from the Neuropsychotherapist, January 2015
Coherence Psychology Institute
Emotional Arousal Is Inherently Necessary for Inducing the Reconsolidation Process
Quite a few psychotherapies of focused, transformational change have emerged since the 1980s, and one of the tenets they have in common is that the client’s engagement in therapy needs to be emotional for deep, lasting change to take place. Perhaps this important clinical tenet contributes to the view maintained by some clinical psychologists that for inducing memory reconsolidation, emotional arousal is necessary (see, e.g., Lane, Ryan, Nadel, & Greenberg, in press).
However, the research shows that the reconsolidation process does not inherently involve emotional arousal.
As noted earlier, successful deconsolidation and erasure have been demonstrated for learnings of many types, some of which have no emotional content per se, such as neutral declarative learnings (set of syllable pairings: Forcato et al., 2009), object recognition learnings (Rossato et al., 2007) and motor task learnings (Walker et al., 2003). In such cases no emotional arousal is involved either in the reactivation and mismatch of the target learning, triggering the reconsolidation process, or in the new learning that then revises the target learning.
The brain clearly does not require emotional arousal per se for destabilizing and erasing the existing learning.
That is a fundamental point.
If the target learning happens to have emotional components, then its reactivation (the first of the two steps required for deconsolidation) of course entails an experience of that emotion. Naturally, target learnings or schemas in psychotherapy usually are emotional, so observable emotion accompanies reactivation and is a key marker of adequate reactivation. However, this emotional arousal is not inherent in the reconsolidation process, and is present only because the target learning happens to involve emotional material. Clinical psychologists and psychotherapists sometimes conflate the emotional nature of target learnings in therapy with the inherent phenomenology of the reconsolidation process, as Lane et al. (in press) appear to do. For an accurate understanding of memory reconsolidation this distinction is important, though from a pragmatic clinical perspective it may seem to be hair-splitting. Emotional arousal is not inherently required in any of the steps that erase a target learning.
When researchers create a new learning to nullify and erase a target learning, this new learning necessarily consists of experiences that sharply contradict the target learning’s expectations and model of the world. Prior to erasure, the target learning is deconsolidated by a mismatch experience that typically consists of either an initial, brief instance of that same contradictory experience or some salient novelty not predicted by the target learning.
For example, the target learning in the human study by Schiller et al. (2010) was a learned fear, specifically the classically conditioned expectation that the appearance of a yellow square on a computer screen would be accompanied in a few seconds by an electric shock to the wrist. For nullification of that learned fear after it had been mismatched and destabilized by a novelty, subjects were repeatedly given the contradictory experience of seeing a yellow square appear and disappear with no shock occurring. The simple experience of seeing each yellow square disappear was not an emotionally arousing experience, yet precisely for that reason it erased the fearful expectation of the shock. Likewise, in psychotherapy we observe that erasure results from a contradictory experience that sharply disconfirms the target learning, and we observe that in some cases the contradictory experience is not in itself emotionally arousing, even though the target learning is strongly emotional. This is possible because the target of unlearning and nullification is the target learning’s schema or model of reality (the semantic knowledge in the target learning), not the emotions generated by that model.
This important point is illustrated by the following case vignette from my psychotherapy practice, which shows successful nullification and erasure of an emotional target learning resulting from a contradictory knowledge that is not emotional.
The client, a married woman, aged 50 and the mother of one child, sought therapy to dispel her aversion to sexuality with her husband, her depression, and her panic attacks, all of which had been afflicting her for at least a decade. I was using coherence therapy, in which the non-conscious, implicit emotional learnings that underlie and drive a given symptom are first brought into direct, explicit awareness, and then subjected to the process of memory reconsolidation and erasure, creating transformational change. Session by session, into explicit awareness was emerging a complex array of underlying, implicit emotional learnings, some of which involved traumatic memories from various developmental stages of her life. In her first session I found that she would dissociate and become glazed and wooden in response to even a small step of interior exploration. She had a total of 45 sessions and was symptom-free at the end.
This vignette focuses only on the particular emotional learning that emerged in her ninth session. This learning had formed when she was 18 years of age and had become pregnant by her boyfriend while living with her parents in a conservative town. She was living in shame and “desperate loneliness,” did not want the baby or the boyfriend, and was struggling to decide about having an abortion when she had a miscarriage. Wanting to find the emotional learnings she had formed in this ordeal, I gently guided her into experientially revisiting and reinhabiting that situation imaginally, and voicing her thoughts and feelings in present tense. This technique is often useful for bringing the implicit meanings of the original experience into explicit awareness. She seemed absorbed in the subjective reality of this material, and her voice was soft but somber as she said, “In this town, a girl who’s been pregnant outside of marriage is just ruined, completely ruined.” In order to elicit fully and explicitly the learning she had formed, I asked softly, “What does ‘ruined’ really mean? What’s going to happen to you now?” After a silence, in an even quieter voice she said, “The rest of my life as a woman is ruined. I’ll never marry, and I’ll never have children.”
There it was, the specific learning she had formed. According to this learning, which had been implicit and outside of awareness for decades, having sex had results that had ruined the rest of her life. Immediately I understood that this dire model of her future was a potent source of both her depression and her sexual aversion. With this clarity about the makeup of this target learning, I saw a possible way to create a contradictory experience: use of the brain’s automatic detection of mismatches, a background process that is always scanning current conscious experience. So in reply to her words, I said, “Please say that again.” Somberly, and clearly feeling the emotional reality of the words, she said again, “The rest of my life as a woman is ruined. I’ll never marry, and I’ll never have children.”
As soon as she spoke the words this time, her wider conscious knowledge networks registered this information, which was new to her conscious networks though it was old in her implicit memory system. Her head made an abrupt movement, and in a sharper, louder voice she said with obvious surprise, “Wait—that’s not true! I did marry! I did have a child!”
This first encounter between the target learning and vivid contradictory knowledge was the mismatch experience or prediction error needed for deconsolidating the target learning. This both-at-once experience of the target learning and vivid contradictory knowledge is termed a juxtaposition experience in coherence therapy to emphasize the simultaneous activation of the two as co-present conscious experiences. Note that in this instance, the mismatching knowledge—“I did marry! I did have a child!”—was familiar, ordinary knowledge that was very real to her experientially, as real and certain as her own existence, but it was not inherently emotional in quality. It would not normally induce emotional arousal by itself. For successful mismatch, the knowledge or experience utilized must feel decisively real to the person on the basis of his or her own living experience, but that does not require this mismatching knowledge to be emotionally arousing in itself, even though the target learning is strongly emotional.
(As noted above, the emotional quality of the target learning is extraneous and incidental to the reconsolidation process, not inherent in it.)
Presumably the neural encoding maintaining “My life as a woman is ruined, I’ll never marry, I’ll never have children” was now rapidly destabilizing, opening that set of learned meanings to being rewritten and erased by the knowledge, “I did marry! I did have a child! My life isn’t ruined!” She said in almost a whisper, “That just feels huge.” Then her head tipped back against the top of her chair, and she gazed at the ceiling with blinking eyes. Then her eyes closed, and after about ten seconds she said, “I feel tingling and buzzing all over my body. It’s weird—I can feel the skin between my toes. It’s huge, it’s huge.” Internally she was repeatedly beholding and marvelling at the new realization, which served as the several repetitions of it needed for rewriting the now deconsolidated target learning. For good measure, I soon created an explicit, out-loud repetition by jokingly saying, “I’m seeing an image of you running down the street waving your arms and shouting, ‘I did get married! I did have a child! My life wasn’t ruined!’” She laughed heartily at that, but even before I said it, her mood had shifted into a happy lilt that I had never seen in her before. Her contradictory knowledge was not emotional in itself, but the liberating effect of its use in the reconsolidation process certainly was. I then reminded her that in our previous session she had raised a major question: “Why did I start feeling unbearable sadness and depression when I became pregnant with my son 13 years ago?” I asked her, “Does today’s session help you see why?”
Her eyes widened with this further powerful realization that the later pregnancy had re-evoked her emotional memory of the much earlier one, reimmersing her in the complex emotional miseries that accompanied that pregnancy and the miscarriage. She said, “Ohhh—that’s an amazing insight.” After that session, her longstanding depressed mood was gone and did not return. This confirmed that the targeted learning had been producing that mood, and that erasure or dissolution of that learning had been accomplished—meaning that “I’ll never marry, I’ll never have children” no longer felt real or true in any memory network. Her depressed mood had been the conscious surface of the unconscious despair and grief generated by the target learning. That session was also the beginning of the end of her sexual aversion, which was dispelled after several more sessions that revealed a number of other episodes in her life where great suffering had resulted from or accompanied sex.
Finally she no longer felt any urge to avoid her husband’s overtures, though she did feel vulnerable and cautious about entering into a new level of sexuality with him. Those of course were natural, appropriate feelings, and I coached her on expressing to him her need for him to sensitively honor her pace and her cues. Her panics attacks proved to be based in yet other emotional learnings. They ceased after the discovery and dissolution of those other learnings through juxtaposition experiences tailored to them. The main purpose of the case vignette above is to show that the disconfirming knowledge or experience used for creating a mismatch experience and then nullifying the target learning does not necessarily have to be emotional in itself. The vignette also illustrates the lifelong durability of original emotional implicit learnings or schemas, as well as their dissociated, encapsulated state, which keeps them insulated from and immune to new experiences and new knowledge formed later in life.
By being retrieved into conscious, explicit awareness, emotional implicit learnings become fully available for contact with other, disconfirming knowledge that can induce transformational change through juxtaposition (mismatch) experiences. Thus, for consistently guiding decisive change through the reconsolidation process in therapy, the required reactivation of a target learning has to be its reactivation as a conscious, explicit experience of the retrieved, specific elements of the target model (such as “I’ll never marry or have children, so my life as a woman is ruined”), not merely the re-triggering of a still non-conscious, unretrieved implicit schema. Such implicit learnings are often re-triggered in day-to-day life without conscious awareness, and often life also provides strong disconfirmations, but because the schema remains outside of awareness, there is no juxtaposition experience—no conscious co-experiencing of both the old and new knowledge of what’s real— and therefore no change takes place. In psychotherapy, when an implicit schema maintaining symptom production becomes a conscious, explicit experience, the schema continues to feel subjectively completely real and compelling, and it persists in driving symptom production. This continues until the schema encounters a mismatch and disconfirmation experience, creating the conscious juxtaposition described above. Then abruptly the schema can lose its feeling of emotional realness and its power to control behavior or state of mind, and symptoms cease. Now the schema is not re-triggered by situations and cues that formerly triggered it. I and other practitioners of coherence therapy have observed this clinical phenomenology many, many times (Ecker & Hulley, 1996; Ecker & Toomey, 2008; Ecker et al., 2012).
Thus, conscious, subjective awareness and attention appear to function as the arena where separate, differing schemas (learnings, knowings, representations of reality) can come into mutual contact and undergo a combined semantic evaluation that allows for a revision of one schema by the other through the reconsolidation process. Our clinical observations suggest that the brain and mind appear to operate according to a metarule that allows dissociated schemas to differ but requires consistency between schemas that are experienced concurrently in the same field of awareness (Ecker & Hulley, 2011).
Guiding a juxtaposition experience cooperates with this metarule in order to transform a symptom-generating schema.
When two mutually contradictory schemas are juxtaposed consciously, the schema that more comprehensively or credibly models reality, and therefore more usefully predicts how the world will behave, reveals the other schema to be false, and the falsified one is immediately transformed accordingly. Maximizing predictive power is well known to be a primary function and organizing principle of the brain (Clark, 2013; de-Wit, Machilsen, & Putzeys, 2010; Friston, 2010).
The previous paragraph emphasizes that a conscious, vividly experienced juxtaposition is found to be critically important in the psychotherapeutic utilization of memory reconsolidation. That emphasis could appear to be at odds with recent research and recent reviews of research: Delorenzi et al. (2014), Pine et al. (2014), and Santoyo-Zedillo, Rodriguez-Ortiz, Chavez-Marchetta, Bermudez-Rattoni, & Balderas (2014) have demonstrated that a target learning can be reactivated without coming into conscious awareness or behavioral expression, and that even under such conditions a mismatch/prediction error can then take place and destabilize the target learning, allowing it to be updated by new learning or disrupted chemically.
How can these findings be reconciled with the clinical picture, in which the unconscious learnings maintaining symptoms are not dissolved until they come into conscious juxtaposition with contradictory knowledge? There are several dynamics that might provide answers to that question (Ecker & Toomey, 2008).
First and foremost, researchers have shown that the stronger and/or older the target learning is, the stronger must be the reactivation in order for destabilization to occur (Frankland et al., 2006; Suzuki et al., 2004). The target learnings in psychotherapy typically are both very old and also very strong, as they involve (and were formed in the presence of) intense emotion and urgent contingencies.
Reactivation that produces conscious, bodily felt emotion, expectations, and meanings (as facilitated in therapy) is much stronger than reactivation that remains outside of awareness, which may be why conscious juxtaposition is observed to be necessary for achieving transformational change in therapy.
Another relevant dynamic is the active suppression and dissociation of emotional learnings that have strongly distressing content, which is the case for many of the target learnings that figure significantly in psychotherapy. Such active, self-protective suppression and dissociation could insulate these nonconscious, implicit learnings from direct juxtaposition with contradictory experiences in everyday life, preventing them from being updated. That insulation is removed in therapy by gently and gradually bringing these learnings into conscious awareness, allowing juxtapositions and transformational change to occur. There is yet another reason why the versatile clinical utilization of memory reconsolidation requires first bringing a target learning into conscious experience. Researchers know the detailed makeup of the target learning, having created it themselves.
This knowledge allows them accurately to reactivate and mismatch the target learning, destabilizing it, and also to then conduct new learning designed precisely to nullify and erase it. In sharp contrast, clinicians are in the dark at the start of therapy, with no knowledge of the makeup of the target learning driving symptom production. Therefore it is only by bringing the target learning into explicit awareness and verbalization that its makeup can be known, and only then and not before can the therapist design and guide experiences of mismatch and nullification learning.
In summary, this section began by explaining that the reconsolidation and erasure process does not inherently involve or require emotion in either the target learning or the new learning that is juxtaposed with and nullifies it.
In psychotherapy, however, the target learnings usually are richly emotional, so emotional arousal accompanies the therapeutic reconsolidation process as a rule, but this presence of emotion should not be conflated with the intrinsic nature of the reconsolidation process. The examination of juxtaposition phenomenology then continued into a clarification of why therapeutically effective juxtapositions have to be conscious experiences, even though reconsolidation research has shown that under special laboratory conditions, the process can take place outside of awareness.