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Dr Sabiha Azmi

Eye movement desensitisation and reprocessing for symptoms of post-traumatic stress disorder in adults with intellectual disabilities

Background:
People with intellectual disabilities (PwID) are at increased risk of all types of abuse. PwID exposed to traumatic events show typical symptoms of post-traumatic stress disorder (PTSD) anxiety, flashbacks, recurring nightmares, and more complex presentations e.g. difficulty in regulating emotions; shame, guilt, worthlessness; difficulties in sustaining relationships and feeling close to others, as well as challenging behaviours. PwID require highly specialist NHS intellectual disability (ID) services, and are at risk of admission to hospital.

Intervention:
To assess if general populations treatments would be effective or provide value for money when used with PwID. Eye movement desensitization and reprogramming (EMDR) is an effective treatment in the general adult population. The first stages of treatment psychoeducation and stabilisation (PES) and EMDR help PwID develop strategies to calm their turbulent emotions; the later EMDR stages involve focusing attention on past traumatic events while making controlled eye movements.

Standard EMDR is difficult to use with PwID because the eye movement exercises are unfamiliar, and difficult to explain. However, the procedure can be adapted to PwID by expanding the introductory PES phase and adapting some of the techniques used in the treatment of traumatised children. We will investigate how well an adapted EMDR protocol works in PwID, compared with treatment as usual (TAU), as defined by the therapist.

Research plan:
Prepilot: 40 PwID to receive PES+EMDR; Main trial: 144 PwID receive either PES+EMDR or TAU. 120 Carers; 21 NHS Therapists interviewed. We will measure how well the treatment is delivered, the costs of providing treatment and improvements in patients’ and carers’ quality of life.
We aim to determine whether EMDR provides value for money, improves the mental health and quality of life of PwID who suffer PTSD and whether the outcomes are influenced by the complexity of the PTSD.