The Brain's Process of Profound Change: A Primer on Memory Reconsolidation for Therapists - B. Ecker

so for those of you that have not joined us before uh welcome i'm robert hilliger and um i'm the chief clinical officer for ethos behavioral health group and today we have bruce ecker joining us for um part of our therapeutic thought leadership talk um i just want to say welcome and thank you again for coming to join us and to talk with us today um you know i i have to thank elena um both for the introduction to hillary our last month speaker and bruce connecting you and i and you and i got to connect

maybe really a couple of years ago uh really at the start of the pandemic stuff i think we got connected and i immediately really fell in love with your work i felt like um you know it was elena saw me giving a talk at a conference and she said oh when did you when did you learn about coherence therapy and adp and i was like i'm sorry what that's what you do so um so i kind of feel like um i worked backwards into finding your body of work and really helped me understand myself more

as a practitioner and um and so i'm just thankful to have you here and you have contributed immensely to our field and so we're just honored to host you today um and with that we'll we'll turn it over and maximize your time just so you guys know we'll have a chat function going feel free to post questions along the way we will have a moderated uh q a at the end where i'll chime in and read back your questions to bruce and he can respond at that time and without further ado i'm going to turn

it over to you and bruce uh thank you so much where's yours thank you robert thank you so much i really appreciate that and i really appreciate this opportunity to give this presentation so i'm going to uh show slides to you know help try to make everything very clear so now i'll share screen in order to do that huh poof you should be seeing the first slide and now i'm very tiny which i like so all right the presentation is called harnessing the brain's process of profound change a primer on memory reconsolidation for psychotherapists i'm

going to progressively explain what whoops didn't mean to do that let's get this going just right okay i think i've got it i'm going to explain what memory reconsolidation is and how it works and then i'll narrate a case example of applying the process in therapy i have only an hour but i hope to give you enough of a glimpse that it would at least make sense to you that i view memory reconsolidation as the single most important emerging knowledge in the psychotherapy field and okay to begin here is a basic definition memory reconsolidation is

the brain's built-in mechanism that allows current experiencing to fundamentally revise what was previously learned and is now carried in memory okay uh sounds simple but there are many different types of memory there is smell memory sound memory spatial memory spatial movement memory face recognition memory memory of the voice tones to you so that your mother will pay attention to you okay memory that making any mistake means you're worthless and deserve the shaming criticism that you'll de that you'll receive for it and and dozens of other kinds of memory and any given memory may be modified

in various different ways so this basic very general definition of memory reconsolidation doesn't imply anything at all about any particular procedures for engaging this mechanism in therapy or what its resulting effects are an analogy would be explaining electricity soon after it was discovered in the 1800s a basic definition of electricity is the directional flow of a current of electric charge in a conductive material but that definition says nothing at all about any particular physical arrangement for that or about whether the electric current is being used to produce heat or light or powering a motor and

similarly the memory reconsolidation mechanism can operate through many different concrete procedures and it can produce many different memory modifying effects so let's begin to get more specific i'm going to define the single most effective process of memory reconsolidation for psychotherapy and for that purpose i need to first set the stage by reviewing the two different types of change that occur in psychotherapy systems sessions the type of change that is most familiar across the psychotherapy field is incremental change which is shown in the graph on the left in the slide this is partial degrees of the

desired changes occurring gradually over time presumably session by session a familiar example of this type of change is the partial reduction of anxiety that's often achieved in therapy by teaching relaxation techniques partial incremental change typically results from methods that guide the new learning of a preferred behavior or state of mind to adhere to instead of the problem pattern that strategy of change is what we call counteracting counteracting simply means building up a preferred behavior or state of mind which produces a partial incremental change as a rule maintaining those partial degrees of improvement requires an ongoing

effort of doing the counteractive practices otherwise relapse tends to occur and that susceptibility to relapse together with the fact that symptoms continue to occur to some degree indicates that counteractive methods compete with the symptom production process for control of behavior and state of mind for example as the client diligently uses the prescribed relaxation techniques the source of anxiety whatever it is keeps trying to generate anxiety and the two are competing so counteractive methods actually tend to exacerbate the divided self situation now the other main type of change that therapists observe is transformational change which is

shown in the right hand side of the graph in transformational change the problem pattern or symptom abruptly stops happening it's completely gone and it doesn't return anxiety is gone or depression is gone or some compulsive behavior is gone for example transformational change is so decisive and unmistakable that detecting and confirming it is very easy and and reliable specifically we define transformational change by these three distinct verifiable markers first the client's presenting symptom no longer occurs at all which means a complete and lasting cessation of an unwanted state of mind and or behavior and or somatic

disturbance also eliminated is any more triggering of the symptoms underlying emotional activation the underlying distressed ego state or emotional schema or part whatever you prefer to call it no longer triggers or is triggerable by the cues and situations that previously triggered it strongly and those two shifts are then effortless to maintain once they've happened they persist permanently without any further efforts to prevent either the symptom or the underlying emotional activation so whenever i refer to transformational change or profound change or decisive liberating change what i mean is this specific set of observable verifiable markers now

if you look only to what psychotherapy outcome research studies have reported you wouldn't know that this type of change transformational change even exists transformational change has been almost completely neglected by psychotherapy outcome researchers however whoops good however [Music] skillful practitioners of several different therapy systems achieve and observe transformational change fairly regularly my colleagues and i who practice coherence therapy see transformational change regularly and i know for sure that many practitioners of these other therapy systems also see transformational change happen regularly and there are numerous documentations of such cases in the peer review clinical literature and

i'm going to narrate such a case later in this talk so we have these two very different types of change incremental or counteractive change and transformational or profound change now i must add and emphasize that there are various situations in clinical practice where counteracting is the necessary and appropriate approach such as teaching emotional regulation practices to a highly unstable client or shifting a client out of hyperactivation in trauma work my point is simply that for understanding how transformational change takes place it's important to understand how transformational change differs from counteractive incremental change this list of

therapies of transformational change begs the question how is it possible that psychotherapy systems that differ so greatly in technique and theory can produce transformational change are they accomplishing it uh through fundamentally different mechanisms or somehow through the same core mechanism my work has focused on showing that an understanding of the brain's mechanism of memory reconsolidation solves that mystery of how transformational change works and why it's possible in the first place and why so many different methodologies of therapy can produce it and in this very short presentation i'm aiming to map out a basic orientation to

all of that neuroscientists have been conducting laboratory research on memory reconsolidation for almost 25 years now i'd say that a rigorous understanding of those research findings really is the only valid basis for understanding the operation of memory reconsolidation in therapy sessions it was first shown in 2010 that the memory reconsolidation process allows a human emotional learning to be profoundly unlearned and nullified through a behavioral procedure that unlocks and rewrites the neural encoding of the target emotional learning now that's a major development because true unlearning and nullification of an emotional learning had never been observed to

result in studies of extinction throughout the 20th century extinction was found to only suppress a target emotional learning temporarily in a counteractive competitive manner so until memory reconsolidation was shown to bring about true unlearning and nullification of an emotional learning memory research memory researchers believed that the brain couldn't do that and since 2010 to the present time which is early 2022 a total of 20 separate laboratory studies by neuroscientists have successfully demonstrated with human subjects and emotional learning and acquired emotional response being decisively unlearned and nullified i have recently posted online my most complete review

of that research giving a detailed analysis of each of those 20 studies and also each of the 14 unsuccessful human studies what i've shown is that even though the concrete experimental procedure varied greatly across those 20 successful studies nevertheless in each study the same series of three subjective experiences was induced in subjects by the procedure all 20 studies created the same three internal experiences which i will soon define for you and when we examine published accounts of therapy sessions that have produced the markers of transformational change we find that those same three distinct experiences are

present we've shown that for sessions from 10 different therapy systems so far therefore that set of three experiences appears to be the key to producing transformational therapeutic change and is a unifying framework for the psychotherapy field the the rest of this presentation consists of spelling out what the crucial three experiences are and showing examples of everything that i've been describing abstractly and my time is very limited so i'm going to move along at a good clip here what i need to do next is give some examples of the emotional learnings that we encounter in psychotherapy

because emotional learnings are the memory contents that can be unlearned and nullified through memory reconsolidation to produce transformational change such learnings don't exist in words or in awareness so uh they are a category of implicit learnings or implicit knowledge and yet they are very specific which is apparent when we guide our clients to access them and shift them from being an implicit knowing into also being an explicit knowing that is felt and verbalized here are three examples of emotional learnings that have been made explicit and verbalized by therapy clients i'll read them if i show

any hurt or sadness or fear i'll be attacked and humiliated so i've got to block my feelings next example the only way to get any attention is to do something really bad and third if i try for what i really want the world will crush it so i better not try for or even feel what i really want as you see in these examples an emotional learning consists of a particular mental model or schema or cluster of core beliefs of how the world acts and reacts the schema is loaded with emotion but it's much more

than emotion it's a particular version of reality it's a mental model of a pattern in the world and that mental model or schema is very specific and well defined even though it's outside of awareness and doesn't exist in words before being verbalized of course to the person it doesn't feel like merely a model or a belief it feels like reality it feels like how the world really is it operates as unknowing of how the world acts and reacts by using experiential methods that elicit and reveal implicit schemas it becomes apparent that emotional learnings underlie and

generate our clients symptoms in nearly all cases memory of these learned schemas these learned patterns in the world is called semantic memory by researchers to distinguish this type of memory from personal experience memory which is called episodic memory by researchers memory of events perceptions and experiences these underlying emotional learnings or schemas are formed in response to intense experiences in life and they are completely adaptive they are all about how to avoid suffering in one form or another so of course they generate self-protective responses as this slide illustrates for those same three emotional schemas for example

consider a person who learned if i feel sad or hurt or scared i'll be attacked and humiliated she or he feels social anxiety and in order to be safe suppresses all vulnerable emotion and avoids intimacy and as an inevitable byproduct of that feels desperately lonely and helplessly stuck there and so may also feel depressed over expecting a future that's endlessly more of the same but the schema is not conscious so these self-protective tactics and unwanted effects that the schema generates such as social anxiety and lacking intimacy seem to be irrational maladaptive personal defects when really

these patterns are fully coherent and make deep sense in relation to life experiences and adaptive learnings of course there are symptoms known to not be based in emotional learning such as sensory processing problems that have a neurological cause memory reconsolidation cannot dispel those types of problem only acquired responses based in learning and memory can be changed through memory reconsolidation that covers the great majority of the clients that most therapists see and even with neurological processing problems people with those problems also have emotional learnings that heavily compound their difficulties so the reconsolidation process is still very

important even with such clients now these core emotional learnings or schemas are extremely tenacious the brain evolved through natural selection in a way that emotional learnings simply do not fade out over time uh and in so many of our therapy sessions we encounter the extreme durability of emotional learnings that formed decades ago but still freshly re-trigger and maintain our clients painful emotions behaviors thoughts or body symptoms the presence of strong emotion during learning has major effects on how and where in the brain the learning is neurally encoded emotion changes the biochemistry of the encoding neurons

and synapses making the memory circuits extremely compelling and extremely durable this means that the ongoing re-triggering of our clients implicit schemas is actually the proper functioning not the dysfunctioning of the subcortical emotional learning and memory system but natural selection also equip the brain with the memory reconsolidation mechanism which does allow an emotional learning or schema to be profoundly unlearned and eliminated so let's now see how that works i mentioned earlier that extensive research has shown that the core process for the unlearning and annulment of the target learning via memory reconsolidation consists of a series of

three experiences for consistently facilitating those crucial experiences in therapy sessions the first step is the conscious reactivation of the target learning or schema that you're aiming to unlearn and nullify in therapy that's the schema underlying and driving the client's presenting symptom now here in step one conscious reactivation means the client is feeling the schema as an embodied affective experience along with cognitive recognition and verbalizing of the schema's specific content just as in our three earlier examples of schemas verbalized by clients of course it's possible for schemas to reactivate without awareness that's how they usually reactivate

in daily life and some laboratory studies have shown that the reconsolidation process can occur without conscious awareness of the reactivated target schema but for the purpose of psychotherapy in order for a therapist to successfully facilitate this process consistently across clients the target schema must be consciously felt and verbalized revealing the specific contents of the schema to the therapist so step one the conscious reactivation of target schema is a pragmatic necessity then it's the addition of the second step that launches the memory reconsolidation process this critical second step is the creation of an experience that sharply

contradicts what the reactivated target schema knows and expects about how the world functions in other words while the emotional reactivation of the target schema is occurring from step one step two is an additional experience that makes it vividly apparent that the world does not function as the schema knows and expects so now there is a juxtaposition of two experiences at once and they contradict each other they both feel real but they cannot possibly both be true it's a very peculiar experience this juxtaposition it's similar to cognitive dissonance but this is fully experiential fully visceral step

one plus step two is what's called a juxtaposition experience in coherence therapy and it's what reconsolidation researchers call a prediction error experience dozens of different studies by neuroscientists have shown that in response to this prediction error or juxtaposition experience the neural encoding of the target learning undergoes a rapid change from a locked consolidated stable state into an unlocked deconsolidated destabilized labile state those are the terms the neuroscience researchers used for that destabilized label deconsolidated and that deconsolidation of the neural encoding that is the launch of the memory reconsolidation process with the target schemas neural encoding

in this deconsolidated destabilized condition the schema is now receptive to being rewritten by experiences that are relevant to the schema but differ from it it's important to understand that the first step alone schema reactivation does not destabilize the schemas neural circuits and does not launch memory reconsolidation that is one of the most common misunderstandings about memory reconsolidation the view that reactivation alone and therefore every reactivation of the memory induces the reconsolidation process is incorrect over 30 studies have shown that what the brain requires to destabilize a memory launching the reconsolidation process is reactivation plus a

prediction error experience reactivation without pre-prediction error does not do it the deconsolidated destabilized condition lasts for about five hours and at six hours the neural encoding has automatically reconsolidated or re-stabilized and is no longer susceptible to modification okay we've looked at steps one and two after step two with the target schemas encoding now unlocked and susceptible what's needed next in step three is an experience that drives the unlearning nullifying and rewriting of the schemas encoding so all we have to do for step three is just a few repetitions during the rest of the session of

the same juxtaposition experience the same experiential disconfirmation as in step two step two was an experience that makes it vividly apparent that the world does not function as the reactivated target schema knows and expects a few repetitions of that experiential disconfirmation drive the unlearning and annulment of the schema so operationally the whole process boils down to creating that first juxtaposition experience and then repeating it a few times the first time is the prediction error that does the unlocking and the next few times do the unlearning and nullifying and rewriting of the schema for the client

subjectively what had seemed so real and definite about the world according to the schema is now deeply recognized in those juxtaposition experiences as not real a lifelong negative emotional learning abruptly dissolves and loses all of its compelling realness its chokehold can just melt away and we'll see this in the case example and the schema is then re-encoded accordingly which nullifies it and dissolves it deletes it from emotional semantic memory and as soon as the symptom generating schema is depotentiated those three markers of transformational change immediately begin to show up as we'll also see so this

sequence of three steps is what the client's brain needs us to do in order for transformational change to take place whatever may be the concrete methods or techniques that we use to bring about these key experiences now for completeness here i must add briefly that some researchers do step three the step that nullifies the target learning in a very different way by administering a chemical agent i'm sure many of you have read about that approach with human subjects the chemical agent is propranolol chemical nullification is a very different matter because it does not occur through

an unlearning and updating of emotional learnings so there is no advance in self-knowledge or knowledge of life only the disappearance of an emotional reaction the case example will show what i mean about the invaluable effects of true unlearning through the behavioral process uh also we've demonstrated that nullification through unlearning is effective for ending an extremely wide range of symptoms whereas the chemical method has been much more limited and of course administering a chemical agent is restricted to an elite class of mental health health practitioners so it's the behavioral unlearning or behavioral updating approach that my

colleagues and i see as having a far greater value for the psychotherapy field overall now you've probably already recognized that a therapist cannot begin guiding these crucial three steps right at the start of therapy with a new client because in order to deliberately carry out these three steps in therapy sessions you need to know the specific makeup of the emotional schema underlying the client's symptom and you need to know what in the client's experiential world strongly and specifically contradicts and disconfirms that schema but at the start of therapy you don't know any of that so

before you can carry out this transformational sequence certain steps of preparation work are necessary preparation step a is identifying the makeup of the client's problem very specifically what does he or she experience that is the problem and when does this happen symptom identification has to be specific and concrete here is a good example uh with with some clients it's it's that straightforward but with others as you well know it takes some work to arrive at a clear description of the presenting problem or symptom but it's really a crucial first step because if you don't know

specifically what the problem features or symptoms are the specific emotions or behaviors or thoughts or somatics you won't be able to proceed to do preparation step b which is to find and bring into awareness the emotional learning underlying and driving those symptoms so symptom identification in step a step a is critically important because that information serves as the the trail head or portal that then gives access to the crucial underlying uh target material in step b in step b that underlying target schema is drawn from the implicit domain into explicit awareness experientially not just as

cognitive insight don't think that putting words on a schema means that the work is merely cognitive different therapy systems have different methods for facilitating that process of discovering and accessing the underlying emotional learning and again we are free to use any suitable techniques or procedures to do this process when the emotional learning and memory material maintaining the problem has become explicit in step b then it's time for preparation step c the last preparation step which is to find a contradictory experience or contradictory knowing that will soon be used to disconfirm and nullify the retrieved schema

by creating a juxtaposition experience but finding that contradictory knowing not yet using it is step c and just as for step b there are many many methods to choose from for finding contradictory knowledge in step c uh my case example will illustrate just one such technique but our website has a six-hour webinar with videos of real sessions showing many different techniques for both revealing the target schema in step b and finding a contradictory experience in step c now here's a list whoops here's a list of the steps that we've covered so far for consistently applying

memory reconsolidation and therapy for transformational change preparation steps abc followed by steps one two and three of the core process of schema unlearning and annulment and we call this the therapeutic reconsolidation process the case example will show the emotional depth and the empathy in facilitating this process usually most of the work goes into preparation steps b and c finding the schema and the contradictory knowledge because once those items are at hand then uh steps one two and three are just a matter of bringing those two things together in juxtaposition which is easy and takes just

a few minutes as we'll see at the end of the therapeutic reconsolidation process for verification that nullification has really occurred there is the same final step as the researchers do we actively look for and test for whether the symptom or the schema can be retriggered we make sure those markers of transformational change are showing up and that is step v for verification if the target schema really is gone cues that formerly triggered it strongly no longer do so so the distressed ego state of the schema is gone and the specific symptoms no longer occur without

any ongoing preventative counteractive efforts in other words the changes persist effortlessly the complete process abc 123 v is the direct translation of memory reconsolidation research into clinical practice for producing transformational change i'm resisting the temptation to ask you to sing it along with me abc123v in other words this step i learned that from milton erickson by the way in other words this step of uh steps for producing transformational change is nothing more than instructions for replicating in therapy sessions the very same steps that researchers did in laboratory studies that produced annulment of emotional learning so

this set of steps is not a theory i think that's important to recognize it's not based in theorizing and it's not some creative invention or pet notion on my part it's the direct use and therapy of the same well-defined set of experiences found by neuroscientists to produce nullification of an emotional learning in human subjects when we carry out these specific steps in therapy we then observe the same markers that neuroscientists regard as the distinctive signature of true unlearning those three markers of transformational change so this isn't some you know fuzzy invoking of neuroscience in support

of our favorite form of therapy this is a very specific empirically confirmed process that has unique verifiable results that cannot occur in any other way according to all current scientific knowledge and yet there is vast scope for therapist creativity and personal style in how we carry out this set of steps uh that list of therapies of transformational change that we saw earlier indicates how vast the scope is for therapists creativity and personal style in fulfilling these steps these steps don't dictate any particular techniques and knowing that the brain requires this set of experiences can guide

you in applying your preferred methods more effectively than ever to induce transformational change the brain just doesn't care about the external procedures as long as the internal experiences of steps one two and three take place those steps of the core process define subjective internal experiences not external techniques and i'm i'm repeating that a few times because that's a major distinction in this framework so any any clinical case example of the therapeutic reconsolidation process is necessarily an example of a choice of particular techniques for fulfilling these steps but the steps themselves are rigorously determined by the

collective findings of memory reconsolidation studies reported by neuroscientists that's why we characterize this series of steps abc123v as being the brain's own rules for nullifying emotional learnings to produce transformational change now this series of steps is also the explicit methodology of coherence therapy coherence therapy equips and guides therapists to carry out exactly this series of steps in the therapeutic reconsolidation process and in the case example that i will now narrate i was using coherence therapy to carry out the therapeutic reconsolidation process well in order to illustrate all seven steps in the short time available here

i've chosen a case example where i was able to do abc123 in a single session but in most cases the preparatory steps abc requires several sessions so please don't think it's all supposed to happen uh in just one session okay please i'm going to leave this set of steps on screen because i'll be walking us through these steps as i narrate the case these steps may seem abstract so far but i'm aiming to bring them to life vividly in this case example this case is uh one that's presented in my 2018 journal article that's listed

in a slide at the end of the talk so if you want to review this case later that's where to find it okay here we go the client is a woman in her early 50s pseudonym noreena and after we had done about 12 sessions on various things she suddenly identified a problem pattern that i had not heard about before it was a mood of angry resentment that had frequently ruled her state of mind and behavior for extended periods ever since childhood and she's now in her in her mid-50s her long bouts of this simmering angry

mood were a major factor in the chronic tension in her 28-year marriage well that description of the presenting symptom was enough of step a symptom identification for me to begin doing step b finding the emotional learning that was generating that anger now as i mentioned emotional learnings always consist of implicit knowledge operating from outside of awareness in order to begin to bring into awareness noreena's emotional learning generating this this angry resentful mood i said to her this i said just see what comes to mind when you hear this question in your whole life what is

it that you resent the most well she answered right away that well she was already well aware that what she resents the most are her childhood or deals starting at age six of being sexually molested by her grandfather on several occasions which had been the focus of extensive therapy long ago manhattan is saying hello to you as i continue the narration i think you can hear my beloved city uh to continue the discovery work i then asked gently well then what is it that you suffered in that ordeal that you resent more than anything else

about it now that question she could not readily answer so she considered it in silence and finally then said with some surprise hmm it doesn't feel like it's my grandfather that i resent the most and then she pondered some more and then said it feels like even more than resenting my grandfather i resent the whole world or life itself so i asked her next what can you see about why you resent the whole world or life itself well after another silence and now with a somewhat furrowed brow norina said it's that the whole world is

just too unfair to make this happen to me and to no one else i was quite surprised to hear that uh and this is this illustrates how important it is to elicit the underlying emotional learning from the client and to learn it from the client and not try to infer or interpret or hypothesize it oneself too much well hearing that from her i understood that that utterance was the emergence into awareness of the implicit emotional learning that had been producing her anger for a lifetime what was emerging was the naive mental model or schema of

a young girl who had never heard of the existence of child sexual abuse she construed that it had happened only to her which in turn makes the world monstrously and unforgivably cruel and unfair so she was indeed profoundly and unceasingly angry and resentful at the whole world or life itself this construal of meaning this schema that it had happened only to her and the world is therefore unforgivably unfair had been outside of awareness it had never received conscious attention in adulthood ever since age six that schema was reactivated by anything else that seemed arbitrary and

unfair and its reactivation brought smoldering anger and resentment but without any awareness of the source of that anger well arbitrary unfair things happen fairly often in daily life including in adult married life i might might actually say especially in adult married life so her resentful anger was a frequent presence throughout her life and when she said it's that the world is just too unfair making this happen to me and no one else her voice had an indignant intonation and she had a facial expression of consternation indicating to me that she was affectively experiencing this schema

in the present moment to some degree not merely intellectualizing about it in other words not only step b but also step one was happening she was in the experience of the reactivated target schema we had not only found the target schema as step b requires but she was also now in the subjective experience of that reactivated schema which is what step one requires so recognizing that i wanted to seize this opportunity and immediately do step two the creation of a concurrent contradictory experience well that's not always possible right after first finding the target schema but

i now saw a way to do step two because the specific content of the revealed schema made it clear to me how i could now induce a contradictory experience you'll see what i mean in a moment the revealed schema that she's experiencing is the world is just too unfair making this happen to me and to no one else she had just said those words and she is inside the subjective ego state of that schema to induce a contradictory experience for step two i replied by saying i see please say it to me again it happened

only to me noreena said out loud it happened only to me and it was clear from her manner and tone of voice that those words once again simply felt true to her so again i asked her please say it again and upon saying it for the third time her facial expression changed immediately into a look of puzzlement that schema had existed entirely inside a certain compartment of emotional memory a child ego state but with its third overt statement it was no longer sealed up in that compartment in memory it was now broadcasting throughout her knowledge

networks and was now bumping into and activating a contradictory knowing that already existed in her adult declarative explicit knowledge networks namely her adult knowledge that child sexual abuse is a widespread reality and that is what i knew was going to happen her look of puzzlement told me that the contradictory knowing was starting to come into awareness alongside the schema so now i said please say it to me again it happened only to me and this time when she said it noreena's eyes began darting around as she fully registered this juxtaposition experience in which both the

mental model of the target learning and the contradictory knowing are both present concurrently in this same field of awareness creating this prediction error experience that unlocks the target learning's neural encoding now i saw a facial expression of wide-eyed amazing surprise and marina said softly quote oh my god i really thought it happened just to me but it happens everywhere it's a part of life everywhere it's an ugly part of life but it keeps happening to girls and to boys too all the time everywhere i wasn't singled out those were her exact words ending with i

wasn't single down there is the contradictory knowing so that was step two and now for step three i had to simply create a few repetitions of that juxtaposition experience so i stayed focused right on that amazing juxtaposition experience simply by empathetically reviewing it with her naming both sides of it in order to repeat the juxtaposition a few times during the rest of the session for example initially i said wow noreena all along it happened only to me seemed really true and yet here you've realized no i wasn't singled out no i'm not at all in

hearing that empathetic review she again had the juxtaposition experience and then i again found some natural way to do that two or three more times in the rest of the session repeating that juxtaposition is disconfirmation and counter learning while the neural encoding is unlocked and that is true unlearning that re-encodes the target schema accordingly and in that way nullifies the target learning then it no longer has any realness as an emotional learning and her comment such as the one i already read to you kept indicating quite clearly that it happened only to me already no

longer felt real or true to her at all that immediate loss of realness of the target schema was the first marker of transformational change to appear the first bit of step v the verification phase the immediacy of transformational change is one of the main characteristics of this core process of steps one two and three now if noreena's schema was now fully depotentiated and nullified she would no longer be in a world that had arbitrarily and unfairly singled her out for cruel treatment which would eliminate the very basis of her angry resentful reaction to any new

encounter with arbitrary unfairness in daily life and that would have to be confirmed over time of course so in our next session one month later i was eager to ask her whether she had noticed any effects of the previous sessions work noreena's exact reply was i've been angry and resentful my whole life it's like something has turned to dust it's not alive anymore before something felt like cords and cables strangling me i feel so freed up boy that was music to my ears and that's more of step v and that's a good example of how

distinct and easily detectable the markers of transformational change typically are over the next few months noreena reported that the marital relationship had a new ease and friendliness and warmth and then eight months later the couple had a particularly stressful month due to not feeling emotionally in sync with each other in the course of some struggles with the extended family marina told me it was rough but i haven't felt any resentment toward him so that's the marker of non-occurrence of the symptom which is more of step v and i took this opportunity to probe for the

marker of schema non-reactivation by asking her can i check with you about the work we did on that core belief it happened only to me i'm wondering whether or not the shift you initially described has held and her exact words in reply were my resentment relentless even with all these troubles that anger is not taking over most of the time i'm in a wonderful energized peaceful state i could hardly believe my ears that's the way i would heart i would describe it even with all these troubles at that point step v and the markers of

transformational change were well established the target emotional learning and the symptoms of mood and behavior it had produced were no longer revoked by a wide range of situations that formerly evoked them strongly and these shifts were persisting long term and effortlessly even in strongly stressful situations now i have to emphasize that that case example should not be taken as a template of techniques for creating the necessary three experiences right i hope it's clear that i'm not defining a protocol of techniques as i said earlier the brain doesn't care uh what external techniques are used to

induce the necessary internal subjective experiences the the therapeutic reconsolidation process is a template of experiences not techniques and you use any experiential techniques in your personal repertoire to induce those experiences in coherence therapy training we teach a number of versatile techniques but only to expand therapist options for carrying out the therapeutic reconsolidation process not as a cookie-cutter protocol we teach a whole array of techniques for step b finding the schema and the whole array of techniques for step c finding the contradictory knowledge that this confirms the schema with noreena in order to find the contradictory

knowledge i used the simple technique of asking her to make an overt statement of the discovered schema it happened only to me if a contradictory knowledge already exists somewhere in the client's memory networks making an overt statement is very likely to bring that contradictory knowing into awareness directly into juxtaposition with the schema fulfilling step two as happened for an arena now we find that that technique for creating uh contradictory knowledge fi i mean finding contradictory knowledge and creating the first juxtaposition works in about half of all cases but when the client's overt statement of the

schema does not draw forth a contradictory knowledge then the voiced schema simply continues to feel fully real to the client and the overt statement is then serving as an integration experience that helps establish the schema newly conscious schema in ongoing conscious awareness which is very important in itself but now the therapist has to actively pursue finding a contradictory knowledge and as i mentioned uh in coherence therapy we have mapped out many techniques that are effective for finding it something else in that case example that i think warren's pointing out is that for transformational change the

target of change is the mental model or schema underlying the client's problematic behavior or state of mind not that behavior or state of mind itself norena's angry resentful mood was arising from a specific mental model that she formed as a child so that revealed mental model was the target for disconfirmation and profound unlearning through memory reconsolidation i also think that case shows so clearly the remarkable durability and timeless persistence of emotionally charged schemas and mental models our website has many case examples with video of actual sessions showing the therapeutic reconsolidation carried out in coherence therapy

for a wide range of major presenting problems and symptoms here's a list of symptoms that we've seen ended using this therapeutic methodology huge range of symptoms is generated by specific emotional learnings and in principle any symptoms produced by the contents of memory can be ended by the therapeutic reconsolidation process however again i i have to mention that carrying out this process is often more complex than it was for an arena's anger because various complications uh may have to be addressed the most common complications are resistance that can develop at any stage of the work and

schemas that tap into traumatic memory that is too raw and intense to face or touch yet which requires the step b discovery work to proceed in very small steps very gradually uh and many such cases of such work are are shown on our website in articles uh and videos now that's the one hour point i have just a few minutes more and we'll wrap it up so far i've been focusing on the therapeutic reconsolidation process as a guiding framework that individual therapists can use to significantly enhance therapeutic effectiveness but that isn't all because in addition

the therapeutic reconsolidation process also can serve as a major framework of psychotherapy unification just consider if it's true that this process is what the brain requires to create a transformational change then it must also be true that this process was present in any therapy sessions that actually have produced transformational change right so one test of this whole framework is to closely examine documented therapy sessions that did indeed produce the markers of transformational change sessions from widely different systems of therapy and see whether these distinct steps of process are detectable in those sessions unambiguously we've been

carrying out that exercise the first four tests were reported in our book unlocking the emotional brain eliminating symptoms at their roots using memory reconsolidation chapter six of that book presents detailed previously published case examples from aedp emotion focused therapy emdr and interpersonal neurobiology and we show that the set of experiences required for memory reconsolidation and profound unlearning is there in each case unambiguously even though none of those therapies identify that set of experiences in how they describe and define themselves and then in this next book memory reconsolidation and psychotherapy four other therapy systems have been

shown to have their uh to to have the same critical experiences likewise embedded within their methods alexander technique neuro-linguistic programming progressive counting and tapping and after that a case example of transactional analysis was provided to us by italian psychologists and we showed that the same steps were present and then we published that case in the italian edition of unlocking the emotional brain we take any sessions for this test the only requirement is that the markers of transformational change have to be definitely present and there is also detailed documentation of the client therapist interaction moment to

moment and so far uh the steps of the process that have been detected in every case we've examined and we plan to examine that list of therapy sessions systems in the upcoming uh second edition of unlocking the emotional brain that's scheduled for publication in 2020. so our hypothesis is that whenever transformational change occurs in any therapy sessions the three experiences in steps one two and three will always prove to be present so we think uh the therapeutic reconsolidation process has this major potential to be a very valuable framework of unification for the psychotherapy field this

this core process can serve as a shared map and to share vocabulary that allows practitioners of very different therapies to understand and appreciate and respect each other's ways of facilitating change because understanding memory reconsolidation shows us why each of the systems works when it works some therapists have told us that understanding the therapeutic reconsolidation process feels like having a kind of x-ray vision because now they can see through the technique level of any therapy system and directly perceive a core process that the brain requires for producing transformational change and for therapists who conceptualize change in

terms of corrective experiences the therapeutic reconsolidation process further refines our understanding of exactly what constitutes a corrective experience that actually does produce deep lasting change now obviously many therapists bring about transformational change without mapping the process of change in this way and without knowing anything about memory reconsolidation but by mapping the process in this way you are viewing the process of change in the same way as your client's brain does and then you will facilitate genuine therapeutic breakthroughs more often because you will find opportunities within your preferred methods for creating these crucial experiences that are

what the brain requires if this framework interests you enough to read more about it there are the two books i mentioned earlier there's a full bibliography on our website and this slide lists our last several peer-reviewed journal articles and the the 2018 article is the one that has the case of noreena thank you thank you bruce thank you so much um let's see hey yeah can you hear me okay i'm sharing yes okay um thank you so much um for those of you that have the opportunity to stick around we're gonna do a moderated q

a several of you have been posting questions i'm gonna try my best to get to as many of them as possible um so i'll jump right in i just want to say before we get into the questions though thank you again um your mastery of this is so evident and it is you've you've been able to take something um so complex and explain it so succinctly and i i just think that your contributions to our field um are profound and important so thank you thank you thank you so much um so we've got a lot

of questions i'm going to try and get to as many of them as i can um the first question is from david uh asking about do you know anyone who's studying speaking or writing about memory reconsolidation and or coherence therapy from an ontological perspective i need to know more what is meant there by ontological perspective when we uh we we have in other writings we have mapped schema structure in great detail it turns out these schemas have a uh uh they always have the same structure uh a four level structure the deepest level the fourth

we just missed that one response um okay so this question is from kerry powell if the client has an experience that confirms the original schema within that five hour window will the old learning return so it sounds like they were not sure about the implications of the five-hour window and we're asking for some clarification okay uh i'll get i want to stick specifically to the scenario that's in the question where during the five hour window the client actually experiences a re-confirmation of what's in the schema and of course i think we all have clients any

experience therapist has clients for whom whatever it was that they suffered mistreatment abuse hardship loss whatever it was that they suffered earlier in life that originally drove the learning of the schema more of that same suffering is still happening in the present so you know we deal with that often in carrying out this process and it is an extra complication um whether or not the client experiencing more of what originally drove the schema will defeat the juxtaposition experience that presumably happened in the session previously and re-establish or continue to maintain the realness of the schema

is too complex to predict if the client comes back session and tells me about what happened that made the schema come to life again i would use that to simply carry the process further anything that looks like a relapse is useful to continue finding what still feels real and true and then continue finding what can disconfirm that earlier excuse me early in my therapy career and early in using this process whenever a client would come in describing a relapse you know my anxiety level would go up and oh no is my ability to facilitate that's

going to be effective enough is this method strong enough to to meet what life is doing here but at this point when a client describes a relapse honestly my response is oh goody life is helping us find even more of what we have to recognize and disconfirm and we'll wind up doing an even more thorough job and that does wind up happening so that's my best answer to that question wonderful and it kind of flows into the next question from michael um do you make this process explicit to the patient so you're saying oh goody

this gives us more to work with are you explaining the memory reconsolidation process explicitly to patients or how does that work technically i don't necessarily explain it i explain it um sometimes uh if the client nowadays with our you know we've we've been writing about this for enough years that we we get clients who've read about it and want uh you know many of them read about it and think it's all supposed to happen in one session and come in expecting that and that's that's a problem okay but we've figured out ways to deal with

that um so when the client wants to know about the process in that mapped out way and there's no harm explaining it that's one of the nice aspects of this framework and this methodology you can be completely transparent with the client about what you're doing and why uh within an explanation of the process the methodology and the principles if the client wants to know uh clients who are therapists and who've read about it really do want to know and for me that's fun to make meta comments about why i just did what i did uh

is is very rich and enjoyable both to both the client and the therapist um but for non-therapist clients the the situation in which i sometimes will explain at least some of the process is when the client starts to notice and object or at least stop things and ask about you're you're you're you're bringing me toward this stuff causing all the trouble this is therapy aren't you supposed to be bringing me away from the stuff causing all the trouble instead of into it and in response to that bit of conscious resistance explaining some of the methodology

may be helpful at a minimum what i'll say to the client who says that is well you know think of how many years you've been trying to do whatever gets you away from this stuff causing all the trouble and it hasn't worked has it and many clients have had previous therapy that was counteractive and was trying to get them away from the stuff causing all the trouble and i would come i comment on that too and i'll say look at all the therapy you've had that also tried that that strategy and it wasn't effective so

what i'm doing with you is what i know is effective and yes it involves going toward the stuff causing all the trouble and really becoming familiar with what it's made of because then there is a process in the brain that can unlearn and truly dissolve that stuff away and you'll be free from these patterns and won't even have to keep trying to prevent them that's why we're heading toward this stuff that has never failed to satisfy a client and bring about nice cooperation with the process great wonderful um the next question also for michael but

uh i think it's quite an important one what about when someone's life is set up in a way to support the problem emotional schema so um i living with a critical parent uh socializing at the bar long-term isolation um they've constructed kind of their their life to support the schema [Music] what what are your thoughts there well the first thought is that's what's always the case yeah that's always the case we deal with that with every client yeah so then what can i add to that let me say something about how we we carry out

the process in the way i described in the talk in other words we start from whatever the client defines as a problem pattern or symptom i i never use the word symptom with clients i use it in talking with therapists you know get that very identified and then work from that to find the emotional learning or schema under that driving that there can be more than one there can be two or more very different emotional learnings driving the same symptom which you discover when you thoroughly dissolve the first schema you found and the symptom keeps

happening and yet the schema clearly has no more realness for the client at all that means there's another schema to find you start the process over again but to answer this question what i have to describe is that the problem that the questioner is getting at life is strongly organized around this game just as it is the way that problem shows up is that when you arrive at the juxtaposition experience for the schema and you facilitate the jokes the position experience well it's experiential there's no signs of resistance to either side of the juxtaposition it

feels experiential you know and and yet the schema remains feeling real which may be apparent a little later in the same session or in the next session you'll discover that the schema still feels real either when you deliberately probe for whether it's still real by having the client imagine being in a situation that always has triggered the schema or the client comes in and says guess what i was in that situation and it still felt like it happened only to me or whatever the schema you know core core material was made up that that it

still feels like that and if i am quite clear with myself that the juxtaposition experience that we carried out was you know was a good one in the way that i described a properly a well executed process that the fact that the schema still feels real is my signal that resistance to transformation of the schema is happening and what we've learned through decades of working this way is that resistance to disconfirmation and dissolution of the schema happens when the results of this schema losing realness are too distressing or difficult to allow yet and i think

that's what is exactly relevant to the question because all scheme all clients are fully organized in their lives around whatever schemas they already have but not all schemas are going to bring so much difficulty of adjustment if they stop feeling real that the client's emotional learning and memory system slams on the brakes at the juxtaposition experience and doesn't allow the schema to be nullified and disconfirmed the emotional learning memory system already knows all the adjustments that are going to have to come from that scheme are no longer feeling real and as the questioner astutely indicated

some adjustments to disconfirmation of the schema are big and distressing and involve major changes sometimes the first marker of transformational change that shows up in a session when the when in the first moments when it's clear to the client that this piece of reality that seemed to be a definite part of life in the world all along is not real i've seen clients grimace in distress in that moment one client for whom that we have a published case example said to me this means that a way i've been living all my life is phony i

didn't have to forego all those things the way i thought i had to so yes it can be really distressing adjustments and when that happens even when the client doesn't begin to immediately say what the problem is and that often they don't they just come in and say the schema still feels real this piece of reality still feels real we then begin to look for what will schema dissolution that is too difficult to allow you we the the whole therapy becomes focused on that at that point in other words we start the same methodology over

again blocking the this confirmation of the schema is now the symptom and we start to do discovery experientially into what makes that emotionally necessary what is going to come from xyz no longer feeling real that is too difficult at this point we get that as gradually as necessary so the work is tolerable like with trauma work once that hardship suffering loss or difficulty is now identified we work the process to get the client to where whatever now has to be disconfirmed and transformed to make that adjustment workable has been carried out i hope i'm not

making this too complicated uh and now when the anticipated difficult adjustment is foreseen and mapped out and worked on and now feels workable then we go back to the original juxtaposition and now the client's emotional learning and memory system allows it and the schema gets disconfirmed that's a long answer to that question but that's the answer that is the answer that's a wonderful answer thank you um i'm mindful of our time i don't want to keep people over we weren't able to get to every question i do just want to reflect on the fact that

um the the feedback already is just outstanding people have said thank you so much this was absolutely clear powerful wonderful crystal clear articulation um so that's music to my ears thank you thank you prayer presentation and research this has helped me so much uh thank you for the queer explanation of the complex process and you're sharing so just over and over repeated uh praise for the talk so thank you very much it reminds me um you know succinctly hannah levinson always uh says patients don't need an explanation they need experience yeah she's quoting karen hornoy

yes yes yeah yeah it's a profound utterance that that lives in me as well yeah and and i think bruce if i could on behalf of everybody just say um i think you've both given us an explanation and an experience today so thank you wow oh thank you thank you that's terrific oh you've made my i was going to say you've made my day i think you've made my month yeah thank you by saying that thank you thank you thank you thank you so much