The eyes have it

It sounds too good, and frankly too bizarre, to be true. After just three 90-minute sessions, people suffering emotionally after severe trauma such as rape, a car accident or abuse, can be rid of their debilitating symptoms. Add the fact that the therapy involves moving the eyes rapidly from side to side, and that it was discovered by an American while out for a walk, and one would forgive a sceptical raising of eyebrows.

Yet the treatment, Eye Movement Desensitisation and Reprocessing (EMDR), is believed by some to be one of the most effective treatments for post-traumatic stress disorder (PTSD). It has been used to help Britons affected by September 11, survivors of the Paddington and Hatfield rail disasters, and those traumatised by the Hillsborough football tragedy. Further afield, it has offered relief to those caught up in the earthquake in Turkey, the floods in Bangladesh and the wars in Bosnia and Croatia.

EMDR was developed by the American psychologist Dr Francine Shapiro, who, struggling to come to terms with a cancer diagnosis in 1987, noticed that her distressing thoughts lessened when she moved her eyes from side to side. Her subsequent research, published in 1989 in the Journal of Traumatic Stress, found in a randomised controlled study of 23 PTSD sufferers, who included victims of rape and abuse and Vietnam veterans, that symptoms were dramatically reduced after one long session of treatment.

The therapy was brought to Britain by Dr John Spector, a consultant clinical psychologist at Watford General Hospital. Impressed by a paper in the Journal of Behaviour Therapy and Experimental Psychiatry in 1991, written by the American psychologist Dr Joseph Wolpe (one of the founders of behavioural therapy), Dr Spector started using the treatment on his patients with "astonishingly good" results.

Dr Spector, who then trained in the method under Dr Shapiro, has since organised the training of more than 2,000 British mental-health professionals, about half of whom work in the NHS. EMDR is now used almost exclusively at the PTSD clinic at Watford General Hospital, and is commonly used at the Maudsley in south London.

PTSD symptoms include nightmares, flashbacks and intrusive and disturbing memories, believed to be the result of trauma too severe to process. The disturbing memories are held in the right hemisphere, the more primitive, non-verbal part of the brain, on which traditional talking therapies are thought to have little effect. Each time a person is reminded of the trauma, perhaps by a sound or image, they experience high anxiety and panic, which rational thought from the left hemisphere does little to quell.

EMDR appears to work by stimulating connections between the right and left hemispheres. "It may be related to what happens in REM sleep, which we know is a time when we process information," says Dr Spector. "During that period the eyes are moving quite rapidly and if you have a nightmare and get to a very frightening point you wake up. What we are doing in EMDR is keeping the eye movements going to get the processing through that point to resolution."

Clients are asked to concentrate on a visual image that represents the most upsetting aspect of their trauma, a corresponding belief such as "I'm bad" or "It was my fault", and notice what they experience physically. Meanwhile, the therapist moves his or her finger swiftly back and forth about 2ft from the client's face. About 24 movements are performed, watched by the client, who is then asked what they experienced. The process is typically repeated 20 to 40 times per session, which lasts from 60 to 90 minutes. The stimulation can also be achieved by tapping alternative hands, or by audio stimulation in each ear, but research has found the eye movement to be more effective.

"The therapist doesn't talk much apart from asking for information such as 'What did you notice?' As long as we are getting new information then we're happy. All we look for is movement of information," says Dr Spector. "At some point in this process, which is often intense and emotional for the person, they get to a point where they begin to notice that it feels less and less disturbing. They begin to notice that their view of themselves in this situation changes in a more positive way. They bring more functional information into the picture which connects with the traumatic material and they start to understand, for example, that it wasn't their fault that they were raped."

Interestingly, neurological changes also take place. Scans have shown a normalisation of brain wave-patterns after three sessions, with dormant left-hemisphere functions beginning to become active again and the right hemisphere dulling down. A client suffering from the effects of a one-off trauma, such as a road accident, would typically need between three and five sessions. Complex trauma, such as childhood abuse, can require up to 40.

EMDR also appears to be useful for anxiety disorders, pain, panic disorder and body dysmorphia (where people have an irrational belief that some part of their body is disfigured or unpleasant), claims Dr Spector. It has been used to help with gambling, personality disorders and depression, but the evidence base is much less strong than that for trauma.

A spokesman for the Department of Health said: "Compared to other treatments in this field, EMDR has been reasonably well evaluated... and the reported outcomes are generally favourable. The DH views any developments in this area with interest."

For Tony Knibb, 39, a constable with Hertfordshire Police, the treatment was "miraculous". At one stage, the policeman's PTSD symptoms were so severe that he contemplated suicide. Problems began several weeks after attending a stabbing incident in March 2001. "It was an upsetting scene, but nothing I hadn't experienced before," he says. "There was a large pool of very dark blood outside a fast-food restaurant and the person who had been attacked was in hospital, and later died."

Over the next few weeks, he thought of the scene more and more. "I couldn't seem to get the pool of blood out of my mind, and I started to have flashbacks. I then started having flashbacks of when I was in the army and had seen similar scenes in Northern Ireland. I hadn't thought about it for 20 years, but I could smell it and hear it. To all intents and purposes I was there. I wasn't able to focus on my normal life. I was overtaken by fear and a bit of guilt about situations I had been to and maybe could have done more about.

"I became very focused on my own personal safety. We were having difficulties getting protective vests, and I train probationers, so I was with quite inexperienced officers. I felt vulnerable. I didn't want to go out. I thought: 'Any time now I'm going to get killed.' I was depressed and it got to the point where I was contemplating suicide. I couldn't see beyond these flashbacks. I was in this world I couldn't get out of."

He turned to the force's occupational health department, and was eventually referred to Watford General. His first treatment was in October 2001. "It was traumatic because I had to think very carefully about the incidents, but I went out more relaxed than I had been in six months and more in control of my emotions." After his second session, he felt almost completely recovered.

Several weeks later he dreamt that he had been sexually abused as a child. Slowly memories came back and his parents confirmed they had suspected something had occurred. The officer had a third and final session of EMDR in January last year. By March he was back to full operational duties. "I haven't had any flashbacks since. I've got the memories, but I'm not disturbed by them. It's put all the ghosts in the past. It's miraculous as far as I'm concerned. I've been in the police for seven years and I haven't enjoyed it as much as I have in the last six months."

EMDR Association UK & Ireland, 020-8752 0429; PTSD clinic at Watford General, 01923 217554