“We see largely with the mind and only partly with the eyes.” William Bates, Better Eyesight without Glasses.1909,1977.

Vision training exercises used in Affect Regulation Therapy facilitate fast and effective relief of stress for our clients. But how does it work? Read on to find out more.

Vision takes place in the brain

The retina has a maximum sensitiveness point, that is called the fovea centralis or central pit. The center of the fovea is the seat of acutest vision. The acuteness of vision rapidly decreases away from this spot. The eye with normal vision sees one part of everything it looks at best and all other parts worse in proportion to their distance from the point of maximum vision. In abnormal conditions of the eye, functional or organic, this central function is lost.

“When sight is normal the sensitiveness of the fovea is normal. When sight is imperfect, the sensitiveness of the fovea is lowered.” William Bates, 1909,1977.

When there is tension, vision becomes imperfect

One of the causes of this loss of function in the centre of sight is mental strain, or stress. Perfect vision requires relaxation, memory and imagination. When tension exists, vision becomes imperfect. In turn imperfect vision causes memory to worsen and impairs the ability to imagine. This pathology illustrates that vision problems can have a psychological component.

What is the evidence?

William Bates, a physician and ophthalmologist, discovered that “when the mind is under strain, the eye usually goes more or less blind.” (William Bates, 1909, 1977). Bates conducted numerous experiments that tested the eyes of tens of thousands of animals and humans. He found that the retina is white when relaxed, pink under mild stress and dark brown under severe stress. He also found that 40% of children have diminished eyesight after only a few years of school due to the stress of learning.

To combat these effects, he developed vision therapy and implemented vision programs in schools in the USA. He used a tool called The Snellen Card, which tested distant vision of a familiar object. The therapy involved asking students to close their eyes and imagine a perfect full stop. His theory was, “central fixation of the eye means central fixation of the mind.” (William Bates, 1909,1977). In other words, good vision requires good mental function and vice versa. His vision therapy used deep relaxation, memory and visualization to correct vision impairments.

Bates’ vision program experienced wide success, decreasing the number of children with lowered eyesight needing glasses. But in spite of his widespread success, his programs were discontinued from the education curriculum. 

Has there been further research?

In his book on vision training, ‘The Suddenly Successful Student’, Skeffington, an optometrist, describes this view on vision and the mind: “Vision is the neurological balancing system, the master coordinator for the whole body mind system.”

Based on his findings in practice, Skeffington developed a new form of vision therapy. His techniques included breathing techniques, self-awareness, postural training and balance exercises. He found that during vision therapy his patients would undergo a transformation or transition period, with neurological and psychological features. During therapy the client typically would experience dizziness, nausea, headaches and depression. At completion of the therapy, client benefits included sound mental health, increased energy, creativity and good vision.

Skeffington’s work showed that vision therapy is also psychotherapy, and importantly, that vision therapy helps to release stress. Skeffington’s methods and results are valuable in explaining for example how a psychotherapy such as EMDR – Eye Movement Desensitization and Reprocessing, might work..

Vision exercises are an aspect of this therapy and since 1989 more than 200 research papers have been published on the effectiveness. of EMDR as a treatment for anxiety and PTSD.

The body and mind feedback loop

Although Bates was an ophthalmologist, and Skeffington an optometrist, and

both were therefore concerned primarily with improving vision, they uncovered the mental and emotional benefits of vision therapy. They found that vision is impaired by stress, and that vision problems have a psychological component. Bates discovered that vision training lowers stress levels and that there is a feedback loop between vision, cognition, learning, mood, memory, imagination, social behaviour and metabolic processes. The eyes thus provide us with a useful biofeedback tool.

Bates found that health was impacted by vision training in a broader sense too. He found the sensory perception of sight, touch, taste, hearing and smell could all benefit from central fixation. He found that digestion, assimilation, elimination are improved by it; symptoms of functional and organic diseases can be relieved, and efficiency of mental skills are increased.

Final thoughts 

In Affect Regulation Therapy vision training exercises are used as part of the psychotherapy treatment program, not to improve vision, but rather as a fast and effective way to decrease stress levels.

The advantages of this approach is that there are many added side benefits for clients – in addition to better mental health, clients also commonly report improvement in social relationships and for example, their reading skills improve. Clearly there are advantages to including vision training as a therapy tool.

Why Silver Medals Can Hurt Olympians

By:  Anca Ramsden

Our  Australian  Olympic athletes have collected twenty medals thus far, one gold, twelve silver and seven bronze. For a small nation this is an excellent achievement and we are proud of our high achievers.

 Although winning a silver or bronze medal is better than going home without a medal, the victory has a bittersweet side to it, because  getting so close to gold and then being beaten, often by just  a fraction of a second, is a painful disappointment. Many tears have been  shed and  have been followed no doubt by much soul searching.

 A case in point is James Magnussen’s loss of the gold medal for the 100metres freestyle to American swimmer Adrian by one hundredth of a second.  Magnussen’s time was 47.53 seconds, Adrian touched at 47.52 seconds. Struggling with disappointment Magnussen said afterwards, ‘This hurts.’

Some Australian sport  commentators have been of the view that our athletes could have performed better had they been more disciplined in their practice and more realistic in their expectation of themselves. Magnussen was very confident of winning gold and after his loss had to acquiesce to being ‘a mere mortal.’ He took some criticism for his pre-games bravado, but whether this attitude could have harmed his performance is uncertain. I doubt it. If examined indepth it  was possibly a defence to cope with the stress of intense competition.

The reality is with the most thorough preparation and best outlook even the most talented Olympic athletes cannot control all influences at the time of competition.

One of the biggest problems athletes face, is that no matter how fit and prepared they may be for an event, they can never be 100 percent certain that they will be performing at their best during an  event. James Magnussen has previously swum the 100 metre freestyle in 47.10 seconds.  “It all [the race] seems like a blur. So much is going on in your mind going into it [the race]. I don’t know if you can notice my eyes are pretty bloodshot, I haven’t had a great deal of sleep but you know I did my best and it wasn’t as quick as trials [47.10s] but it’s a different ball game here.’

Read more: http://www.smh.com.au/olympics/swimming-london-2012/agony-for-magnussen-beaten-to-gold-by-narrowest-of-margins-20120802-23g8l.html#ixzz22iNuKQhw 

One of the reasons for erratic performance is that the stress of the pressure to perform  during an event harms performance. Magnussen described the swim itself as being a blur, indicating performance stress was active and potentially affecting his speed. The best way  to insure oneself against the negative effects of stress on athletic performance is to raise baseline stress tolerance.

It is my experience that it is possible to raise baseline stress tolerance  with a body/ mind stress control technique such as Affect Regulation Therapy and improve the way an  athlete can control stress just prior and during  an event. The fact that stress will harm performance is unavoidable and one of  biggest threats to ultimate success  remains pressure to perform on the field.

When it comes to stress management most athletes prepare themselves to perform under pressure by rehearsing for every aspect of the event and having strategies in place to cope during the event. Although this approach  does have benefits for performance stress it is unfortunately of limited benefit, because it cannot redress the pervasive negative effects of our total life history  of stress, the factor that lowers our baseline  stress tolerance.

There are two specific problems with stress that affect competing athletes. Stress can have either an activating or an immobilising effect on us.  The problem when we get even slightly stressed is that either of these states can kick in. And both states can often act on body and mind  simultaneously.  If stress were only a mobilising force it would always be positive, but unfortunately it can very rapidly and uncontrollably switch to an immobilising force. This directly impacts on speed and can make the difference between gaining or losing the one hundredth of a second.

The second problem athletes face with stress, is that fully controlling stress with our conscious mind is impossible, because our stress reactions start as physical reflexes and  this biological fact makes stress a very slippery fish to catch. By activating the stress control centres (the hippocampus) of the brain to inhibit the reflex stress centres (the amygdala) a body/mind stress control technique can give natural control over stress emotions. My experience with sports people shows they  can then maintain better mental and emotional control while they compete.

My research on the psychology of stress over the past twenty years has made me appreciate the  nefarious effects of  life stress on mental, emotional and physical performance. My view now is that  better baseline stress tolerance is the key to Olympian athletes’ maintaining their maximum mental and physical fitness when it matters most. 

Recently, I saw a client who had made a significant and rapid shift from being depressed, anxious and uncertain to being very self confident after only ten sessions of Affect Regulation Therapy. I thought this was a good illustration of how the client had done the bulk of his self development work using a variety of psychotherapies over several years and how Affect Regulation Therapy could complete the personal development process in an elegant way for the client.

So I asked the client to give a personal account of his therapy experience and this is what he wrote:

‘I believe that I am a victim of child trauma, which until recently, has been untreated, incorrectly treated, then well treated but with little effect.

About 25 years ago, the career stresses were so overwhelming that for the first time in my life I engaged in the abuse of prescription as well as recreational drugs. This led to anxiety attacks & adopting a psychiatric approach which involved minor tranquilizers as well as antidepressants. The whole exercise was a total disaster and made my symptoms worse. I decided to drop the meds and shrinks and learn to live with it.

About 10 years ago, the relationship woes that were sitting on top of my inner child injuries were so severe that I decided to disconnect from everyone who was causing me distress & had ever caused me distress.

As horrible as this move was for all concerned, it was the beginning of my healing.

My first long term therapy involved family systems study, mindfulness and inner child work, all of which I feel was on the right track but not powerful enough for my “condition”.

Next I tried ACT (Acceptance and Commitment Therapy), which is a fine method – I find it useful for everyday stresses – eg if the bills are hard to pay, I can practice cognitive defusion as a way of accepting the stress without being overwhelmed by it.

All of these methods enabled me to realise that I was living in a house with bad foundations, understanding & accepting the situation with grace, and getting on as best I could.

What Affect Regulation Therapy enabled me to do was to rebuild the foundations.

I didn’t just soothe my inner child. I was able to empower him. Now I feel assertive….and liberated. Not in an arrogant way – actually, I find that I have more empathy for others, because I am not as worried about my inner child. My question to those with a similar history would be: “Why accept, when you can rebuild?”

This testimonial illustrates how complementary Affect Regulation Therapy  can be to other psychotherapies and how  ideal for clients who need more long term work because of childhood trauma. The rapid and dramatic changes in the client are made possible because of his previous self development work. He had already laid a good foundation on which to build.

It is good for clients to know that any personal development work they do is always a building block towards future wellbeing. It is helpful to use different therapy methods. And Affect Regulation Therapy  can be an ideal method to move the client to next level of wellbeing and health after other psychotherapies.






When psychologists start using their Affect Regulation Therapy skills immediately after their training they often choose to work with their long-term clients first. They seem to be more comfortable explaining the new techniques to clients with whom they have a well established trust relationship. At the time their clients have often had several months, or in some cases several years of psychotherapy.

One of my trainees, a counseling psychologist, explained to me that she had been using CBT (Cognitive Behavior Therapy) and ACT (Acceptance and Commitment Therapy) with a client for 12 months to treat several anxieties.  The client felt anxious in social situations and had not driven a car for six years. She started A.R.T. and after six sessions her client noticed  more confidence socially and he also started driving again. The client also felt he was getting a better result from hypnotherapy after A.R.T.

In another instance, I recently got the feedback from an A.R.T. practitioner, also using her new skills with her long-term clients, that her clients observed immediate improvements in mental clarity and better emotional control after A.R.T. They felt less emotional over-reactivity and sensitivity.

The evidence here points to the value of A.R.T. as a preparation for other psychotherapy techniques, such as CBT, EMDR, ACT and hypnotherapy. And A.R.T. also has unique ‘add on’ benefits for clients who have already had those particular psychotherapies.

When A.R.T. is used as a preparation for other psychotherapies, therapists can find that their clients respond much faster and better to their interventions. The reason for this is that A.R.T. can very specifically reduce emotional stress and lower hyper-arousal states. This means clients become more receptive to cognitively based approaches after A.R.T. Practically this means less work for the client, faster results and being able  to use their often limited funds to cover more  psychological ground, so better quality of life for the client.

Where the client has already been treated long-term with one of the abovementioned treatment methods, A.R.T. can be very effective in still further improving client wellbeing by accessing and developing certain psycho-social-emotional-cognitive areas not previously tapped into. Developing these areas proffers the hallmarks of A.R.T. benefits: the increased mental clarity, emotional regulation, emotional appropriateness and better cognitive/emotional balance. It is fairly standard for clients to specifically report these improvements in their mental health after A.R.T., even when they have had many years of cognitive-behavior or a psychodynamic psychotherapy.

Based on my own observations in my practice and also on the feedback I regularly get from my trainees A.R.T. delivers certain unique benefits to clients’ mental health and it is a valuable aid at any stage in a psychotherapy process.

I ran Level Two A.R.T. training in Townsville, Australia this April, after being invited by four practitioners who had completed Level One in November 2011.  They were actively using the Level One A.R.T. techniques in their practice with clients and were getting good results, so they were keen to master the Level Two skills as well.

After clients have completed the short term therapy phase of 6 to 15 sessions, and released most acute stress, they generally need to do more in depth work on their social and emotional developmental phases and this is taught in Level Two.  The practitioners found that they now needed these skills in order to move forward with their long term clients.

The group consisted of three psychologists Dr Martha Landman, Dr Alana Bowen and Dr Evelyn Graham and a clinical social worker. Kylie Osborne. Dr Landman, Dr Bowen and Kylie Osborne had also each previously submitted three case studies and received supervision and are now listed as A.R.T. practitioners on the A.R.T. website.

The trainees found the protocols and tools for working with the social, emotional and sensori-motor developmental stages and the integration of these into therapy in a practical way to be valuable and immediately useful in practice with their own clients. Dr Martha Landman immediately used the protocols and information on the second stage of social emotional development with a long term client during the training and could report a successful outcome with the client to the group.

Whereas Level One training teaches how to use A.R.T. as a brief intervention, of up to 15 sessions, Level Two training gives the psychologist a deeper understanding of the growth processes their client goes through in long term therapy. It also teaches more varied skills, allowing the psychologist to work more in depth with long term clients who have more chronic or complicated conditions.

The trainees mentioned that they found the information about physiological signs of emotional processing very valuable. In practice, they observe their clients frequently reporting body sensations that seem related to emotion processing and they found it helpful knowing where emotions are expressed in the body, as well as the significance of certain sensations.

For example, one psychologist reported that her client had experienced a tingling sensation in and around the lips and she found it helpful to learn that this sensation can be linked with an infant fear reflex, the Moro reflex. This would indicate that her client was both releasing early infancy fears and also learning better controls over his anxiety responses. She could report that her client had made significant gains with stress control and an improvement in mood since she had been working with him.

The group had already learnt many physical signs of emotion processing in Level One training, but could now add a new library of knowledge in this area and they found that it gave them more insight into what they had been observing in their clinical practice.

Another of the reasons trainees had for attending Level Two was they wanted to learn more about using sensory integration in psychotherapy. They had been incorporating the sensory exercises into therapy for clients “when they are not into talking”.  They find that clients often do not want to talk about their past or about trauma and that it is helpful to have another medium to access the client’s emotional or mental state. As a participant said, ‘My type of client doesn’t talk, so it’s very helpful.’

They had also observed that when their clients practice the sensory integration exercises at home they respond better in therapy sessions. I concur on this, as I have seen in my practice that those clients who practice the exercises at home on a regular basis make faster progress in therapy sessions.

They had also found, to their surprise, that many of their clients spontaneously used the exercises at home for self calming, without being instructed to do so. It was mentioned that clients find the stretch exercises particularly valuable.

Another valued aspect of A.R.T. that practitioners mentioned was the instantaneous positive effects of A.R.T. For example, a client goal was ‘To have a clear head’, (a very common therapy goal for stressed clients) and the client’s feedback at the end of the session was, ‘I feel so sharp’. Practitioners find this immediate result makes it a positive intervention. I find that in the case studies that practitioners submit this is a very common outcome.

Dr Graham said that she finds that clients come into sessions stressed and tense and at the very least this state can be altered immediately. That is worthwhile in itself and it can also be a way of preparing the client for therapy as well. She gets referrals of clients for whom other therapy methods have not delivered results and she then uses  A.R.T. as  an alternative approach.

Practitioners also discussed how to prepare clients for A.R.T. Each practitioner has developed their own way of introducing the therapy to clients. Dr Graham has given clients the DVD on the book “The brain that changes itself” by Norman Doidge, as this explains concepts like neuroplasticity. This is an area psychologists often discuss. In my practice I explain the technique as being a method for improving the left and right brain connection and that this calms emotions. I suggest each practitioner find their own rationale, based on their own understanding of the therapeutic ingredients.

Apart from discussing cases and clinical applications for various disorders and learning how to use the techniques, we also practiced the techniques with one another, which meant that each participant had a few sessions to personally experience the therapy. Observing one another and experiencing the physical and emotional changes firsthand was a valuable learning tool. And we also get the benefits personally, which is a great plus to doing the training. I regularly get feedback from my students about how well they are doing in their personal lives after completing a training course.

One practitioner said she had had the happiest time of her life since the Level One training.  Another said A.R.T. had helped her cope significantly better with a personal loss. The group also noticed that some trainees looked refreshed and younger after a session.

This improvement in appearance is a common observation after one or several sessions and can be attributed to an improved toning of the facial muscles after stress release and a better left right brain integration, which gives the face a more symmetrical appearance, which is more pleasing to the eye of the beholder. And dullness in the iris of the eyes is replaced by a shiny brightness and better colour. This result raised the comment, “Oh, so it is also a beauty therapy”. Well, that is just an added bonus to solid results on improved mental health!

Affect Regulation Therapy can be used to support the initial delicate phases in psychotherapy of rapport building and contracting for treatment with the client, because it is consistently effective at immediately lowering stress levels and raising mood in a client-friendly way. Here is how it can support you, the clinician, in your practice.

When clients present for psychotherapy they are propelled by a state of psychological discomfort, which may have a variety of causes, commonly difficulties with relationships and latent immaturities.

At time of presentation, the client’s stress levels are usually high. In a general clinical psychology practice, clients may commonly present for treatment with symptoms of stress, depression and anxiety that can range from mild, moderate to severe. Without this type of psychological discomfort, clients wouldn’t arrive for help.

Clients expect assistance from the psychologist to relieve their pain and, at this point, the client wants to know “Can you help me?” “Do you understand what my problem is?”  and “How long will it take to fix it?”

The psychologist is immediately faced with a number of urgent tasks at the first interview. He or she must form a working alliance and positive rapport, or positive transference, with the client and establish a relationship of trust with the client, a goodness of fit to work together. The psychologist must also communicate how therapy works, what goals can be worked on, the context or interpretation of the client’s problem and approximately within what time frame the client can expect what type of result.

This is known to be a delicate period when the contract can easily be derailed and the working relationship lost. However once these tasks are under the belt, both client and psychologist can be more confident, comfortable and relaxed about their joint project, because they have established a mutual trust relationship with a mutual positive expectation of a good result. They have made a commitment to work together, hopefully based on mutually realistic expectations.

A.R.T. can be used by the experienced clinician to support this initial, delicate phase of rapport building, introducing, and contracting, and then starting a psychotherapy process, because it is a client-friendly model that supports your relationship with your client in many ways, the most important of which is that the clinician can use A.R.T. to help the client right away.

It is important that the client feels that he or she got help in the first session. A.R.T. can support this goal by being used as a very brief 5 to 15 minute intervention in the first, second or third interview, to immediately and observably lower the client’s stress level. Generally this will elicit a comment by the client such as ‘Now I feel really relaxed’. This observable shift or change in tension level raises client confidence in the likelihood of future positive therapy outcomes.

This brief intervention, together with the supportive interview and debriefing nature of the first and second interview, will often result in an immediate, significantly reduced score on depression, anxiety and stress scales. This positive result obviously elevates client commitment and can lower overall dropout rates in a practice.

Feedback by a psychologist after she attended a recent training course in A.R.T. illustrates the value of immediate stress relief in a first session.  She had been in psychotherapy for several years to resolve early childhood attachment issues, which had resulted in chronic elevated stress levels for her.

She was surprised that after one session of A.R.T., in a demonstration setting during training, she had significant relief from chronic stress. Her long term psychotherapy had been enormously helpful and she had made progress, but she had reached a point in her therapy where she felt  ’stuck’ and was not making enough ongoing progress and her therapist had concurred with her on this.

She made the following comment after the A.R.T. training,   ‘I am still feeling very good and even feel more sociable. I went to an outdoor boxing class last night that I have felt cynical about due to my perceived clique-iness of the local women! It was fine and I felt normal and great that I went! Thank you.’

Such a reduction in stress and positive change in emotional status can be observed by the client within minutes in a session or within a 24 hour period after a session. I find that even  young children can comment on their change in mood and well being after the intervention.

This elevation of positive emotion translates directly into the client’s enthusiasm
and motivation to set up a treatment contract with the therapist, which fulfills one of the aims of the first three psychotherapy sessions.