Memory Ain’t What It Used to Be – And That’s Good for Psychotherapy
New insights into memory are helping to explain treatments for serious problems, and guide us to making them better. Many psychotherapies use the one-two punch of targeting (focusing on a memory or other source of anxiety, flash backs, or related symptoms) and state change (the best-known being relaxation, as in systematic desensitization, and bilateral stimulation in EMDR). Now, researchers are exploring other ways to accomplish this, and they are being guided by new insights into how memory works.
The theory in play is that memories are more vulnerable to change when they are brought to mind, and they can be connected with different feelings most readily at that time. There is a window of time, perhaps 10 hours, for this, but in psychotherapy, the work is done at the same time. Thus, if a veteran’s flashbacks are depriving them of sleep, the understanding is that those flashbacks are encoded with intense emotion that can be changed. The memories can go from stormy and tormentous to significant and meaningful. For trauma therapists, this is a very familiar process, and they are very intuitive about doing this work.
There hasn’t been a popular word for this experience, so I coined the term “shimmering” for it. I teach people a version of this targeting/state change under that generic term. The professional terms related to this include desensitization and reprocessing, and memory reconsolidation.
It’s becoming more obvious why there are so many variations of this process, and why they can be found in numerous approaches to therapy, and countless processes and rituals found in cults, personal growth programs, and religions. The difference is that, instead of intuitively stumbling into it, we can continue to improve upon this through research and application. Joseph Wolpe, MD, really got the ball rolling in 1955, and now, 57 years later, this is headed for a new level.
Essentially, we’re talking about altering memories while they are volatile so they can be reconsolidated in long-term memory without disturbing emotions or destructive unconscious beliefs attached. There is reason to believe that matching the stimulus with the main sense modality that is disturbing will be an improvement on existing protocols. So, if the person has intrusive visual memories, using a visual stimulus while the person recalls the memory would be more effective than a sound.
I think it’s sad that, with such a great need for continued improvement in PTSD treatment, there are studies with veterans being published that still use longer, more arduous treatments such as prolonged exposure (where there is no sophistication regarding using state change such as relaxation in order to make the treatment less traumatic and prolonged — they even use the word prolonged in the name of the therapy. How’s that for being stuck in a paradigm?)
Now, researchers are even exploring Tetris as a stimulus.
Holmes EA, James EL, Kilford EJ, & Deeprose C (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: visuospatial Tetris versus verbal Pub Quiz. PloS one, 5 (11) PMID: 21085661
Below are the citations form that article that appear to be the most interesting, if you would like to learn more about this subject:
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van den Hout M, Muris P, Salemink E, & Kindt M (2001). Autobiographical memories become less vivid and emotional after eye movements. The British journal of clinical psychology / the British Psychological Society, 40 (Pt 2), 121-30 PMID: 11446234
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Bourne C, Frasquilho F, Roth AD, & Holmes EA (2010). Is it mere distraction? Peri-traumatic verbal tasks can increase analogue flashbacks but reduce voluntary memory performance. Journal of behavior therapy and experimental psychiatry, 41 (3), 316-24 PMID: 20359691
Vallar, G., & Baddeley, A. (1982). Short-term forgetting and the articulatory loop The Quarterly Journal of Experimental Psychology Section A, 34 (1), 53-60 DOI: 10.1080/14640748208400857
Gunter RW, & Bodner GE (2008). How eye movements affect unpleasant memories: support for a working-memory account. Behaviour research and therapy, 46 (8), 913-31 PMID: 18565493
Kemps E, & Tiggemann M (2007). Reducing the vividness and emotional impact of distressing autobiographical memories: the importance of modality-specific interference. Memory (Hove, England), 15 (4), 412-22 PMID: 17469020
Kemps, E., Tiggemann, M., Woods, D., & Soekov, B. (2004). Reduction of food cravings through concurrent visuospatial processing International Journal of Eating Disorders, 36 (1), 31-40 DOI: 10.1002/eat.20005
Engelhard IM, van den Hout MA, Janssen WC, & van der Beek J (2010). Eye movements reduce vividness and emotionality of “flashforwards”. Behaviour research and therapy, 48 (5), 442-7 PMID: 20129601
Krans J, Naring G, & Becker ES (2009). Count out your intrusions: effects of verbal encoding on intrusive memories. Memory (Hove, England), 17 (8), 809-15 PMID: 19657961
May, J., Andrade, J., Panabokke, N., & Kavanagh, D. (2010). Visuospatial tasks suppress craving for cigarettes Behaviour Research and Therapy, 48 (6), 476-485 DOI: 10.1016/j.brat.2010.02.001
Hagenaars MA, Brewin CR, van Minnen A, Holmes EA, & Hoogduin KA (2010). Intrusive images and intrusive thoughts as different phenomena: two experimental studies. Memory (Hove, England), 18 (1), 76-84 PMID: 20391178
Pearson, D., & Sawyer, T. (2011). Effects of Dual Task Interference on Memory Intrusions for Affective Images International Journal of Cognitive Therapy, 4 (2), 122-133 DOI: 10.1521/ijct.2011.4.2.122
Kindt M, Soeter M, & Vervliet B (2009). Beyond extinction: erasing human fear responses and preventing the return of fear. Nature neuroscience, 12 (3), 256-8 PMID: 19219038
Schiller D, Monfils MH, Raio CM, Johnson DC, Ledoux JE, & Phelps EA (2010). Preventing the return of fear in humans using reconsolidation update mechanisms. Nature, 463 (7277), 49-53 PMID: 20010606
Pitman RK, Sanders KM, Zusman RM, Healy AR, Cheema F, Lasko NB, Cahill L, & Orr SP (2002). Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological psychiatry, 51 (2), 189-92 PMID: 11822998
Liao, S., & Sandberg, A. (2008). The Normativity of Memory Modification Neuroethics, 1 (2), 85-99 DOI: 10.1007/s12152-008-9009-5
Henry M, Fishman JR, & Youngner SJ (2007). Response to open commentaries for “Propranolol and the prevention of post-traumatic stress disorder: is it wrong to erase the ‘sting’ of bad memories?”. The American journal of bioethics : AJOB, 7 (9) PMID: 17849329
Depue, B., Curran, T., & Banich, M. (2007). Prefrontal Regions Orchestrate Suppression of Emotional Memories via a Two-Phase Process Science, 317 (5835), 215-219 DOI: 10.1126/science.1139560
Anderson MC, & Green C (2001). Suppressing unwanted memories by executive control. Nature, 410 (6826), 366-9 PMID: 11268212
Anderson MC, Ochsner KN, Kuhl B, Cooper J, Robertson E, Gabrieli SW, Glover GH, & Gabrieli JD (2004). Neural systems underlying the suppression of unwanted memories. Science (New York, N.Y.), 303 (5655), 232-5 PMID: 14716015
Anderson, M., & Levy, B. (2009). Suppressing Unwanted Memories Current Directions in Psychological Science, 18 (4), 189-194 DOI: 10.1111/j.1467-8721.2009.01634.x
Holmes, E., Moulds, M., Kavanagh;, D., Depue, B., Curran, T., & Banich, M. (2007). Memory Suppression in PTSD Treatment? Science, 318 (5857), 1722-1722 DOI: 10.1126/science.318.5857.1722a
Bolger, N., Davis, A., & Rafaeli, E. (2003). Diary Methods: Capturing Life as it is Lived Annual Review of Psychology, 54 (1), 579-616 DOI: 10.1146/annurev.psych.54.101601.145030
Dalgleish, T. (2004). Cognitive Approaches to Posttraumatic Stress Disorder: The Evolution of Multirepresentational Theorizing. Psychological Bulletin, 130 (2), 228-260 DOI: 10.1037/0033-2909.130.2.228
Dewar, M., Cowan, N., & Sala, S. (2007). Forgetting Due to Retroactive Interference: A Fusion of Müller and Pilzecker’s (1900) Early Insights into Everyday Forgetting and Recent Research on Anterograde Amnesia Cortex, 43 (5), 616-634 DOI: 10.1016/S0010-9452(08)70492-1
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Foa EB (1995) The posttraumatic diagnostic scale (PDS) manual. Minneapolis, MN: National Computer Systems.
Lee, J. (2009). Reconsolidation: maintaining memory relevance Trends in Neurosciences, 32 (8), 413-420 DOI: 10.1016/j.tins.2009.05.002
Riccio, D., Millin, P., & Bogart, A. (2006). Reconsolidation: A brief history, a retrieval view, and some recent issues Learning & Memory, 13 (5), 536-544 DOI: 10.1101/lm.290706
Stuart, A., Holmes, E., & Brewin, C. (2006). The influence of a visuospatial grounding task on intrusive images of a traumatic film Behaviour Research and Therapy, 44 (4), 611-619 DOI: 10.1016/j.brat.2005.04.004
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