BEHAVIORAL AND BRAIN SCIENCES (2015), Page 1 of 64 doi:10.1017/S0140525X14000041,e1 Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science Richard D. Lane Department of Psychiatry, University of Arizona, Tucson, AZ 85724-5002 Departments of Psychology and Neuroscience, University of Arizona, Tucson, AZ 85721 [email protected] Lee Ryan Department of Psychology, University of Arizona, Tucson, AZ 85721 [email protected] Lynn Nadel Department of Psychology, University of Arizona, Tucson, AZ 85721 [email protected] Leslie Greenberg Department of Psychology, York University, Toronto, Ontario M3J 1P3, Canada [email protected] Abstract: Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components – autobiographical (event) memories, semantic structures, and emotional responses – supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: (1) reactivating old memories; (2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and (3) reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed. Keywords: change processes; emotion; implicit processes; memory; neuroscience; psychotherapy; reconsolidation 1. Introduction understanding the past, whereas Ferenczi deviated from Freud by emphasizing the importance of emotional The modern era of psychotherapy arguably began with arousal in psychotherapy (Rachman 2007). Ferenczi’s ap- Breuer and Freud’s(1895/1955) Studies on Hysteria. In proach became the basis for the humanistic tradition that seminal work, Breuer and Freud hypothesized that the launched by Carl Rogers and Fredrick Perls (Kramer inability to express emotion at the time of trauma was the 1995). Within psychoanalysis, however, the therapeutic im- cause of hysteria (now called conversion disorder). They portance of emotion was further refined by Alexander and proposed that the key to treatment was emotional abreaction, French (1946), who proposed that the “corrective emotion- or catharsis. Once the feelings that had not been expressed al experience” was the fundamental therapeutic principle were brought to conscious awareness and relived, the symp- of all “etiological psychotherapy.” In their definition it toms, Breuer and Freud proposed, would disappear. meant “to re-expose the patient, under more favorable cir- Within the psychoanalytic tradition, Freud increasingly cumstances, to emotional situations which he could not emphasized the importance of remembering and handle in the past. The patient, in order to be helped, © Cambridge University Press 2015 0140-525X/15 Downloaded from https:/www.cambridge.org/core. University of Basel Library, on 30 May 2017 at 18:25:45, subject to the Cambridge Core terms of use, available at 1 https:/www.cambridge.org/core/terms. https://doi.org/10.1017/S0140525X14000314 Lane et al: Memory reconsolidation, emotional arousal, and the process of change in psychotherapy must undergo a corrective emotional experience suitable RICHARD D. LANE is a Professor of Psychiatry, Psychol- to repair the traumatic influence of previous experiences” ogy, and Neuroscience at the University of Arizona. A (Alexander & French 1946). They also pointed out that psychiatrist with a Ph.D. in Psychology (cognitive “intellectual insight alone is not sufficient.” neuroscience), he is the author of more than 130 articles ’ and chapters and is senior editor of one book. His The integrity and reliability of the evidence for Freud s research on emotion, the brain, and health has been theories continue to be a topic of heated debate (Erdelyi funded by grants from the National Institute of 2006; Esterson 2002; Gleaves & Hernandez 1999; Mental Health, the National Heart, Lung and Blood McNally 2005). Research shows that emotional catharsis Institute and multiple other sources. He is a past alone (e.g., beating a pillow) does not attenuate or dissipate president of the American Psychosomatic Society, a affect but rather leads to a heightening of it (Bushman Distinguished Fellow of the American Psychiatric 2002). Nevertheless, the importance of inducing emotional Association, an elected member of the American arousal as an ingredient in bringing about therapeutic College of Neuropsychopharmacology, and an change has stood the test of time. In his seminal overview Honorary Fellow of the American College of Psychoan- of psychotherapy practices, Jerome Frank (1974a) stated alysts. He is an award-winning teacher who has been director of Psychiatric Residency Training in Psycho- that emotional arousal was a key ingredient in the success of psychotherapy. Modern psychoanalysts hold that re- therapy at the University of Arizona for the past 20 fl years. experiencing and resolving core emotional con icts in the transference relationship has a reality and authenticity LEE RYAN is a clinical neuropsychologist and a Profes- that cannot be surpassed by other means (Luborsky sor of Psychology and Neurology at the University of 1984), and evidence for the effectiveness of psychodynamic Arizona, and the associate director of the Evelyn psychotherapy is emerging (Leichsenring & Rabung 2008; F. McKnight Brain Institute. Her research focuses on Shedler 2010). the role of medial temporal lobe structures in In behavior therapy (BT), cognitive-behavioral therapy memory, as well as age-related changes in brain struc- (CBT), and emotion-focused therapy (EFT), emotion ture and function and their impact on memory and ex- plays a central role in change. In behavioral therapy (BT) ecutive functions. She is the author of more than 80 for anxiety disorders, activation of affect in the therapy peer-reviewed articles. Dr. Ryan is the director of Grad- uate Studies in the Department of Psychology and has session is a critical component and predictor of therapy won awards for her outstanding undergraduate and success (Foa & Kozak 1986). CBT assumes that emotional graduate teaching, including the Humanities College distress is the consequence of maladaptive thoughts. Thus, Outstanding Teacher award (2012). the goal of these clinical interventions is to examine and challenge maladaptive thoughts, to establish more adaptive LYNN NADEL is currently Regents Professor of Psychol- thought patterns, and to provide coping skills for dealing ogy and Cognitive Science at the University of Arizona. more effectively with stressful situations (Dobson 2009). His research, published in more than 175 journal Eliciting emotional responses through role-playing, imagi- articles, chapters, and books, has been supported by nation, and homework exercises is key to the identification grants from the National Institute of Mental and reformulation of these maladaptive thoughts. Recovery Health, the National Science Foundation, the National is facilitated by activities that encourage engagement of rel- Institute of Child Health and Human Development, the National Institute of Neurological Disorders and evant pathological cognitive structures in a context that also Stroke, and several private foundations. He was the provides information at odds with existing beliefs. In the co-recipient in 2005 of the Grawemeyer Prize in humanistic tradition, research on EFT has also demonstrat- Psychology (for the “cognitive map” theory) and re- ed that the intensity of emotional arousal is a predictor of ceived the National Down Syndrome Society’s Award therapeutic success (Missirlian et al. 2005). One must con- for Research (2006) and the Sisley-Lejeune Internation- clude that there is something about the combination of al Prize for Research on Intellectual Disability arousing emotion and processing that emotion in some (2013). He is a Fellow of the American Psychological way that contributes to therapeutic change, but the specif- Society, the American Association for the Advancement ics of what it is about emotion that actually brings about of Science, and the Society of Experimental change are not clear. Psychologists. Insight-oriented psychotherapy places heavy emphasis on the recollection of past experiences. It is typically LESLIE GREENBERG is Distinguished Research Professor Emeritus of Psychology