A Cognitive Strategy Approach to EMDR for Trauma Post Severe Traumatic Brain Injury: A Single-Case Feasibility and Acceptability Study

Abstract

Cognitive strategy approach eye movement desensitization and reprocessing (EMDR) is a new approach to adapting the standard eight-phase EMDR protocol to the needs of clients with a traumatic brain injury (TBI). This is a single case study of a 23-year-old female with severe TBI following a road traffic accident with posttraumatic stress disorder (PTSD). On neuropsychological assessment, she scored below the average range across subtests of immediate and delayed memory, language, attention, and visuospatial perception, and on clinical observation, she had significant difficulties with executive functioning including emotional lability and poor planning and problem solving, suggesting significant cognitive impairment. Cognitive strategy approach EMDR was used as a key intervention to reprocess the trauma memory within one 40-minute session. She was assessed, pre- and postintervention as well as at 3-month follow-up, on measures of depression and anxiety (Hospital Anxiety and Depression Scale) and PTSD (Clinician-Administered PTSD Scale and Impact of Events Scale-Revised), which all showed a significant immediate reduction on reliable change indices for symptoms of PTSD and anxiety that either improved or was maintained at 3-month follow-up. This case study represents a first in terms of the evidence base for the benefits of cognitive strategy approach EMDR to treat emotional difficulties, including PTSD, experienced by a person with marked cognitive deficits as a result of a severe TBI.