Save and Strong after sexual trauma - psychomotor therapy for people with mild intellectual disability or borderline intellectual functioning who were sexually abused

The consequences of sexual abuse, especially in people with mild intellectual
disability or borderline intellectual functioning (MID-BIF), can manifest in
complex behavioral, psychological and health problems with broad and long-term
impact on functioning. An important but often insufficiently recognized effect
of sexual abuse involves body experience. From recent research focused on body
experience of people with MID-BIF, there is an indication that particularly in
the domain of body awareness, more problems are experienced when there has been
sexual abuse (Smit et al., 2023). People with MID-BIF who have experienced
sexual abuse are more aware of their body signals, but are less able to pay
adequate attention to, tolerate and interpret these body signals than people
with MID-BIF who have not experienced sexual abuse (Smit et al., 2023).
Problems in body experience are related to difficulty feeling, recognizing and
regulating arousal and emotions and indicating needs and boundaries within
social relationships. Disturbances in body experience are related to the
consequences of sexual abuse such as trauma-related symptoms, psychological
symptoms and coping skills. Psychomotor therapy (PMT) is an experiential
treatment with specific attention to disturbed body experience, arousal and
emotion regulation, and learning to set boundaries. PMT is often used in
general mental health care (GGZ) for (sexual) trauma with valuable scientific
results for effectiveness of this form of treatment (van de Kamp et al., 2019,
2023). PMT has been integrated into the treatment offerings within the care of
people with intellectual disabilities, with experiential treatment matching the
target group. But to date, the scientific evidence for effectiveness and
well-described experiences about PMT of people with MID-BIF is lacking.

The aim of the proposed research is to test the effect and evaluate the PMT
module Safe and Strong, a psychomotor intervention targeting the consequences
of sexual abuse in people with MID-BIF and improving the body experience and
psychological health.
1) a) Does the use of the PMT module Safe and Strong have an effect on the body
experience, arousal complaints, coping skills and the treatment goals of
clients as reported by clients themselves, caregivers and relatives?
b) Does the use of the PMT module Safe and Strong have an effect on
trauma-related complaints and psychological problems of clients?
2) a) What is the social validity (suitability for daily life) of the PMT
module Safe and Strong?
b How is the PMT module Safe and Strong evaluated by clients themselves,
caregivers and relatives and which elements are mentioned as most effective?*

In cooperation with psychomotor therapists from different regions of 's Heeren
Loo, the PMT module Safe and Strong will be offered. To realize the
implementation and advice, experts by experience with MID-BIF and an expert
group consisting of people from different disciplines within 's Heeren Loo will
be involved in the research.
We use a 'multi-method design' to test the effect and evaluate the treatment:
- An N=1 design with a controlled non-concurrent multiple baseline across
subjects experimental design quantitatively tests the effect of treatment.
Appropriate to this study design, frequent repeated measurements are caried out
with the clients and also with the (in)formal network during a randomized
baseline period, an intervention period with three phases of treatment and
post-intervention period. The frequently repeated measurements focus on,
achievement of individually set treatment goals, coping skills and arousal
regulation complaints. Within this N=1 design, measurements in the baseline
period are compared with measurements in the intervention period for each
individual client, which allows clients to serve as their own control. The
replicability of the effect is tested by applying this design to multiple
clients with different starting points of the intervention. In this multiple
baseline design, the effect is tested from client to client through a
randomization test. In addition, trauma-related symptoms, psychological
problems and body experience are measured with standardized questionnaires in
the client and network at six points in time.
It is expected that with inclusion of fifteen clients even with dropout of
clients -during treatment and at follow-up- a total of at least twelve N=1
studies can be realized (Bouwmeester & Jongerling, 2020). In combination with
the research design, the number of repeated measurements, the randomly assigned
baseline period and the analysis plan, we expect to be able to make statements
about the individual effect of the PMT module and by using a randomization
test, statements about replicability become possible.
- The qualitative part of the research, as an in-depth and supplement to the
quantitative part, focuses on the experiences and perceptions of the clients,
caregivers and relatives during and after the psychomotor intervention. Based
on semi-structured interviews, we answer the question of how those involved
assess the social validity (suitability for daily life) and efficacy of the
treatment and what their considerations are.

At the request of PMT practitioners working in the care of intellectual
disabilities, the PMT module Safe and Strong was developed with the help of
experts by experience and focus groups of psychomotor therapists working in the
care of intellectual disabilities. The PMT module was developed for individual
treatment of people with MID-BIF who have experienced sexual abuse with the
involvement of a support network. The PMT module focuses on positively
influencing body experience, arousal and emotion regulation and learning to
actively set boundaries. The PMT module Safe and Strong is composed of three
phases and lasts between 26 and 44 sessions and was examined for feasibility
and efficacy in an initial pilot study with five participants


The pilot study is approved by the Social Sciences Ethics Committee of Radboud
University under No. ECSW-2020-116 and publication in preparation.

The intervention involves a protocolized offering of treatment elements that
are already present in treatment practice. For this reason, the risk is not
increased with respect to regular treatment. As far as possible, the
questionnaires will be included in the existing procedures for diagnosis and
treatment. The burden on the clients, caregiver and relative consists of
completing a short self-report questionnaire twice a week (5 minutes),
completing several standardized questionnaires at six times (30-45 minutes)
(largely integrated into the treatment sessions) and participating in an
interview after the module (30-60 minutes).