When psychotherapy works - what are the brain changes?

The journal Brain and Behavioral Science circulates forthcoming articles for peer commentary before their final publication in the journal. I thought I would pass on the abstract of such an article by Lane et al., who propose that the essential ingredients in therapeutic change include: 1) reactivating old memories; 2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and 3) reinforcing the integrative memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts.

Memory Reconsolidation, Emotional Arousal and the Process of Change in Psychotherapy: New Insights from Brain Science

Richard D. Lane, Lee Ryan, Lynn Nadel, and Leslie Greenberg

Abstract: Since Freud clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about therapeutic change.

The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. The authors present an integrative memory model with three interactive components - autobiographical (event) memories, semantic structures, and emotional responses - supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: 1) reactivating old memories; 2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and 3) reinforcing the integrative memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new neurobiologically-grounded synthesis for research, clinical practice and teaching are discussed.