FAQ: Coherence Therapy and Reconsolidation
Q: What induces destabilization, causing the reconsolidation window to open?
Q: Are juxtaposition experiences in Coherence Therapy ever unsuccessful?
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Q: On what basis do you maintain that Coherence Therapy follows the same process subsequently found by neuroscientists to induce reconsolidation? Neuroscientists' procedures in reconsolidation experiments seem very different from what could possibly be happening in therapy sessions.
A: Reconsolidation research was done initially with animals and chemicals, until two studies with human subjects and no chemicals were published, showing the erasure of an implicit learning in humans:
---Walker, M. P., Brakefield, T., Hobson, J. A., & Stickgold, R. (2003). Dissociable stages of human memory consolidation and reconsolidation. Nature, 425, 616-620.
---Galluccio, L. (2005). Updating reactivated memories in infancy: I. Passive- and active-exposure effects. Developmental Psychobiology, 47, 117.
Each of those studies followed this process: create an implicit memory, then reactivate it, then create an experience that contradicts what the memory expects while the memory is reactivated. The contradictory experience during reactivation is the critical ingredient in response to which the synapses of the target implicit memory unlock. Then, further new learning directly revises and rewrites the old learning stored in the memory.
In a study published in 2010, the same process was applied yet again by Schiller et al at New York University to erase a fear response in adults, so the relevance of this study to psychotherapy is particularly apparent. (To see the article, click here.)
---Schiller, D., Monfils, M.-H., Raio, C. M., Johnson, D. C., LeDoux, J. E., and Phelps, E. A. (2010). Preventing the return of fear in humans using reconsolidation update mechanisms. Nature, 463, 49-53.
Coherence Therapy consists of the same specific process: reactivate the symptom-producing implicit memory to be erased, then, while the memory is reactivated, create an experience that contradicts what the memory knows or expects, and repeat the contradictory new learning in the presence of the original memory (which is called a "juxtaposition experience" in Coherence Therapy writings).
That process was identified by Ecker and Hulley through several years of studying therapy sessions in which there occurred a profound dissolution of a previously intense emotional theme and response. They culled the process by working backwards from clients' profound change events in therapy, then defined a therapy consisting of that process, which they described in their 1996 book. Subsequently, neuroscientists arrived at the same process.
Q: What verifiable observations support the proposal that Coherence Therapy achieves change by inducing reconsolidation?
A: There are four clinical observations which, taken together, give legs to that hypothesis:
1. The process followed in Coherence Therapy is manifestly and verifiably the same as that used by neuroscientists, as described in answer to the previous question – reactivation of the target memory followed by an experiential disconfirmation of the reactivated, retrieved memory.
2. In response to successful facilitation of that process, a client's symptom of mood, behavior or thought ceases abruptly, and remaining symptom-free is then effortless.
3. In response to successful facilitation of that process, the intensely negative, compelling emotional schema retrieved from implicit memory at the start of the process now cannot be re-evoked by cues that easily re-evoked it before completing the process. (It is standard practice in Coherence Therapy to test for elimination of the target memory by deliberately trying to re-evoke it using previously effective cues.)
4. With some therapy clients, there is a delay of several sessions from the point where memory retrieval is achieved (conscious experiencing of an emotional schema that was previously unconscious) until the session in which the memory-nullifying juxtaposition experience is successfully created. In the intermediate sessions, the retrieved emotional memory remains compelling and reactive and associated symptoms persist, as they did before retrieval made the implicit material conscious. When the disconfirming juxtaposition experience is finally created, abruptly the longstanding, intense material loses all force and symptoms cease. The shift is clearly felt and described by the client. In the room, the client's shift is remarkable to witness and feel, because a major, lifelong source of personal torment has disappeared.
Those four observations taken together are a significant indication of possible memory deletion, even by neuroscientists' standards. It is not proof, certainly, but it lends plausibility to the hypothesis that Coherence Therapy dispels existing, unwanted emotional responses by inducing reconsolidation.
Q: Neuroscientists describe reconsolidation as applicable to the erasure of fear memories and traumas. Is Coherence Therapy restricted to treating fears and traumas?
A: Coherence Therapy is a completely generalized model of the same process, so it is not limited to specific types of problem. Practitioners have applied the process successfully for many types of symptoms and associated, underlying emotional implicit memory, such as those centered upon loss, powerlessness, attachment patterns, despair, aloneness, low self-worth, anger, autonomy, injustice, and many others, as well as fear, anxiety and panic.
When Ecker and Hulley were studying profound change events in their therapy sessions, they were looking for a process pattern that remained the same for all memory contents and types of symptoms. This resulted in identifying a broadly applicable process and techniques for carrying out that process for a wide range of presenting complaints.
Q: In the NYU study in Nature, Schiller et al used wrist electrodes and a computer screen with colored squares. Is that how Coherence Therapy is done?
A: No, yet it is the same process, carried out using different methods in different contexts, as suitable for the subject and the type of implicit memory. Such differences in concrete technique are seen in comparing different neuroscience studies as well as in comparing neuroscience studies to psychotherapy sessions.
For example, neuroscientist Lissa Gallucio at Rutgers University used a technique with infants that was physically quite different from the technique used by NYU neuroscientists Schiller et al with adults, yet the same process was followed: reactivation of the target implicit memory followed by an experience that contradicts what the memory expects, while the memory is reactivated.
For carrying out that same process in Coherence Therapy, we use techniques suitable to the more complex and emotionally vulnerable implicit memory material involved, as compared with the simple implicit memories that neuroscientists create for their studies. Description of how the process takes place in a Coherence Therapy session is available in articles published in 2008 and 2010.
The keys steps of the core process are well-defined in Coherence Therapy, but because of the complexity of emotional implicit memory in therapy, the process is not entirely reducable to a formulaic protocol. Success requires skill on the part of the therapist to carry out the key steps of the process suitably for the individual client’s unique material and personality.
The tenor of the process in Coherence Therapy is not that of a "procedure" being administered; rather, the work has a very personal quality, and the therapist's empathetic accompaniment is an important catalyst.
Q: The terminology is confusing: neuroscientists refer to the entire process as "reconsolidation," but isn’t it the very last stage of the process where reconsolidation occurs?
A: That is correct. The reconsolidation or re-locking of the altered memory is the very last stage of the process. Nevertheless, the term "reconsolidation" has already come to be the name of the whole process.
What comes first is the unlocking or de-consolidation of the target implicit memory, what neuroscientists term the "destabilization" of the memory trace, returning it to a "labile" condition in which it is revisable or disruptable. The previously locked synapses are physically, molecularly unlocked. Then the "reconsolidation window" is open for a limited time, during which a contradictory experience can rewrite the memory, altering or deleting it. In less than 6 hours, a built-in, complex molecular mechanism re-locks the synapses, closing the window and launching the reconsolidation of the memory. Like the original consolidation of a new memory, which takes weeks, reconsolidation takes an extended time to complete the molecular and structural process that finalizes the redesigned synapses.
Q: What induces memory destabilization, causing the reconsolidation window to open?
A: Regarding how memory destabilization occurs, there is a critically important nuance: Some neuroscientists (and all science journalists) have written that what triggers destabilization of the memory, opening the reconsolidation window, is simply the reactivation of the memory. However, at least four different research teams have shown that what triggers destabilization of the memory is not memory reactivation alone, but reactivation of the memory plus a concurrent experience that significantly mismatches what the memory expects.
Those groups have demonstrated that reactivation alone does not destabilize the memory, and not all neuroscientists seem to be aware of this finding yet. For example, if you turn ON a blue light that in prior training was always paired with getting a shock, destabilization is not launched by the memory reactivation that occurs in response to the blue light. It is when the blue light goes OFF without a shock happening, disconfirming the memory, that destabilization is launched.
That may seem like a detail, but it is all-important for successful destabilization of the memory in neuroscientists' experiments. A 2007 review article on reconsolidation in Nature found that memory erasure was successful in 24 of 43 studies, or slightly over half. The authors, two Yale neuroscientists, suggest that incorrect conditions for reconsolidation might explain the 19 unsuccessful studies and that exploring this possibility might better define what the conditions for reconsolidation are.
Q: Neuroscientists always wait at least 24 hours before testing the outcome after a new, contradictory learning experience has been administered during the reconsolidation window. In Coherence Therapy, do you likewise have to wait until the next session to know whether a juxtaposition experience has been effective?
A: When a juxtaposition experience has been successful with therapy clients, the subjective experience of a dramatically changed emotional reality is immediately felt and described by them. Later in the session, when we test for the existence of the old memory by guiding the client to focus on former trigger cues (such as guiding a client to imagine her mother getting angry at her), the non-re-evocability of the old memory is equally evident. When we persist in guiding the client to have the old response and empathetically remind him or her of the old emotional reason for having that response, the client tries to allow that response to happen but then says that that response feels either lifeless or seems "silly" to have, or even funny or absurd, and some clients actually go into laughter at how funny the old response now seems to them (such as former terror of mom's rage).
These effects are plainly apparent in videos of such sessions. The newly revised memory may not yet be well-stabilized neurally, but it is clearly in effect immediately, as well as in subsequent sessions.
Q: Are juxtaposition experiences in Coherence Therapy ever unsuccessful?
A: Yes. In the minority of cases where the original memory still gets re-evoked in response to the test, this tells us that the juxtaposition experience either needs to be repeated; or that resistance to schema dissolution is occurring, which is a topic in itself; or that there exists some other component of the original schema that was not specifically disconfirmed and needs its own juxtaposition experience (real-life emotional schemas typically have several linked components).
Q: Does reconsolidation actually erase the physical existence of the neural circuits storing an implicit memory? Or do the neural circuits still exist, but with altered contents of the memory that is encoded by them?
A: There appear to exist both types of outcomes, depending on the type of reconsolidation experiment.
In many reconsolidation studies using animals, researchers reactivated an implicit memory that they had previously created, de-consolidating the memory and opening up the reconsolidation window. They then introduced no new learning, so normally the memory would reconsolidate unchanged and generate the same responses; but while the memory was still destabilized, they injected a chemical known to prevent synapse formation. They then found that the memory no longer responded and could not be re-evoked. Neuroscientists understand this to mean that the synapses that linked the neurons to form the circuit had become unlocked during the reconsolidation window and then were chemically prevented from re-locking, which "disrupted" the synapses physically so that the neural circuit no longer existed physically. That is what neuroscientists mean by "erasure" or "deletion" in this class of experiments that use a "chemical blockade."
(Another nuance enters the picture here. Among neuroscientists there is currently a controversy as to whether the disrupted circuit is that of the original memory or that of the neural process that retrieves the original memory. To neuroscientists that is an important difference that has been difficult to solve experimentally; they refer to a "storage deficit" versus a "retrieval deficit." The preponderance of evidence currently is in favor of storage deficit, i.e., erasure of the original memory. This point shows the subtlety that can be involved in all this. Neuroscientists choose their phrases very carefully in their writings as they steer their way among considerations that are not necessarily made explicit.)
In contrast to the animal experiments with a chemical blockade, reconsolidation studies with people do not use such chemical agents, which are toxic. Neuroscientists in this case alter the original memory by introducing new learnings during the reconsolidation window, and they describe the original memory as being updated, edited, or re-written by those new learnings. In other words, the results of these studies allow only the interpretation that the memory circuit has been altered according to new learning, not that it has been physically dissolved (which is still possibly the case, but is not inferrable from the evidence). Nothing is known yet about how bits of subjective knowledge correspond to the physical pattern of synaptic linkages.
It has been established that during the reconsolidation window, in response to new learning, an implicit memory and the behavioral response it produces can be increased in strength, decreased in strength, revised in its details, or, as in the Schiller et al study, completely canceled out.
When in that way a fear memory is completely canceled, in a colloquial sense it still makes sense to say that the fear response has been "erased" or "deleted" because there literally no longer exists a fear memory. Even neuroscientists sometimes indulge in this word usage; as for example in the title of this article: Kindt, M., Soeter, M. & Vervliet, B. (2009). Beyond extinction: erasing human fear responses and preventing the return of fear. Nature Neuroscience, 12, 256–258.