Handout Camft Keynote 2013

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

Two Kinds of Change

Unlocking the Emotional Brain Counteractive, Transformational, incremental liberating, profound Memory Reconsolidation, Therapeutic Effectiveness, change change and the Further Evolution of Psychotherapy  Partial symptom  Total elimination reduction of symptom Bruce Ecker, MA, LMFT  Effort to maintain  Effortless to maintain

 Relapses occur  Permanent, no relapses COHERENCE PSYCHOLOGY INSTITUTE

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Brain’s Built-In Process of Symptoms Dispelled in Therapy Brain’s Built-In Process of by the Memory Reconsolidation Process Transformational Change Aggressive behavior Food / eating / weight problems Agoraphobia Grief and bereavement problems Alcohol abuse Guilt • Identified independently by clinicians Anger and rage Hallucinations Anxiety Inaction/indecision and by neuroscientists Attachment-pattern-based Low self-worth, self-devaluing behaviors & distress Obsessive thoughts Attention deficit problems Panic attacks Codependency Perfectionism • Memory reconsolidation: Complex trauma symptomology Post-traumatic symptoms / PTSD Compulsive behaviors Brain’s process for erasing an existing piece Procrastination / Inaction Couples’ problems of of emotional learning / conditioning conflict / communication / closeness Psychogenic / psychosomatic pain Depression Sexual problems Family and child problems Shame Fidgeting Underachieving COHERENCE COHERENCE PSYCHOLOGY Voice / speaking problems PSYCHOLOGY INSTITUTE INSTITUTE

Ramiﬁcations of Convergence Memory Reconsolidation of clinical observations and memory research 1995 2004 2012 • Enhanced effectiveness of individual Memory reconsolidation clinicians and of the field as a whole • Psychotherapy integration: Unified under- standing of core process in diverse therapies

• Role of attachment in therapy is clarified

• Empirical process of profound change refutes nonspecific common factors theory COHERENCE COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Keynote Address www.CoherenceInstitute.org 2013 CAMFT Annual Conference © 2013 Coherence Psychology Institute, LLC Unlocking the Emotional Brain: Memory Reconsolidation, Therapeutic Effectiveness, and the Future Evolution of Psychotherapy Bruce Ecker, MA, LMFT Emotional Learnings Emotional Learnings

♦ Learnings formed in the presence of strong emotion Examples (after becoming explicit): • If I feel sad or hurt or scared I'll be attacked ♦ Content: How the world functions so as to cause and humiliated. suffering or pleasure • Dad never talking to me or playing with me means I’m unworthy and don’t matter. ♦ Nonverbal, implicit knowing (knowings we don’t know  we know)  • If I try for what I really want, the world will crush it, so I better not try for or even feel Verbal, explicit knowing (knowings we know we know) what I really want. COHERENCE COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Emotional Learnings Extinction Research Implied SCHEMA SYMPTOMS GENERATED Emotional Learnings Are Indelible • If I feel sad or hurt or scared • Suppressed emotions, I'll be attacked and humiliated. avoids intimacy For example: • Dad never talking to me or • Depression, self-devaluing,  LeDoux, J. E., Romanski, L., & Xagoraris, A. (1989). playing with me means I’m too low self-esteem Indelibility of subcortical emotional memories. unworthy to matter. Journal of Cognitive Neuroscience, 1, 238–243. • If I try for what I really want, • Passivity, underachieving, the world will crush it, so I emotional disconnection better not try for or even feel

what I really want. COHERENCE COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Memory Reconsolidation Meaning of “Erasure”

• Overturned the tenet of one-time consolidation • No loss of memory of events in one’s life and indelibility of emotional learning based on a century of extinction research • Dissolution of meanings, models, core beliefs formed in response to events • 1997–2000: Conclusive detection • Cessation of emotional states and behavioral • Synapses unlock (de-consolidate) and after tactics driven by those meanings/models/beliefs about 5 hours they re-lock (re-consolidation): “reconsolidation window”

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Core Process for Schema Erasure Preparation for Core Process

Reactivate the target emotional schema. 1. A. Symptom identification. What / when: specific behaviors, 2. Guide a contradictory experience. emotions, thoughts, somatizations. This juxtaposition unlocks (de-consolidates) the target schema’s memory circuits. B. Retrieve underlying emotional schema. (“Mismatch” / “prediction error” experience.) Implicit  Explicit Repeat contradictory experience 3. Find contradictory experience. in juxtaposition with target schema. C. Find contradictory experience. This re-writes and erases target schema. COHERENCE COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Therapeutic Reconsolidation Process Markers of Schema Erasure

A. Symptom identification A. Symptom identification ♦ Non-reactivation B. Schema retrieval A specific emotional activation no longer gets triggered. C. Find contradictory experience ♦ Symptom cessation 1. Reactivate target schema Behaviors, emotions, thoughts and somatics disappear. 2. Evoke contradictory experience in juxtaposition 3. Repetitions of step 2 ♦ Effortless permanence Non-recurrence continues without counteractive or V. Verification of erasure preventative measures of any kind.

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Translation of Ramiﬁcations of Reconsolidation Research into Therapy Memory Reconsolidation ~~~~~~~~~~~~~~~~~~~~~ • Enhanced effectiveness of individual clinicians and of the field as a whole Therapy following the same process Psychotherapy integration: Unified under- yields the same markers of change • standing of core process in diverse therapies as in reconsolidation research ~~~~~~~~~~~~~~~~~~~~~ • Role of attachment in therapy is clarified • Empirical process of profound change refutes COHERENCE nonspecific common factors theory COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Ramiﬁcations of Many Therapies Congenial to TRP

Memory Reconsolidation Such as… AEDP Coherence Therapy • Enhanced effectiveness of individual EFT (both of them) clinicians and of the field as a whole EMDR Focusing • Psychotherapy integration: Unified under- Gestalt Therapy standing of core process in diverse therapies Hakomi IFS • Role of attachment in therapy is clarified Imago IPNB • Empirical process of profound change refutes NLP SE nonspecific common factors theory COHERENCE COHERENCE PSYCHOLOGY TIR PSYCHOLOGY INSTITUTE INSTITUTE

Memory Reconsolidation as a Framework Ramiﬁcations of for Psychotherapy Integration Memory Reconsolidation

• Enhanced effectiveness of individual ABC-123-V is evident in clinicians and of the field as a whole AEDP, Coherence Therapy, EFT, EMDR, IPNB… • Psychotherapy integration: Unified under- standing of core process in diverse therapies …and maybe all other therapies of transformational change? • Role of attachment in therapy is clarified • Empirical process of profound change refutes COHERENCE nonspecific common factors theory COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Case Example: Enduring Abuse At Work Ramiﬁcations of His retrieved emotional schema: Memory Reconsolidation

Life suddenly took away and crushed the • Enhanced effectiveness of individual top-notch life that I worked so hard for and clinicians and of the field as a whole deserved and was going to have. Psychotherapy integration: Unified under- I've got to never again really want anything or • Psychotherapy integration: Unified under- standing of core process in diverse therapies really try for anything I want, because then life could crush me again! If I want or try for a • Role of attachment in therapy is clarified better job, it could happen to me again—so, no, thank you. • Empirical process of profound change refutes nonspecific common factors theory COHERENCE PSYCHOLOGY INSTITUTE

Nonspecific Common Factors Theory Nonspecific Common Factors Theory

 75 years of randomized controlled trials (RCTs): 14+ different therapies have about equal, modest efficacy  Flaw in nonspecific common factors theory: totally based on RCT statistical averages  RCTs measure average outcomes of many individual cases.  Averaging buries the most successful cases; and RCTs don’t study those cases for specific factors.  RCT statistics imply: 15% of efficacy is due to specific factors 85% of efficacy is due to nonspecific common factors  RCTs hide rather than reveal the operation of specific factors, so the conclusion that specific factors can never be highly effective is illogical and unscientific.  Nonspecific common factors theory asserts: Specific methods and processes can never be

the cause of powerful therapeutic effects. COHERENCE COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Psychotherapy Process Studies Specific Factors Shown To Be Show Specific Factor Dominance Potently Effective in Controlled Studies

 Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11, 338-346.  Facilitation of an emotional experience previously  Elliott, R., Greenberg, L., & Lietaer, G. (2003). Research on experiential psychotherapy. In M. Lambert (Ed.), Bergin & Garfield’s handbook of psychotherapy & behavior change (pp. 493-539). New York: John Wiley. avoided, plus attention to emotional meanings  Greenberg, L. S., Warwar, S. H., & Malcolm, W. M. (2008). Differential effects of emotion-focused therapy and psychoeducation in facilitating forgiveness and letting go of emotional injuries. Journal of Counseling Psychology, 55, 185-196.  McCarthy, K. S. (2009). Specific, common, and unintended factors in psychotherapy: Descriptive and —strongly fulfilled by Step B of correlational approaches to what creates change. Doctoral dissertation, University of Pennsylvania. Available online: http://repository.upenn.edu/edissertations/62 therapeutic reconsolidation process  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 of Consulting and Clinical Psychology, 73, 861-871.  Oei, T. P. S., & Shuttlewood, G. J. (1996). Specific and nonspecific factors in psychotherapy:  Memory reconsolidation process: A case of cognitive therapy for depression. Clinical Psychology Review, 16, 83-103.  Oei, T. P. S., & Shuttlewood, G. J. (1997). Comparison of specific and nonspecific factors in a group steps 1-2-3 are a specific procedure cognitive therapy for depression. Journal of Behavior Therapy and Experimental Psychiatry, 28, 221-231.  Pennebaker, J. W. (1997). Opening up: The healing power of expressing emotion. New York: Guilford Press. shown by research to produce profound change  Weinberger, J. (1995). Common factors aren't so common: The common factors dilemma. Clinical Psychology: Science and Practice, 2, 45-69. COHERENCE COHERENCE PSYCHOLOGY PSYCHOLOGY INSTITUTE INSTITUTE

Erasure in Human Studies via Specific Factor of Reconsolidation Process

 Schiller, D., et al. (2010). Preventing the return of fear in humans using reconsolidation update mechanisms. Nature, 463, 49–53.

 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): e38849.

 Xue, Y.-X., et al. (2012). A memory retrieval-extinction procedure to prevent drug craving and relapse. Science, 336, 241–245. Science, 336, 241–245. COHERENCE PSYCHOLOGY INSTITUTE