The Official Publication of the
International Society of Schema Therapy
In This Issue
A Hierarchy of Confrontational Interventions Facing 8 Dysfunctional Parent Modes by Ofer Peled (Israel)
Schema Therapy with Children and Adolescents an Extract of Mode Work by Christof Loose (Germany)
Experiential Strategies in Group Schema Therapy by Dr. Rita Younan (Australia)
Memory Reconsolidation: Can we Unlearn Emotional Learning? by Dr. Bruce A. Stevens (Australia) & Dr. Pierre Cousineau (Canada)
Imagery Rescripting, Practical ways to Improve Skills by Chris Hayes (Australia)
Memory Reconsolidation: Can we Unlearn Emotional Learning?
Dr Bruce A. Stevens
Advanced Schema Therapist, Australia
Dr Pierre Cousineau,
Advanced Schema Therapist, Canada
In over 25 (Bruce) and 40 (Pierre) years of being therapists, we have sat for countless hours with patients who have struggled with accepted ‘truths’ about themselves, beliefs that have governed their lives, limited their choices and flooded their relationships with ugly emotions. We have agonized with our patients in the slowness of the change process.
One of the most important questions in therapy is how can the brain unlearn something? Think of one of your patients with early abuse or neglect. Or trauma. Or low self-esteem. Or dysfunctional relational patterns. This is often the focus of therapeutic efforts and it is frustrating how much the brain resists any change, even of early learning which is inherently irrational and completely dysfunctional. And it can last a lifetime driving dysfunctional patterns of behaviour.
Emotional Learning (EL) is something like a ‘bad tenant’. The person pays no rent and keeps trashing your house. You want to evict them but nothing works. Even when you hand them a legal notice it is ignored. You bring in the bailiffs but there is some obscure law they can appeal. Nothing works and the tenant remains.
Martin believed “I am un-loveable” from experiences of neglect as a child. What he missed out on continued and this belief about himself became consolidated. For many years it was believed that once learnt, such beliefs were indelible, ‘written’ in the brain in a way that it could not be erased (e.g., van der Kolk, 1994). Or that the process of change was to learn new habits over the old established patterns. This has been called ‘counter-active learning’ (Ticic, et al., 2015). This is an attempt to suppress the old learning and to allow a different behaviour, but the old remains and tries to resist. In this view our brain (specifically the limbic system) is a kind of psychological prison.
We will call this approach ‘old therapy’, like Bruce’s children used to say ‘old school’, and unfortunately most current therapies are counter-active. The counter-active techniques include relaxation strategies superimposed on anxiety, new behaviours to overcome a sluggish lack of motivation and thought blocking to oppose negative thinking. It is like trying to evict the unwanted tenant by wearing down their resistance to leaving.
But what needs to happen to effect real and lasting change? Change must happen at the level of Emotional Learning.
A Scientific Advance
Now some welcome news. There has been some remarkable, if somewhat obscure, research in memory reconsolidation. Memory consolidation is when something is learned and later strengthened; memory reconsolidation is when something new is learnt in place of what was previously learned. Obviously both are central to the concept of Emotional Learning.
In the following discussion of theory and research I have cited some relevant studies so that you can look at the neuroscientific evidence. It is hard to follow, but worth the effort.
This memory research found that once an emotionally charged memory was formed, certain later circumstances provide an opportunity for change (Pedreira, et al., 2002). The surprising discovery was that the brain is able to wipe-out and change an established belief (Pedreira, et al., 2004). This research was initially done with animals, such as the sand crabs used by Pedreira, but it demonstrated an important neurological mechanism in which an animal can unlearn something and re-learn it (Perez-Cuesta & Maldonado, 2009). The stimulus with the sand crabs was of a predator (Pedreira, et al. 2004) which produced a trauma-like response – which could be unlearned and safety re-learned. A similar mechanism has been found in human memory research (Forcato, et al., 2007). The process of memory formation (consolidation), retrieval and re-consolidation has now been well described and it would appear that a number of different types of reactivation, such as waking reactivation (Walker et al., 2003), can lead to reconsolidation (Alberini & LeDoux, 2013; also Lattal & Wood, 2013). An interesting by product of this line of inquiry is how to match certain drugs to gain a similar effect (discussed in Alberini & LeDoux, 2013). This could have important implications for the practice of psychiatry. Nader & Einarsson (2010) have provided a useful review.
If you are interested in a thorough review of fundamental research in memory reconsolidation, we recommend the textbook edited by Alberini ( Alberini, 2013). Also, Bruce Ecker (2015) wrote an important paper on the specifics of memory reconsolidation process.
All this has revolutionary implications for therapy. Bruce Ecker has incorporated principles of memory reconsolidation into his Coherence Therapy, the “reactivation of a well-consolidated, longstanding implicit memory appeared to have rendered the stored emotional learning susceptible to dissolution.” (Ecker, 2012, p. 18; also Ticic, et al., 2015). What came to be appreciated was that a reactivation can de-consolidate a memory into a flexible state, which was temporary and could be followed by a relocking or reconsolidation with new learning if some mismatching information was present. The new ‘over-writes’ the old. Arntz mentioned memory reconsolidation in his key note address at Istanbul, 2014.
New learning is supported by realization or direct perception. This gives an understanding of the reasons why visualization techniques could be so efficient in Schema Therapy. We suspect that memory reconsolidation, as a mechanism, operates not only in ST but in a range of experimental therapies such as Coherence Therapy, EMDR, Emotion Focused Therapy, and possibly psychoanalysis in its various forms. This is why such transformational therapies ‘work’, though not all practitioners are aware of the neuroscience mechanism of memory reconsolidation.
At the risk of overstating a claim, memory reconsolidation is the ‘holy grail’ of psychotherapy. Of course there will need to be future research to establish or contradict this explanation of effective therapeutic change. But few would deny its considerable potential or applicability to the most intransient of therapeutic problems.
Now to some practical steps:
Reconsolidation is highly selective and affects only the memory that is being mismatched, whatever that memory might be. This appears to be an inbuilt mechanism to allow flexibility and change in learning. The change mechanism requires both:
(a) Reactivation, and
(b) Mismatch (an experience that mismatches the target memory or what EL expects).
This “prediction error” is at odds with what is expected. This is what sets off a different mental process which leads to what is best described as transformational change. It replaces old learning. Completely. There is nothing to remain in competition with the old learning (Ticic, et al., 2015).
Coherence Therapy has identified juxtaposition of the old and the new learning as elemental for change. A lot is claimed about the effects of such an experience: New learning deletes old learning, is not subject to relapse, remaining symptom free is effortless, and there is an increased sense of a unified self. We can also see juxtaposition in chair-work and rescripting in ST.
Extended Case 1 Example of Sally (Bruce)
The following case is used with permission. I have found that the discovery of EL and juxtaposition works well in therapy, though I would hasten to add that this was a dramatic example of it working.
Sally is a senior military officer. She is highly respected in her field and had responsibility for hundreds of soldiers in a training camp. She thought that her life was “travelling well. I had what I thought was a loving husband, two teenage children and some very close friends. I also had a range of people I knew through a family movie club I attended with my children.”
In a few months things deteriorated. Her husband announced he was leaving her. He had been in an affair, which shocked her, and he went to live with his new partner. Sally survived all this but about six months later her three closest friends, for a variety of reasons, ended their friendship with her. One started to gossip about her at church, another moved to another city to pursue graduate studies and the last became over-involved in romantic relationship. The new relationship took precedence and the girlfriend objected to his friendship with Sally.
All this devastated Sally. She became acutely suicidal and had to be admitted to a psychiatric facility. She was seeing a counsellor who did some good work on Sally’s grief, but became worried about the suicidal crisis. I saw Sally at that point and worked closely with her family doctor and a psychiatrist who prescribed anti-depressant medication.
Over the next year I saw Sally more or less weekly. Some of my graduate students were also involved in counselling support. She made great progress. She was able to return to her military duties through a variety of psychological interventions including exposure therapy. She seemed like she was almost fully recovered and we were thinking about completing therapy. But then I thought about how intensely suicidal she had been. It was as if she held her life ‘lightly’. Almost with no value. I worried that a similar crisis might occur in the future and then she would be highly at risk of suicide. It had been a ‘close thing’.
So I used sentence completion about why she felt she had to kill herself. I had the sentence completion “I need to kill myself because …” The result was very surprising:
“I am of value only to the degree I am helpful to others. If I need others, I become a burden. My overall worth is the balance, if it is negative then I should kill myself to restore the balance to zero.”
I wrote this on a card and she said that every word resonated as true for her. She was asked to read the card once a day for the next week. A week later she reported a huge shift. She said that the first sentence “I am of value only to the degree I am helpful to others” felt about 40% true but the rest “not at all true” and was rated 0% true. She saw that previously her sense of self-worth was extrinsic and was shifting to be intrinsic, and she felt “freer”. She revised her emotional learning to the following statement, “I am a valuable person because I have my own values which I can satisfy without needing affirmation from others. I can make a valuable contribution without needing it recognized.”
I had Sally visualize saying this to a crowd that included her ex-husband, children, parents and siblings. She had made some new supportive relationships and they were included as well. I asked if anyone was missing and she said, “I want to see me there too.” She added, “I need to hear myself say it.” I could see a profound shift and I was finally satisfied that the risk of suicide was in the past. Her recovery from risk of suicide was as complete. Indeed I have seen her in follow-up sessions since this turbulent period and while she has faced challenges, she is emotionally stable.
Extended Case 2 Example of Martine (Pierre)
The following case is used with permission. Martine was already known to the therapist. The reason for this new consultation was her ambivalence towards a love relationship and her mother’s opposition to it (she disliked the boyfriend).
In one session, Martine expressed her wish to go out for a weekend with her boyfriend, but at the same time was literally terrified to inform her mother about it. After this intense fear was clarified, the therapist asked her to close her eyes, visualize herself informing her mother, focus on her somatic sensations while doing so, ending up by an affective bridge to past experiences with such sensations (discovery work). The patient retrieved childhood memories of physical assaults from her mother. This led us to the following formulation of a fundamental emotional learning (punitive parent - abuse).
“Mom, when you’re angry at me, I’m afraid that you’ll grab me by the throat to kill me, I’m terrified of dying. I become a little defenceless girl. That is what is triggered in me whenever someone is angry with me or demands something from me.”
The daily reading of this emotional belief which was written on a card (integrative work) triggered mismatching experiences (error detection under spontaneous mind processing). Two situations confirmed an emotional memory modification: Martine didn’t experience fear when she informed her mother of her plan of the weekend, and subsequently discarded her mother’s objection to her personal decision. Martine was astonished that this was done without extensive effort, a complete turnaround from her historical reactions.
But a few weeks later, Martine reported fear again while anticipating another situation. She wanted to stop one of her voluntary work commitments. She had many such commitments and had a hard time saying no to new solicitations (self-sacrifice schema) — this had led her to burnout in the past. But the anticipation of saying to collaborators that she would conclude this specific commitment triggered a fear anticipation. The intensity of this fear was close to terror and it told us that our previous work left another memory track untouched. Metaphorically, work with memory reconsolidation is like a laser beam intervention, you have to make sure you are on the right memory track in order to modify it.
So, we extended our discovery work to this anticipated situation and ended up with the following emotional belief, which added a subtle nuance to the previous one:
“Mom, you’re too strong for me. When you squeeze my arms, grab me by the throat and threaten to kill me, I can’t do anything. If I try to defend myself, you will kill me.”
Spontaneously, Martine came out with a mismatching belief (another emotional belief—not a cognitive disputation):
“Today, it is no longer true that I can’t do anything. I would be able to defend myself and stop you from killing me.”
This second emotional belief referred to a situation in which, as an adult, she prevented her mother from grabbing her by the throat. We then asked her to read alternatively both emotional beliefs and check out how much they felt true to her (juxtaposition phase). She reported that after a few days, the first one didn’t feel true to her anymore. Moreover, the fact that she didn’t experience terror or fear with anticipation or actual announcement of her decision to end her voluntary work with the group, confirmed the emotional memory modification. This was done in just a few sessions and the new emotional belief maintained itself effortlessly.
The quest to find what works in therapy has has drawn both of us to the edges of therapy. The needs of our patients have kept us unsatisfied with our answers. Of course we have to preference evidence based therapy, but we would never advance to new EBTs unless we are at some level dissatisfied. So in this brief paper we have presented a process for therapeutic change using memory reconsolidation from the neurosciences. There are a lot of edges but thankfully we do not live on a ‘flat world’ so we will not fall off if we go there!
Alberini, C. M. (2013). Memory Reconsolidation. London, UK: Academic Press.
Alberini, C. M. & LeDoux, J. E. (2013). Memory reconsolidation. Current Biology, 23(17), R746-R750.
Ecker, B. (2015). Memory Reconsolidation Understood and Misunderstood. International Journal of Neuropsychotherapy, 3 (1), 2-46.
Ecker, B., Ticic, R., & Hulley, L. (2013) Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York: Routledge.
Forcato, C., Burgos, V., Argibay, P., Molina, V., Pedreira, M. & Maldonado, H. (2007). Reconsolidation of declarative memory in humans. Learning and Memory, 14, 295-303.
Lattal, K. M., & Wood, M. A. (2013). Epigenetics and persistent memory: Implications for reconsolidation and silent extinction beyond zero. Nature Neuroscience 16(2), 124-129.
Nader, K. & Emerson, E. (2010). Memory reconsolidation: An update. Annals of the New York Academy of Sciences, 1191, 27-41.
Perez-Cuesta, L. & Maldonado, H. (2009). Memory reconsolidation and extinction in the crab: Mutual exclusion or coexistence? Learning and Memory, 16, 714-721.
Pedreira, M. Perez-Cuesta, L. & Maldonado, H. (2004) Mismatch between what is expected and what actually occurs triggers memory reconsolidation or extinction. Learning and Memory, 11, 579-585.
Stevens, B. (2016) Emotional Learning: The way we are wired for intimacy. Ebook available through Amazon.com, Kindle and ibook.
Stevens, B. & Roediger, E. (in press, 2016) Breaking negative relationship patterns, Wiley Publishers.
Ticic, R., Kushner, E., & Ecker, B. (2015). What’s really going on here? How to navigate life using the hidden intelligence of our emotional brain. On line publication by Coherence Psychology Institute.
Van der Kolk, B. (1994). The body keeps the score: Memory and the evolving psychobiology of post-traumatic stress. Harvard Review of Psychiatry, 1(5), 253-265.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy. A practitioner’s guide. New York: The Guilford Press.
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