Unlocking the Emotional Brain: Memory Reconsolidation, Therapeutic Effectiveness, and the Future Evolution of Psychotherapy Bruce Ecker, MA, LMFT

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1 Unlocking the Emotional Brain:, Two Kinds Change Unlocking the Emotional Brain, Therapeutic Effectiveness, and the Further Evolution Psychotherapy Counteractive, incremental change Transformational, liberating, pround change Partial symptom reduction Total elimination symptom Effort to maintain Effortless to maintain Relapses occur Permanent, no relapses Brain s Built-In Process Transformational Change Identified independently by clinicians and by neuroscientists Memory reconsolidation: Brain Brain s process for erasing an existing piece emotional learning / conditioning Symptoms Dispelled in Therapy by the Process Aggressive behavior Agoraphobia Alcohol abuse Anger and rage Anxiety Attachment-pattern-based behaviors & distress Attention deficit problems Codependency Complex trauma symptomology Compulsive behaviors Couples problems Couples conflict / communication / closeness Depression Family and child problems Fidgeting Food / eating / weight problems Grief and bereavement problems Guilt Hallucinations Inaction/indecision Low self-worth, self-devaluing Obsessive thoughts Panic attacks Perfectionism Post-traumatic symptoms / PTSD Procrastination / Inaction Psychogenic / psychosomatic pain Sexual problems Shame Underachieving Voice / speaking problems Convergence clinical observations and memory research Memory reconsolidation 2012 Psychotherapy integration: Unified under

2 Unlocking the Emotional Brain:, Learnings formed in the presence strong emotion Content: How the world functions so as to cause suffering or pleasure Nonverbal, implicit knowing (knowings( we don t t know we know) Verbal, explicit knowing (knowings( we know we know) Examples (after becoming explicit): If I feel sad or hurt or scared I'll be attacked and humiliated. Dad never talking to me or playing with me means I m I m unworthy and don t t matter. If I try for what I really want, the world will crush it, so I better not try for or even feel what I really want. SCHEMA If I try for what I really want, the world will crush it, so I better not try for or even feel what I really want. SYMPTOMS GENERATED If I feel sad or hurt or scared Suppressed emotions, I'll be attacked and humiliated. avoids intimacy Dad never talking to me or Depression, self-devaluing, playing with me means I m I m too low self-esteem unworthy to matter. Passivity, underachieving, emotional disconnection Extinction Research Implied Are Indelible For example: LeDoux,, J. E., Romanski,, L., & Xagoraris,, A. (1989). Indelibility subcortical emotional memories. Journal Cognitive Neuroscience, 1,, Overturned the tenet one-time consolidation and indelibility emotional learning based on a century extinction research : Conclusive detection Synapses unlock (de-consolidate) and after about 5 hours they re-lock (re-consolidation): reconsolidation window Meaning Erasure No loss memory events in one s s life Dissolution meanings, models, core beliefs formed in response to events Cessation emotional states and behavioral tactics driven by those meanings/models/beliefs

3 Unlocking the Emotional Brain:, Core Process for Schema Erasure Reactivate the target emotional schema. Guide a contradictory experience. This juxtaposition unlocks (de-consolidates) the target schema s s memory circuits. ( Mismatch / prediction error experience.) Repeat contradictory experience in juxtaposition with target schema. This re-writes and erases target schema. Preparation for Core Process A. B. C. Symptom identification. What / when: specific behaviors, emotions, thoughts, somatizations. Retrieve underlying emotional schema. Implicit Explicit Find contradictory experience. Therapeutic Reconsolidation Process A. Symptom identification B. Schema retrieval C. Find contradictory experience 1. Reactivate target schema 2. Evoke contradictory experience in juxtaposition 3. Repetitions step 2 V. Verification erasure Markers Schema Erasure Non-reactivation A specific emotional activation no longer gets triggered. Symptom cessation Behaviors, emotions, thoughts and somatics disappear. Effortless permanence Non-recurrence continues without counteractive or preventative measures any kind. Translation Reconsolidation Research into Therapy ~~~~~~~~~~~~~~~~~~~~~ Therapy following the same process yields the same markers change as in reconsolidation research ~~~~~~~~~~~~~~~~~~~~~

4 Unlocking the Emotional Brain:, Many Therapies Congenial to TRP Such as AEDP Coherence Therapy EFT (both them) EMDR Focusing Gestalt Therapy Hakomi IFS Imago IPNB NLP SE TIR as a Framework for Psychotherapy Integration ABC-123-V is evident in AEDP, Coherence Therapy, EFT, EMDR, IPNB and maybe all other therapies transformational change? Case Example: Enduring Abuse At Work His retrieved emotional schema: Life suddenly took away and crushed the top-notch life that I worked so hard for and deserved and was going to have. I've got to never again really want anything or really try for anything I want, because then life could crush me again! If I want or try for a better job, it could happen to me again so, no, thank you.

5 Unlocking the Emotional Brain:, Nonspecific Common Factors Theory 75 years randomized controlled trials (RCTs( RCTs): 14+ different therapies have about equal, modest efficacy RCTs measure average outcomes many individual cases. RCT statistics imply: 15% efficacy is due to specific factors 85% efficacy is due to nonspecific common factors Nonspecific common factors theory asserts: Specific methods and processes can never be the cause powerful therapeutic effects. Nonspecific Common Factors Theory Flaw in : totally based on RCT statistical averages Averaging buries the most successful cases; and RCTs don t t study those cases for specific factors. RCTs hide rather than reveal the operation specific factors, so the conclusion that specific factors can never be highly effective is illogical and unscientific. Psychotherapy Process Studies Show Specific Factor Dominance Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits expressive writing. Advances in Psychiatric Treatment, 11, Elliott, R., Greenberg, L., & Lietaer, G. (2003). Research on experiential psychotherapy. In M. Lambert (Ed.), Bergin & Garfield s handbook psychotherapy & behavior change (pp ). New York: John Wiley. Greenberg, L. S., Warwar, S. H., & Malcolm, W. M. (2008). Differential effects emotion-focused therapy and psychoeducation in facilitating forgiveness and letting go emotional injuries. Journal Counseling Psychology, 55, McCarthy, K. S. (2009). Specific, common, and unintended factors in psychotherapy: Descriptive and correlational approaches to what creates change. Doctoral dissertation, University Pennsylvania. Available online: Missirlian, T. M., Toukmanian, S. G., Warwar, S. H., & Greenberg, L. S. (2005). Emotional arousal, client perceptual processing, and the working alliance in experiential psychotherapy for depression. Journal Consulting and Clinical Psychology, 73, Oei, T. P. S., & Shuttlewood, G. J. (1996). Specific and nonspecific factors in psychotherapy: A case cognitive therapy for depression. Clinical Psychology Review, 16, Oei, T. P. S., & Shuttlewood, G. J. (1997). Comparison specific and nonspecific factors in a group cognitive therapy for depression. Journal Behavior Therapy and Experimental Psychiatry, 28, Pennebaker, J. W. (1997). Opening up: The healing power expressing emotion. New York: Guilford Press. Weinberger, J. (1995). Common factors aren't so common: The common factors dilemma. Clinical Psychology: Science and Practice, 2, Specific Factors Shown To Be Potently Effective in Controlled Studies Facilitation an emotional experience previously avoided, plus attention to emotional meanings strongly fulfilled by Step B therapeutic reconsolidation process Memory reconsolidation process: steps are a specific procedure shown by research to produce pround change Erasure in Human Studies via Specific Factor Reconsolidation Process Schiller, D., et al. (2010). Preventing the return fear in humans using reconsolidation update mechanisms. Nature, 463,, Oyarzún,, J. P., et al. (2012). Updating fearful memories with extinction training during reconsolidation: A human study using auditory aversive stimuli. PLoS ONE 7(6): 7 e Xue,, Y.-X., et al. (2012). A memory retrieval-extinction procedure to prevent drug craving and relapse. Science, 336,

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