MEMORY RECONSOLIDATION: Key To Transformational Change in Psychotherapy -- Bruce Ecker, LMFT

hello everyone hello well I have to confess that for me the details of brain anatomy do not help me do effective Psych therapy but there's an area of Neuroscience known as memory reconsolidation that my colleagues and I see as having enormous value for the Psychotherapy field because it spells out what we can do in our sessions to have liberating therapeutic breakthroughs occur regularly consistently probably everyone in this room would agree that therapy at its very best produces transformational change we all sometimes have sessions that produce the distinctive markers of transformational change long-standing symptoms stop happening

the distressed emotional reaction or ego State underlying and driving those symptoms stops happening and then those changes persist effortlessly and permanently those are the markers of transformational change also known as therapeutic breakthrough I often call it profound change panic attacks stop depression is gone compulsive eating Falls away and a new quality of well-being is felt this is therapy at its most effective best but transformational change is not really the norm or the expected outcome in the therapy field much of what therapists do is incremental change de degrees of symptom relief through methods that counteract symptoms

or regulate the underlying emotional reaction there are various Therapy Systems that do produce transformational change and many of you here today use them if you are seeing transformational change regularly in your sessions with many kinds of clients you really have no need to learn about memory reconsolidation the thing is therapies that do produce transformational change have very different ways of conceptualizing it and this fragmented situation has kept our field in something of an awkward muddle regarding the key question how does transformational change take place what has to happen in a therapy session to bring it

about that is arguably the single most important question for our field to answer but we've not had any bedrock definitive answers that are independent of each particular school's methods and theoretical model but what if the brain could speak for itself what would the brain tell us to do to bring about transformational change what would that description look like what are the brain's own rules for transformational change if we had that fundamental information guiding therapeutic breakthroughs would be far more reliable and frequent in our sessions not to mention how it would create an integrated understanding of

the core workings of different therapeutic systems all of that is exactly what our new knowledge of memory reconsolidation gives us remarkably we now do know the brain's own rules for transformational change here is one way to begin to understand what memory reconsolidation is and does we already know that any new learning creates new neural circuits in the brain in that sense any new learning rewires the brain but new learning does not necessarily unwire existing old learning that's driving unwanted responses normally new learning and its new neural circuitry set up separately from existing old learning and

the new learning competes with the old learning the result of that is incremental change that flickers and is susceptible to relapse because life finds a way to re-trigger the potent old learning which as we all know easily brushes aside the new learning and you're back to square one for transformational change to occur we need the new learning to not just set up its own new circuits but actually land directly on the circuits of the old learning maintaining the problem and unwire and rewire those circuits then the result is transformational change because then the old learning

is profoundly unlearned and erased right down to its neural circuits so it cannot re-trigger then The Unwanted pattern disappears and this change persists without further efforts of any kind that's the neural view of transformational change new learning updating rewriting and replacing the neural circuits of old learning memory reconsolidation is precisely the brain's built-in process for getting that to happen in fact it's the only known type of neuroplasticity that can do that so we now do know the brain's rules and the brain's process for erasing old learning and this knowledge is completely non- theoretical and independent

of the various schools of psychotherapy in a minute we'll get into a case example that I'll use to delineate for you exactly what the client's brain needs us to do so that new learning will be put not into separate circuits but right onto and into Old learning creating a transformational change that makes everybody very happy but first in order to appreciate how broadly useful and powerful memory reconsolidation is for psycho therapy it helps to understand how pervasively our clients's problems are driven and maintained by emotional learnings here's a simple example of an emotional learning now

such learnings don't exist in words or in Awareness they are implicit learnings we learn many many life-shaping things with no awareness of doing so but after such implicit learnings are brought into explicit awareness and are felt emotionally and are put into words they sound like this example if I feel sad or hurt or scared I'll be attacked and humiliated so I've got to keep my feelings pushed away that expectation of attack together with that tactic for avoiding it is an emotional learning you can call this a core belief an implicit schema a mental model A

Part emotional conditioning an ego state a complex whatever you call it it's learned it's stored in memory on neural circuits and it's what generates so many of the behaviors moods thoughts and emotions that show up on the surface as symptoms that people see therapists for this slide lists many such symptoms that we've seen ended by using the memory reconsolidation process to unlearn and dissolve specific emotional learnings what we've OB oberved again and again and again is that as soon as a given symptoms underlying learnings are dissolved and no longer exist the symptom simply stops and

disappears well when a symptom disappears immediately after a specific negative emotional learning has dissolved that's a pretty strong indication that the cause of that symptom was that piece of emotional learning so the observed broad effectiveness of using memory reconsolidation and therapy indicates that in the broad majority of cases the root cause of our client symptoms is memory emotional learnings in implicit memory now our case example a woman I'll call Adrien described panic attacks since her early teens they really baffled her she was finally coming for therapy at age 34 because the frequency and intensity of

her panicking had in increased right after starting at a new job recently it was now almost daily her panics ended permanently after five sessions because I focused on doing what her brain required for unlearning what she had learned that was generating Panic let's go through the three steps of the memory reconsolidation process that erases an emotional learning and I'll describe how each step unfolded for Adrien the first step is the reactivation of the emotional learning underlying the symptom as a conscious emotional experience of that learning now in session one Adrian described her panic attacks but

she sure didn't describe the emotional learning underlying her panic attacks because it was implicit it was completely unknown to her conscious mind so I too had no idea what it was and in order to to do step one conscious reactivation first I have to guide her to find the implicit learning or schema underlying her panic and then guide her into direct emotional experience of it well that's deep experiential work in a a core unresolved area of emotional vulnerability now I use coherence therapy and it's first phase is designed for exactly this step of creating direct

experiencing of the target emotional learning underlying a given symptom with Adrien this took two sessions and what she became aware of was this at her new job for the first time in her life she was responsible for making decisions that directly affect the people under her that situation was igniting the following emotional learning into sheer Terror I am a harmful dangerous person and if I do anything that directly disturbs someone it could Gravely harm them or even kill them so I've got to stay off to the side and never have any direct effect on anyone

that had been completely unconscious she learned it in her family she was an only child and the family was organized totally around her mother's extreme physical and emotional fragility little Adrien received clear forceful warnings frequently from from both parents that if she did anything that upset Mom it could make Mom collapse or die she once found mom collapsed on the floor in pain and believed she had caused it actually it was appendicitis so in her primary attachment relationships she learned that it was urgent to stay off to the side and never have any direct effect

her new job had suddenly ruled out that strategy and thrust her into having very direct overt effects on several people and this was sending her into raw Panic so now we have the target learning that will be reactivated consciously for step one she's now feeling and knowing that schema consciously and it still feels compellingly real and true for her at this point let's see what step two is step two is the creation of an experience that sharply contradicts what the reactivated Target schema expects about how the world functions in other words while the emotional reactivation

of the target learning is occurring from step one step two is a concurrent experience that makes it vividly apparent that reality does not function the way the schema knows or expects it to do something that strongly contradicts the schema step one plus step two is an experience of two things that cannot possibly both be true that's called a juxtoposition experience in coherence therapy and it's what reconsolidation researchers call a mismatch experience or a prediction error experience it's this just a position where the target learning collides with a strongly contradictory Vivid knowing that is the key

to transformational change because when the brain registers this dismatch or adjust a position the synapses that encode and maintain the target learning undergo a rapid change the encoding synapses change from an extremely stable Consolidated locked State into an unlocked deconsolidated laile State and then during a window of several hours these synapses are open to being re-encoded by new learning after which the neural circuit reconsolidate back into a stable state in its re-encoded form it is this step number two that launches this synaptic unlocking and allows new learning to directly land on and rewrite the target

learning that is what we mean by the unlocking of the emotional brain so for step two I had to guide Adrien into some experience that would sharply contradict her schema and there are many many ways to do that for a Adan I wrote the words of her schema on an index card handed her the card and suggested that she read it every day and also have the card in front of her during her weekly telephone talk with Mom that's a mindfulness practice focused on the schema in her next session she said she had not had

any panic attacks at work for nearly a week when she described what happened during her phone talk with Mom I saw that she was describing a jxap position experience mom became tense and with her tone of voice and phrasing had sent Adrien the Oho familiar message you're upsetting me you're harming me you're dangerous to me normally Adrien just absorbed that message with no awareness of it and she would just shrivel up and withdraw shamefully but this time because she had her eyes on that index card she was explicitly aware that Mom was sending her the

message you're being harm ful and dangerous so that was step one conscious reactivation she then became lucidly aware that in fact she was talking to Mom very gently and caringly and yet mom was telling her that she's being dangerously harmful she told me it felt very peculiar to suddenly see this big discrepancy and she said to me I realized it's that I've always been given the message that I'm dangerous not that I actually do anything harmful well that was it that fulfilled steps one and two juip position it's this conscious ju position of old and

new learnings that is the brain's recipe for a corrective emotional experience with transformational results and then in the next minutes and hours Adrien fulfilled step three by focusing repeatedly on her fascinating new learning I'm not harmful I'm gentle and caring and I've only been told I'm harmful step three is the rewriting of the unlocked Target learning by the new learning she then had all the markers of transformational change no more panics with no effort to avoid Panic which indicates that her lifelong potent schema had dissolved and no longer existed followup at 6 months and 2

years showed the shift had held with no counteractive effort and no relapses after 20 years years of panic attacks by the way those markers of transformational change are exactly what neuroscientists use as confirmation that reconsolidation and eraser of an emotional learning have happened because the brain has no other known process that can produce those markers now with some clients complications can develop and require some extra steps and extra sessions to clear away blockages but the core process of these three steps Remains the Same coherence therapy closely follows and calls for those three steps but what

about other Therapy Systems that bring about transformational change more or less regularly I'm suggesting that these therapies have methodologies that make it likely for these critical three steps to take place in one way or another my colleagues and I have combed through published case studies from several different therapies of transformational change aedp EMDR emotion focused therapy and ipnb and sure enough unambiguously those three steps of the memory reconsolidation process are there if you're interested in seeing that exercise it's in our recent book unlocking the emotional brain eliminating symptoms at their Roots using memory reconsolidation in

closing we now have the brain's instruction manual for guiding transformation will change consistently and the brain doesn't care what techniques we use if we're fulfilling its three required steps we think this is huge and historic it's only 10 years ago in 2004 that researchers discovered these rules for neural unlocking and eraser after a century where researchers thought the brain lacked any process for erasing ingrained emotional learnings this discovery just riveted us back in 2005 and my colleagues and I predict that in the future we won't have competing Therapy Systems that therapists choose between rather therapists

will learn this Universal innate process of the brain and will use the various therapies plus newly invented techniques as a rich repertoire of different ways to facilitate this core process and hey no knowledge of brain anatomy is needed thank you that