Sequential EMDR and CBT for Small-t Trauma in an Adult With Autism Spectrum Disorder: A Clinical Case Report

This clinical case report describes a sequential combination of eye movement desensitization and reprocessing (EMDR) therapy and cognitive behavioral therapy (CBT) for small-t trauma in an adult patient with autism spectrum disorder (ASD). Individuals with ASD could be vulnerable to the accumulation of nonlife-threatening adverse interpersonal experiences, often described as small-t trauma, which can contribute to anxiety, depressive symptoms, and social withdrawal. The patient was a 25-year-old woman with ASD who presented with flashback-like symptoms and social anxiety related to distressing childhood and adolescent experiences with family members and school-related experiences. Treatment consisted of EMDR sessions targeting these traumatic memories, followed by CBT focused on cognitive restructuring and adaptive interpersonal coping. Across treatment, traumatic stress, anxiety, and depressive symptoms decreased, and the patient transitioned from unemployment to employment through a disability employment scheme. This case illustrates how EMDR may reduce trauma-related distress sufficiently to allow subsequent CBT work on current interpersonal difficulties. Although causal conclusions cannot be drawn from a single case, this report suggests that EMDR adapted to the characteristics of ASD, followed by CBT, may be clinically useful for addressing small-t trauma in adults with ASD.