Remote Eye Movement Desensitization and Reprocessing for Posttraumatic Stress Disorder in Adult Congenital Heart Disease: A Clinical Case Study

Abstract

This case study describes the remote Eye Movement Desensitization and Reprocessing (EMDR) treatment of a 27-year-old woman with Tetralogy of Fallot presenting symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and insomnia. After perceived lack of therapeutic fit for psychological support, she was referred by her adult congenital heart disease (ACHD) cardiologist following clinically significant distress noted at a routine outpatient visit. A structured 10-session psychotherapeutic intervention was delivered entirely via secure videoconference between May and November 2023. The treatment followed all eight phases of EMDR and targeted trauma-related memories linked to early cardiac surgery, procedural sedation, perceived relational absence, and somatic hyperarousal. The clinical approach integrated an attachment-informed and interoception-focused stance consistent with Gestalt pacing, emphasizing embodied awareness, emotional pacing, and relational attunement. Outcomes were monitored at eight time points using validated measures: the Patient Health Questionnaire 9 (PHQ-9), the Generalized Anxiety Disorder 7 (GAD-7), the Insomnia Severity Index (ISI), and the Impact of Event Scale-Revised (IES-R). Substantial improvements were observed across all domains. This case appears to be the first report of a full eight-phase, all-telehealth EMDR course embedded in an ACHD service for an adult with Tetralogy of Fallot, offering reproducible remote adaptations and an interoception-focused pacing strategy. This case underscores the value of trauma-informed psychological care within multidisciplinary cardiac services and supports repeated symptom monitoring to guide pacing and track progress. It was prepared in accordance with CARE case study guidelines.