A therapist-led treatment for symptoms of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities (ID) using eye movement desensitisation and reprocessing (EMDR)

INTERVENTION: Intervention: Patients will be treated using an adapted PES+EMDR protocol based on a combination of adult, child and attachment‐focused EMDR. The PES phase of the protocol (Phase 1) comprises ten weekly sessions: this extended Phase 1 is intended to increase engagement and trust, so as to promote retention in the trial during EMDR. The EMDR phase (Phase 2) involves up to ten weekly sessions, typically fewer. However, in keeping with the NICE recommendation that the standard 8‐12 sessions should be extended if multiple traumas and/or other comorbidities are present, the treating clinician may if clinically necessary extend Phase 2 beyond 10 sessions, but should not exceed a further 5 sessions (Phase 2A) unless this is clinically essential. The protocol will be delivered by experienced ID specialist clinicians (typically clinical or consulting psychologists) who have undergone EMDR training. This is preferable to using EMDR therapists who are not ID specialist clinicians. Work with PwID requires specialist skills that are acquired slowly and not by everyone, and in a roll‐out of the intervention, buying in therapy would often be impractical. Therapists recruited to participate in the project will be trained to administer the protocol by one of the co‐investigators, who is an accredited EMDR trainer. Comparator: The comparator is treatment‐as‐usual (TAU). TAUh would typically include medication, behaviour support plans delivered through carers (intended to decrease challenging behaviour, e.g. by creating a less stressful environment); and/or trauma‐focused or non‐trauma‐focussed (such as anger/stress management) psychological interventions. Participants in the TAU arm of the trial will not be offered trauma‐focussed therapy but could receive any of the other items on the menu of the clinical team supporting them. A process evaluation will include a descripti CONDITION: Post‐traumatic stress disorder in adults with intellectual disabilities ; Mental and Behavioural Disorders ; Post‐traumatic stress disorder in adults with intellectual disabilities PRIMARY OUTCOME: Score at the 8 month (post‐treatment) follow up assessment using the Impact of Events Scale‐revised for people with intellectual disabiltiies (IES‐ID). INCLUSION CRITERIA: Patients with intellectual disabilities (PwID) 1. Aged > = 18 to < = 65 2. Meeting criteria for a diagnosis of ID 3. Meeting ICD‐11 diagnostic criteria for PTSD 4. Major identified trauma at least a year earlier 5. Able to communicate in English and to provide informed consent to both the referral and study participation Carers 1. Aged > = 18 and over 2. A family member or carer of a person with ID who has consented to participate in the trial 3. Able to communicate in English and to provide informed consent to study participation SECONDARY OUTCOME: ; 1. PTSD symptoms measured using the Impact of Events Scale – Intellectual Disabilities (IES‐ID) at 4 months and 14 months; 2. PTSD symptoms measured using Lancaster & Northgate Trauma Scales (LANTS) at 4 months, 8 months and 14 months; 3. Depression symptoms measured using the Glasgow Depression Scale (GDS) at 4 months, 8 months and 14 months; 4. Anxiety symptoms measured using the Glasgow Anxiety Scale (GAS) at 4 months, 8 months and 14 months; 5. Mental Health measured using Clinical Outcomes in Routine Evaluation – Learning Disability (CORE‐LD) at 4 months, 8 months and 14 months; 6. Mental Health measured using Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS‐ADD) at 4 months, 8 months and 14 months; 7. Quality of life measured using the Short Form Health Survey ‐ 12 (SF‐12) at 4 months, 8 months and 14 months; 8. Quality of life measured using the Personal Wellbeing Index (PWI) at 4 months, 8 months and 14 months; 9. Challenging behaviour measured using the Aberrant Behavior Checklist (ABC) at 4 months, 8 months and 14 months; 10. Carer burden measured using the Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS) at 4 months, 8 months and 14 months; 11. Economic impact measured using the Client Service Receipt Inventory ‐ Intellectual Disabilities (CSRI‐ID) at 4 months, 8 months and 14 months;