methodology Clinical Translation of Memory Reconsolidation Research: Therapeutic Methodology for Transformational Change by Erasing Implicit Emotional Learnings Driving Symptom Production Bruce Ecker Abstract Afer 20 years of laboratory study of memory reconsolidation, the translation of research fndings into clinical application has recently been the topic of a rapidly growing number of review articles. Te present article iden- tifes previously unrecognized possibilities for efective clinical translation by examining research fndings from the experience-oriented viewpoint of the clinician. It is well established that destabilization of a target learning and its erasure (robust functional disappearance) by behavioral updating are experience-driven processes. By interpreting the research in terms of internal experiences required by the brain, rather than in terms of external laboratory procedures, a clinical methodology of updating and erasure unambiguously emerges, with promising properties: It is applicable for any symptom generated by emotional learning and memory, it is readily adapt- ed to the unique target material of each therapy client, and it has extensive corroboration in existing clinical literature, including cessation of a wide range of symptoms and verifcation of erasure using the same markers relied upon by laboratory researchers. Two case vignettes illustrate clinical implementation and show erasure of lifelong, complex, intense emotional learnings and full, lasting cessation of major long-term symptoms. Te experience-oriented framework also provides a new interpretation of the laboratory erasure procedure known as post-retrieval extinction, indicating limited clinical applicability and explaining for the frst time why, even with reversal of the protocol (post-extinction retrieval), reconsolidation and erasure still occur. Also discussed are signifcant ramifcations for the clinical feld’s “corrective experiences” paradigm, for psychotherapy integration, and for establishing that specifc factors can produce extreme therapeutic efectiveness. KEYWORDS: Memory reconsolidation, clinical translation, destabilization, psychotherapy, memory erasure, behavioral updating, memory interference, emotional schema, transformational change, unlearning, specifc factors, reactivation-extinction, retrieval-extinction, corrective experiences Submitted: January 19, 2018. Accepted for publication: January 29, 2018 Published online: June 7, 2018 Author information: Correspondence concerning this article should be addressed to Bruce Ecker: Coherence Psychology Institute, 319 Lafay- ette St # 253, New York NY 10012 USA. Email: [email protected] Cite as: Ecker, B. (2018). Clinical translation of memory reconsolidation research: Terapeutic methodology for transformational change by erasing implicit emotional learnings driving symptom production. Interna- tional Journal of Neuropsychotherapy, 6 (1), 1–92. doi: 10.12744/ijnpt.2018.0001-0092 1 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 6 Issue 1 (2018) Contents 1. Introduction ....................................................................... 3 2. Emotional learnings and memories underlying clinical symptoms ......................... 5 3. Verifcation of memory reconsolidation in psychotherapy ................................ 11 4. How destabilization of a target learning occurs .......................................... 13 5. How erasure of a target learning occurs ................................................ 18 6. From research fndings to clinical methodology ......................................... 24 6.1. Te empirically confrmed process of behavioral erasure ............................. 24 6.2. Experiences versus the procedures that induce them ................................ 25 6.3. A proposed universal clinical methodology of memory reconsolidation . 27 7. Clinical observations of the therapeutic reconsolidation process ........................... 32 7.1. Clinical case example: erasure of chronic anger ..................................... 33 7.2. Clinical case example: erasure of complex attachment trauma ........................ 37 7.3. Are the observed transformational changes due to reconsolidation? . 50 7.4 Clinical feedback on researchers’ anticipated translation difculties . 51 7.4.1. Will mismatch experiences be too exacting for clinicians to create reliably? . 51 7.4.2. Do the age and strength of target learnings in therapy cause mismatch difculties? . 53 7.4.3. Will therapeutic changes made via reconsolidation be durable? . 54 7.4.4. Is episodic memory resistant to destabilization and updating? . 55 7.4.5. Can clinicians navigate complex memory structure? ........................... 58 8. Ramifcations for fundamental issues in psychotherapy .................................. 60 8.1. Reconsolidation clarifes the “corrective experience” ................................ 60 8.2. Reconsolidation provides a unifying framework of psychotherapy integration . 65 8.3. Reconsolidation explains psychotherapy RCT outcome research and refutes non-specifc common factors theory. 66 9. Other emerging clinical translation methodologies analyzed in relation to reconsolidation research ........................................................................... 67 9.1. Post-retrieval extinction. 68 9.2. Episodic memory interference ................................................... 70 9.2.1. Kredlow and Otto, 2015 ................................................... 71 9.2.2. Högberg, Nardo, Hällström and Pagani, 2011 ................................ 72 9.3. Emotional arousal: Lane, Ryan, Nadel and Greenberg, 2015 .......................... 78 10. Conclusion ....................................................................... 80 Acknowledgements ................................................................... 81 References .................................................................................. 81 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 6 Issue 1 (2018) 2 1. Introduction compulsive behavior, addiction, depression, anxiety, low self-esteem, and perfectionism, among many other A primary dilemma in clinical psychology has been symptoms (e.g., Greenberg 2012; Schore, 2003; Toom- described by one of that feld’s leading voices in this ey and Ecker, 2007; Van der Kolk, 1994). A versatile, way: “Afer decades of psychotherapy research, we reconsolidation-based clinical methodology that tar- cannot provide an evidence-based explanation for how gets and reliably nullifes the specifc emotional learn- or why even our most well studied interventions pro- ings maintaining such symptoms would revolutionize duce change, that is, the mechanism(s) through which the feld of psychotherapy. Envisioning that new treatments operate” (Kazdin, 2007, p. 1). Te present landscape, neuroscientists Clem and Schiller (2016, p. article proposes that a fundamental breakthrough in 340) wrote, “To achieve greatest efcacy, therapies… that dilemma may be developing through the trans- should preclude the re-emergence of emotional re- lation of memory reconsolidation neuroscience into sponses.” Defning complete elimination of unwanted clinical application. emotional responses as the goal of psychotherapy is a Memory research has identifed an innate type of statement that no neuroscientist would have ventured neuroplasticity in the brain, known as memory recon- to make prior to 2000, before the discovery of memory solidation, that can destabilize the neural encoding of reconsolidation. It is a goal now recognized as a possi- learnings of many types, including emotional learn- bility grounded in empirical research. Tat goal is the ings. Destabilization in turn allows the target learn- operational defnition of erasure in this article: lasting, ing to be nullifed either endogenously, by behavioral efortless, complete cessation, under all circumstances, counter-learning, or exogenously, by pharmacological of an unwanted behavior, state of mind, and/or somatic blockade that disrupts the natural molecular and cel- disturbance that had occurred either continuously or lular process of restabilization, or reconsolidation, that in response to certain contexts or cues. normally would occur afer several hours (Duvarci and Currently, at the end of the second decade of lab- Nader, 2004; Pedreira et al., 2002; Pedreira and Mal- oratory research into reconsolidation, researchers’ donado, 2003; Walker et al., 2003). Tus nullifed, the attention is extending to considerations of clinical subsequent durable, robust disappearance of all expres- translation at a rapidly accelerating pace (e.g., Beckers sions of the target learning has been termed its erasure and Kindt, 2017; Dunbar and Taylor, 2016; Elsey and by many researchers (e.g., Kindt et al., 2009; for re- Kindt, 2017a; Krawczyk et al., 2017; Kroes et al., 2015; views see, e.g., Agren, 2014; Nader, 2015; Reichelt and Lee et al., 2017; Nader et al., 2014; Treanor et al., 2017). Lee, 2013; Schwabe et al., 2014; for a review of early, Tose authors have consistently called for a two-way anomalous observations of erasure prior to discovery fow of knowledge between researchers and clinicians of reconsolidation, see Riccio et al., 2006). By putting in order to achieve the fullest clinical utilization of the transformational change of memory on empirical memory reconsolidation. Nader et al. (2014, p. 475) solid ground, research on memory reconsolidation has wrote: paved the way for new common ground between neu- roscientists and clinicians,