Dr. Joanne Porter

Clinical Psychologist

CLDT Livewell Southwest

Eye Movement Desensitization and Reprocessing: Is it an effective intervention for people with Learning Disabilities?

?

• Why should we offer EMDR?

• Is it effective?

• How do we do it? process and adaptations.

EMDR

EMDR involves 8 phases

Phase 1: History and treatment planning Phase 2: Preparation Phase 3: Assessment Phase 4: Desensitization Phase 5: Installation Phase 6: Body Scan Phase 7: Closure Phase 8: Reevaluation

Phases 3-7 in detail.• Memory (He hit me)

• Negative cognition (NC) associated with the memory (It’s my fault)

• Positive cognition (PC) that would be later used to replace the

negative thought (it wasn’t my fault)

• Validity of Cognition VoC Measurement where 1 = feels false and 7=

feels true (4)

• Emotions (Frightened)

• A 10 point Subject Units of Disturbance (SUD) scale is used to

measure the level of disturbance where 0=none or neutral and 10 =

most disturbance (10)

• Physical Sensations location in the body (My chest)

Why should we offer EMDR?EMDR for people without Learning Disabilities.

• Effective treatment for PTSD

• NICE Guidelines – Consider EMDR for adults

with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented between 1 and 3 months after a non-combat-related trauma.

PTSD and Learning Disabilities

• Increased likelihood trauma (Tsakanikos, et al. 2007)

• Higher risk PTSD

• PTSD under diagnosed

• Minimal evidence-based treatment methods for people who suffer PTSD and have a Learning Disability.

Is it effective?

• Existing evidence• Outcome data

– Offered….. 13– Not Sutiable..1 – Drop Outs… 3 (after 2-4 sessions)*– Returns… 2

–Total 9 (7 with complete outcome data).

– 4-8 assessment sessions– 8-20 treatment sessions

Outcome Measures

Impact of Events Scale –ID• Hall 2012; Hall Jobson and

Langdon 2014

CORE-LD

Is EMDR effective?Outcome Data: IES-ID

0

10

20

30

40

50

IES ID Start IES ID End

a

b

c

d

e

f

g

Is EMDR effective?Outcome Data: CORE-LD

0

10

20

30

40

50

CORE-ID Start CORE-ID End

f

a

Is EMDR effective? “How has EMDR helped you?”

“I’m more relaxed…calmer.” “it’s made me open up, I'm remembering things I

haven't before”

“gone” “good dreams”.

“I can cuddle my dad….my husband again”“I’m doing things”

“More happy. “I had to think the other day to rememberQuite upsetting. who that (perpetrator) was!” Overwhelmed..”

“More confident, thinking about yoga,starting to feel happy…”

Should we be offeringEMDR to PWLD?

“Yes” (smiling)

“yeah… it’s fine… yeah..”

“yes use it all the time”

“use it!” (stated emphatically)

Is the Process of EMDR the Same or Different?

Process…

Process Issues

• Avoidance

• Anxiety

• Blinded by the model?

• Timing

• Systems

Standard EMDR involves 8 phases:

Phase 1: History and treatment planning

Phase 2: Preparation (coping strategies)

Phase 3: Assessment (targets)

Phase 4: Desensitization

Phase 5: Installation

Phase 6: Body Scan

Phase 7: Closure

Phase 8: Reevaluation

Process..

Supportive Network

• Education

• Carer resources

• Meetings

• 1:1 support

• A support worker or CPN

• Regular reviews

• Regular check-ins

Adaptations

Adaptations

• Identify the Target

• Worst Image

• Negative Cognition

• Positive Cognition

• VOC Scale

• Emotions

• SUDS (Image and Emotion)

• Body Location

• “They grabbed me”

• “Their eyes”

• “I should have stopped it”

• “I did the best I could”

• “Middle”

• “Scared, angry”

• “Highest”

• “Head, tummy”

Example Timeline

Adapting BLS

Is EMDR a useful tool?

Should we offer EMDR?

Is it effective?

How do we do it?

Practical Issues

joanne.porter7@nhs.net

Helpful References

• Jowett, S., Karatzias, T., Brown, M., Grieve, A., Paterson, D., and Walley, R., (2016) Eye Movement Desensitisation 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. online

• Mevissen, L., and De Jongh, A., (2010) PTSD and its treatment in people with intellecual disabilities: Areview of the literature. Clinical Psychology Review (30) 308-316.

• Seubert, A (2005) EMDR With Clients With Mental Disability. In Shapiro, R. (Ed.), EMDR Solutions:Pathways to Healing; Norton: London