Yes, as therapists, we seek to change EMPs (Entrenched Maladaptive Patterns), and Memory Reconsolidation is the final common pathway for essentially all enduring change in psychotherapy. But it turns out that the information needing to be modified comes in four quite different flavors. In practice, they demand distinct approaches, and that’s what this post is about.
The four kinds of mental content are the implicit (meaning not conscious) learnings or learned expectations that guide the mind in making predictions (or judgments in the case of how things should be). These learnings represent rules for predicting:
- How it will feel (emotion)
- How things will be
- How things should be
- How the body will feel
Before going into the details of each of these flavors, let’s look for a moment at how information, including these learned expectations, is encoded and stored in memory to be activated later when particular combinations of words and circumstances provide a triggering stimulus.
The nature of information in the brain
The brain, like the RAM in your computer, stores diverse kinds of information in much the same way. The computer encodes music, images, text, numbers, etc.. all in ones and zeroes. The brain uses clumps of neurons that tend to fire together, otherwise known as “neural networks.” This incredibly flexible system handles everything from words to images, to a “weird feeling.” Of course, that also includes nonverbal information such as tone of voice or a fleeting facial expression, as well as principles or rules an individual might draw from experience.
The idea that problems of the mind that causes so much trouble in humans can be thought of as problems of information was expressed in a little known, but prescient book, Snapping by Flo Conway and Jim Siegelman (1978/95). They wrote:
We can identify a common element, whether it be the most intense personal growth experience, the most profound thought, the deepest emotion, or the most mundane phrase or fleeting image that sets off some massive, life-changing human response. It is that wonderous, elusive stuff called information.
The development of implicit learnings or rules
Based on multiple experiences, or perhaps even a single but highly impactful experience, the mind generalizes and stores the knowledge gleaned in the form of learned expectations, otherwise described as schemas, implicit learning, or semantic memory. Just as very small children absorb the rules of grammar, the developing mind seeks to make sense of the world by learning the principles that govern what to expect. Very early, and long before language is learned, mothers can tell the difference between a baby’s cry when it wants something versus a tone of outrage when it expects something. The implication is that the baby has already learned a rule and used it to form a prediction. Furthermore, the rageful cry is an indication that reality has caused a “prediction error” by failing to match expectations. While we are at it, consider what makes babies laugh. Their “jokes” very often involve prediction error, when things aren’t the way they are “supposed” to be.
Nonverbal rules have confused our field
In the field of trauma, therapists often make the same observation as Freud, when he reported that “We found to our great surprise at first, that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect…" In Freud’s description as well as contemporary accounts of the permanent erasure of the intense dread associated with traumatic memories, observers have tended to stop with the incomplete conclusion that conscious awareness accompanied by emotion is the curative agent.
More recently, appreciation of the neurophysiology of Memory Reconsolidation confirms that activation of the traumatic memory and its associated limbic emotion is one of the conditions for resolution of the dread accompanying painful memories. On the other hand, activation of the old memory is not enough. In addition, stored information is only rewritten when a prediction error is generated, signaling a clash between new information and the old. The juxtaposition of two elements, activation of old information and illumination by contradictory new information, is the sine qua non of Memory Reconsolidation.
The emotion-focused view of Memory Reconsolidation
Leslie Greenberg acknowledges the necessary clash of two pieces of information with his phrase, “changing emotion with emotion.” Here the calming and reassuring emotion of the therapist travels down a channel from consciousness to the limbic system, where a prediction error is generated as the new emotion disconfirms the old feeling of horror, “frozen in time” since the traumatic event took place. What is often forgotten is that a calm facial expression and a soothing tone of voice do, themselves, constitute information.
This view of Memory Reconsolidation relates to learned expectations in the first category, “how it will feel.” The required contradictory information is best communicated as a nonverbal expression of emotion, because that is the form in which it is stored. Obviously, nonverbal information meeting nonverbal information should be far more effective as an antidote than a dry cognitive statement such as, “your intense negative feelings are no longer warranted.”
The cognitive view of Memory Reconsolidation
On the other hand, proponents of memory reconsolidation such as Bruce Ecker, with an interest in cognitive schemas, have emphasized a different face of Memory Reconsolidation. The cognitive version of Memory Reconsolidation focuses on learned expectations about “how it will be.” Those implicit learnings are often described as “semantic memory.” They are probably not stored in verbal form at all, but, like the rules of grammar, are retained in some nonverbal form as principles or schemas. (For those interested in ChatGPT, the rules that govern its responses are, likewise, wordless principles buried deep in unknowable connections.)
When such learnings are translated into words and shared in the consulting room, to be effective they need to “resonate,” meaning that they evoke some subtle or not so subtle bodily response or “affect,” indicating an open channel between the limbic system, where they originate, and consciousness. Then, as new, updated meanings travel back down that channel, they are presumably translated into a form compatible with the original memory traces. That is where the important interaction takes place. When the new finally collides with the old, a prediction error is created, leading to memory volatility, rewriting, and ultimately, reconsolidation. Then the old schema or expectation of “what will be” is forever changed.
“How things should be”
A third conundrum is little recognized. The mind holds expectations about how things should be. These are our values. But this stored information is not the same as learned expectations about how things will be. The latter are better described as the mind’s version of facts, rather than values. Values are also distinct in that they inform judgments and lead to special emotions of pride, shame, and guilt. Unlike the anger and disappointment or sadness generated in the limbic system when expectations are not fulfilled, shame and guilt arise in the cortex and are not directly represented in the limbic system.
In many contemporary accounts, these two forms of information are treated as if they were the same. While changing learned expectations is relatively easy, changing values may not be. This is why I question the assumption that treatment recommendations for inappropriate shame and guilt resulting from trauma are the same as those for modifying expectations of what will be.
My clinical experience is that the values that inform the conscience and its production of pride, shame, and guilt, are much harder to change. This makes sense in that a conscience whose values could easily be altered or corrupted under the influence of desire, would no longer be effective. I remain curious as to any relevant research or observations about change processes governing values. My own working hypothesis is that new values can be internalized and activated in such a way that they take precedence over the old ones, but that adverse circumstances can always bring back old, trauma-based negative values in relation to the self. That would suggest that “erasure” of values by Memory Reconsolidation does not happen and that internalization of values is a distinct process.
The final group of learned expectations is about how the body will feel. This, too, involves information learned and stored, but susceptible to rewriting by Memory Reconsolidation. It is time to recognize (or at least hypothesize) that this relatively new realm of psychotherapy makes use of the same change mechanisms as other types of therapy. We are only beginning to acknowledge a range of ways to communicate and share experiences and learnings of the body. Peter Levine often talks about states of self-inhibition that are held as bodily information and become accessible to change when re-activated through verbal exploration. Similarly, Pat Ogden, focuses on how natural bodily responses to traumatic situations can be left incomplete. This unnatural state, for example, being unable to fight back, leads to symptoms until the frozen state is re-activated and, for the first time, brought to completion through embodiment in words, images, or action.
In each case, from an information standpoint, the conditions described are the same as those required for Memory Reconsolidation, namely, activation of the old experience in a way that is contradicted by a new experience.
The take-home of this discussion is that the mind is not nearly as concerned about specific types of information as we are. There is only one way to encode and store wide ranging varieties of information, namely neural networks, or clumps of interconnected neurons that, based on synaptic connections, tend to fire as a unit. When we clinicians begin to think in terms of information in general, rather than specific flavors, the science of Memory Reconsolidation becomes more broadly applicable as a guideline to clarify the universal conditions required for enduring change. To repeat one more time:
- Activation of the old, obsolete information
- Illumination with new, contradictory information
- Affect, indicating openness of a two-way channel linking the client’s limbic system with shared consciousness, where therapist and client work to co-create new meaning.
Jeffery Smith MD
Freud, S. and Breuer, (1893) Preliminary Communication, The Standard Edition, Vol. 2, Hogarth Press, London, 1955, p. 6.
Conway, F. and Siegelman, J. (1995) Snapping, 2nd Edition, Stillpoint Press, New York, p. 97.
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