Memory reconsolidation and the crisis of mechanism in psychotherapy

Abstract

Internal mechanisms of lasting therapeutic change have eluded empirical identification despite decades of outcome research. A breakthrough may be at hand in neurobiological research on memory reconsolidation (MR), which has identified (a) a fundamental mechanism of the brain capable of targeted, profound unlearning and nullification of subcortical emotional learnings and the behaviors and states of mind they generate, and (b) the specific experiences required by the brain for such unlearning. We review the empirically identified process of annulment of emotional learnings, show that it fulfills clinical theorists' criteria for a mechanism of change, and define an empirical study to validate or falsify this MR mechanism's hypothesized clinical occurrence and causal role in therapeutic change. Extensive preliminary clinical observations of transformational change, also described, strongly support the causal role of the mechanism. The MR framework could significantly advance psychotherapy effectiveness and unification, and resolve longstanding clinical conundrums and controversies.