This post was originally published in Neuropsychotherapist magazine January 2015
and written by
Bruce Ecker
Coherence Psychology Institute
Misconception 4:
Anxiety, Phobias, and PTSD Are the Symptoms That Memory Reconsolidation Could Help to Dispel in Psychotherapy, but More Research Must Be Done Before It Is Clear How Reconsolidation Can Be Utilized Clinically
This section really comprises a blend of two misconceptions. First is the view that for clinical use, reconsolidation could be suitable for helping to dispel learned fears of various kinds, with symptomology such as PTSD, phobias, panic attacks and anxiety. This impression probably stems from the consistent tendency of researchers to comment in their research articles that reconsolidation has significant potential for treatment of PTSD and anxiety disorders. Researchers have to be ultraconservative in what they write so that everything they propose is firmly based on what is known according to the current state of research. Reconsolidation is relevant as a candidate treatment only for conditions that are maintained by memory, and for a brain researcher there is no risk that PTSD could be unrelated to memory and therefore no risk of a departure from the required empiricism.
Furthermore, fear is the most reliably detectable and measurable type of negative emotional response, so that researchers preferentially envision applications of the reconsolidation process to fear symptomology. Clinicians, however, regularly observe phenomenology showing that an extremely wide range of other conditions also are rooted in and driven by implicit memory (Ecker et al., 2012; Ecker & Toomey, 2008; Toomey & Ecker, 2007; Schore, 2003; Siegel, 2006).
Nevertheless, it is not conventional practice for neuroscience researchers to reference that body of knowledge. In fact, reconsolidation research has already demonstrated that the process applies to many types of learning other than fear learnings—for example, appetitive (pleasure) learnings (Stollhoff et al., 2005), operant (instrumental) learnings (Exton-McGuinness, Patton, Sacco, & Lee, 2014; Gallucio, 2005), spatial learnings (Rossato et al., 2006), object recognition learnings (Rossato et al., 2007), motor task learnings (Walker et al., 2003), taste recognition learnings (Rodriguez-Ortiz, De la Cruz, Gutierrez, & Bermidez-Rattoni, 2005), human declarative learnings (Forcato et al., 2007), human episodic learnings (Hupbach, Gomez, Hardt, & Nadel, 2007), and emotionally compelling human preferences (Pine, et al., 2014), among others.
In fact, to my knowledge, as of this writing, all tested types of learning and memory have been found to submit to the process of reconsolidation. That is extremely good news for psychotherapy, as the learnings that underlie and drive individuals’ problems and symptoms are of many different kinds and not necessarily fear-based.
Examples from my own practice of non-fear-based implicit emotional learnings brought into direct awareness include: the expectation to be allowed no autonomy, with reliance on secrecy and lying to maintain personal power; the heartbreak-laden memory of father abandoning the family when the client was 4 years old and the ensuing conviction that the cause was her own deficiency; and the expectation of severe devaluing and derision from others for any mistake or misstep, generating paralyzing states of shame and inhibition.
The second misconception in this category is this: In reconsolidation research articles, the authors typically comment that much more research must be done before it is clear how reconsolidation can be utilized in psychotherapy. This is hardly the case. In reality, for over a decade before neuroscientists’ discovery in 2004 of the sequence of experiences that triggers reconsolidation (Pedreira et al., 2004), psychotherapists had been knowingly guiding clients through that sequence, having recognized from clinical observations that it was responsible for transformational therapeutic change (as described below). Furthermore, since 2006, psychotherapists have been translating reconsolidation research findings into successful therapeutic methodology. In 2006 I gave a keynote address to a conference of psychologists and psychotherapists (Ecker, 2006), describing the critical sequence of experiences that is required, according to reconsolidation research, for erasing a target emotional learning. In that talk, a clinical case example from my practice illustrated the guiding of that sequence and the resulting permanent disappearance of a longstanding, intense emotional reaction. In subsequent years, many articles and conference talks have presented the critical sequence in many clinical case examples of using it to decisively dispel a wide range of symptoms and problems (e.g., Ecker, 2008, 2010, 2013; Ecker, Ticic, & Hulley, 2012, 2013a,b; Ecker & Toomey, 2008; Sibson & Ticic, 2014).
Note that according to current neuroscience, memory reconsolidation is the only known process and type of neuroplasticity that can produce what we have been observing clinically: the abrupt, permanent disappearance of a strong, longstanding, involuntary emotional and/or behavioral response, with no further counteractive measures required.
So, in psychotherapy we have been guiding the same well-defined sequence of experiences and observing the same distinctive signs of erasure as reconsolidation researchers have. We have applied the process successfully to the real-life, highly complex emotional learnings that underlie and maintain symptoms of many different types (see citations in the previous paragraph). Also, successful clinical use of protocols designed to induce reconsolidation and erasure have been reported by Högberg et al. (2011) and Xue et al. (2012).
The latter demonstrated, in a controlled study, a strong degree of elimination of heroin addicts’ cue-induced craving for heroin. Thus the new era of the psychotherapy of memory reconsolidation is well underway. It had a curious birth: From 1986 to 1993, my clinical colleague Laurel Hulley and I closely scrutinized the occasional therapy sessions in our practices in which abrupt, liberating change had somehow occurred—the lasting cessation of a problematic pattern of emotion, behavior, cognition and/or somatics. Finally we identified a sequence of experiences that was always present, across a wide range of clients and symptoms, whenever such transformational change occurred. We developed a system of therapy focused on facilitating that key sequence of experiences right from the first session of therapy, and found that working in this way made our sessions far more consistent in producing transformational therapeutic breakthroughs. We began teaching this methodology in 1993 at a workshop in Tucson, Arizona, followed by our first published account of it in the volume Depth Oriented Brief Therapy (Ecker & Hulley, 1996). Subsequently the same sequence of experiences emerged in reconsolidation research, providing corroboration of our clinical observations by empirical, rigorous studies. It seemed remarkable that the same process for erasing emotional learnings had been discovered independently in the therapeutic domain of subjective, experiential phenomenology and in the laboratory domain of research on animal memory circuits. In hindsight that convergence now seems most natural, because any process of lasting change that is truly innate to the brain would inevitably be apparent in both domains.
Our psychotherapy system, now known as coherence therapy, guides the series of experiences required by the brain for reconsolidation and erasure to occur, creating transformational change (Ecker & Hulley, 2011). It is the only system of psychotherapy that explicitly calls for and maps directly onto the process identified in reconsolidation research, but there are many other systems of therapy in which the same process also takes place, albeit embedded within methodologies conceptualized quite differently.
It is clear that no single school of psychotherapy “owns” the process that induces memory reconsolidation, because it is a universal process, inherent in the brain.
In any therapy sessions, the occurrence of transformational change can now be presumed to mean that reconsolidation and erasure of the target response have occurred, whether or not the therapist was knowingly guiding that process. Toward confirming that universality, we began an ongoing project of explicitly identifying the embedded steps of the reconsolidation and erasure process in published case examples of various forms of psychotherapy (Ecker et al., 2012; see Chapter 6).
Thus, knowledge of memory reconsolidation can enhance the effectiveness of individual psychotherapists, but more importantly, it also translates into a unifying framework of psychotherapy integration in which the many different systems of therapy form a huge repertoire of ways to guide the brain’s core process of transformational change. This framework gives practitioners of different therapies a shared understanding of their action and a shared vocabulary for their action. Of course, not all systems of psychotherapy are equally consistent and reliable in fulfilling the sequence required by the brain for erasure of a target learning, and this too becomes apparent through this unified framework.
Reprinted from International Journal of Neuropsychotherapy Volume3 Issue 1 (2015)
