You would be forgiven for thinking that eye movement desensitisation and reprocessing (EMDR) looks a bit like hypnosis. The procedure typically involves the therapist quickly passing their fingers backwards and forwards across their client’s field of vision to encourage eye movement.
This ‘bilateral stimulation’ helps the client to become desensitised to distress associated with particular images or events (see Shapiro 2001 for detailed overview).
A vast body of evidence supports the use of EMDR in treating post-traumatic stress disorder (PTSD) (Bisson et al 2007), however little research has explored the efficacy of EMDR for people with learning disabilities.
Reported prevalence of PTSD within the learning disability population is widely inconsistent yet we know that people with learning disability are vulnerable to abuse and neglect (Mencap 2012) which can increase the likelihood of developing PTSD (Sullivan et al 2006), making this an important evidence base to explore. A recent paper by Gilderthorp (2014) set out to review all previous studies which evaluate the use of EMDR for treating PTSD in people with a learning disability.
The author accessed a range of online databases – PsychInfo, Cochrane databases (Systematic Reviews and Randomised Controlled Trials), CINAHL, ASSIA and Medline – to search for papers dating from ‘the present day’ back to 1987; the year when EMDR was first conceptualised. Papers were selected if they included participants with learning disabilities who had received EMDR as a treatment for PTSD.
Reference lists of papers were checked for salient work, however two relevant papers were not available in English and were therefore discarded, and unpublished work was not sought. A total of five papers, all case study design, were ultimately included.
Three studies described the use of EMDR for nine people with mild learning disabilities, and two people with moderate learning disabilities.
Two further studies described the use of EMDR for six people with moderate or severe learning disabilities.
Most appeared to have achieved positive outcomes such as reduced distress, improved mood, and/or improved PTSD symptoms. In a minority of cases EMDR had limited beneficial impact.
The author goes on to critically evaluate the papers. Although they were all highly applicable to real practice, their case study design meant they lacked reliability and control. For example, in some cases EMDR was administered at the same time as other interventions which reduces the validity of claims that EMDR was responsible for the therapeutic outcomes.
The author also critiques the papers’ overall lack of consistency in diagnosing ‘mild’, ‘moderate’ or ‘severe’ learning disability, as well as difficulties diagnosing PTSD. Additionally, follow up assessments were used inconsistently, making it difficult to draw conclusions about the long term benefits of EMDR for this population.
The papers also lacked detail in their descriptions of the intervention itself, particularly where adaptations had been made to accommodate peoples’ intellectual or cognitive abilities.
This paper presents some tentative early findings which suggest people with learning disabilities do benefit from EMDR for the treatment of PTSD.
The author suggests that more work could explore factors which impact on the usefulness of EMDR or ability to deliver EMDR according to the protocol.
Strengths and Limitations
The main weakness in this review is the failure to seek out all sources of evidence to be included. Firstly, two non-English papers were not included and secondly, unpublished work was not sought. Publication bias suggests that work with non –significant improvements are the least likely to go forward to publication (Sterne et al 2001).
By not seeking out these unpublished sources the author could have inadvertently skewed the conclusions towards a more optimistic outcome.
Although this paper was engaging and interesting, I was left wondering about the use of EMDR in people with learning disabilities.
In many cases the author gives no detail on how EMDR had been delivered, the period over which these sessions lasted, who delivered the EMDR, or how studies decided upon their outcome measures.
The author made no attempt to draw comparisons between the studies, perhaps due to their case study design. However it would have been interesting to see an overview (perhaps a simple table?) of the studies highlighting key facts e.g. level of learning disability, other diagnosis, how long EMDR was administered for and what outcome measures were used.
Moreover, the author talks about how the studies offered “flexibility” to clients, adapting EMDR to their individual needs however the review gives little insight into these adaptations and methods of delivery.
This is really more a criticism of the original papers and of research publication practice in general; so often papers fail to describe their methods in replicable detail. Indeed, the author suggests none of the papers have enough detail to allow replication of the intervention and their adaptations.
This paper emphasises the potential benefits of EMDR with a learning disability population. However, lack of detail regarding delivery of the intervention itself may make it difficult for individuals to integrate this into their practice, particularly regarding any adaptations from the generic EMDR protocol.
The review importantly brings attention to this gap within learning disability literature and outlines the foundations upon which future research studies may be able to build.
To hit the ‘gold standard’ in demonstrating efficacy of EMDR for people with learning disabilities we need to see some randomised controlled trials!
Gilderthorp, R.C. (2014). Is EMDR an effective treatment for people diagnosed with both intellectual disability and post-traumatic stress disorder? Journal of Intellectual Disabilities, [abstract]
Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder Systematic review and meta-analysis. The British Journal of Psychiatry, 190(2), 97-104 [abstract]
Mencap. (2012). Out of sight: stopping the neglect and abuse of people with a learning disability. Mencap, London.
Shapiro, F. (2001) Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. 2nd ed. New York: The Guildford Press.
Sterne, J. A., Egger, M., & Smith, G. D. (2001). Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ: British Medical Journal, 323(7304), 101 [abstract]
Sullivan, T.P., Fehon, D.C., Andres-Hyman, R.C., Lipschiz, D.S., & Grilo, C.M. (2006). Differential relationships of childhood abuse and neglect subtypes to PTSD symptom clusters among adolescent inpatients Journal of Traumatic Stress, 19(2), 229-239 [abstract]