.12) and internal pilot (to m.18) studies. Anticipated impact and dissemination: We will publish the findings, present them at scientific and public meetings, and disseminate them widely to professional and lay audiences. If the intervention is supported we would expect it to be adopted as a standard pathway for PwID with PTSD. We also anticipate a heightened awareness of the prevalence and potential treatability of PTSD in this population
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know