Depotentiation of Symptom-Producing Implicit Memory in Coherence Therapy

Abstract

In this second of three articles, we suggest criteria defining the optimal use of neuroplasticity (synaptic change) in psychotherapy and provide a detailed examination of the use of neuroplasticity in coherence therapy. We delineate a model of how coherence therapy engages native mental processes that (a) efficiently reveal specific, symptom-generating, unconscious personal constructs in implicit emotional memory and then (b) selectively depotentiate these constructs, ending symptom production. Both the psychological and the neural operation of this methodology are described, particularly how it defines and follows the built-in rules of change of the brain–mind–body system. On neuroscientific grounds, we suggest a fundamental distinction between transformative change, which permanently eliminates symptom-generating constructs and neural circuits, and counteractive change, which creates new constructs and circuits that compete against the symptom-generating ones and is inherently susceptible to relapse. We propose that coherence therapy achieves transformative change through the reconsolidation of memory, a recently discovered form of neuroplasticity, and present evidence consistent with this hypothesis. Subjective attention emerges as a critical agent of change in both the phenomenological and neural viewpoints, profoundly connecting these two domains.

The authors are grateful to Laurel Hulley and to Timothy Desmond for many valuable examinations and discussions of drafts of this article. Niall Geoghegan and Elina Falck also supplied helpful comments. Critiques provided by the anonymous reviewers of this article also led to valuable enhancements, for which we are most appreciative.

Notes

1. The name used from 1993 through 2005 was depth-oriented brief therapy, or DOBT. The change to “coherence therapy” and “coherence psychology” is intended to reflect the central principle of the approach.

2. Ecker previously worked in experimental physics research for 14 years.

3. Ecker and Hulley (1996) refer to the discovery process as radical inquiry to denote both its focus on root material and its swiftness.

4. Upon perceiving an action done by another, one's mirror neurons fire as if one had performed that action oneself. They are thought to help create a model of the internal states of others, facilitating empathy and the ability to reliably infer the presence of certain subjective states in others (sometimes termed mindsight). Mirror neuron dysfunction has been linked to autism.

5. An opposite effect, the disruption of explicit memory formation, is caused by the yet higher hormonal levels produced during experiences of extreme emotional arousal or stress, as during trauma (McGaugh, 1989; Payne, Nadel, Britton, & Jacobs, 2004; van der Kolk, 1994). Under these conditions the hippocampal memory formation system is rendered inoperative, and memories are stored instead as separate, unintegrated affective and perceptual components, which tend to be exceptionally vivid and enduring. Thus, as noted by van der Kolk (1994), the effect of trauma on memory is bimodal: An absence of explicit, narrative memory (amnesia) is accompanied by a sharp enhancement of perceptual and affective memory (hypermnesia).

6. Hippocampal synapses that encoded a mouse's spatial memory of a newly encountered neutral environment, which attracted little attention, lasted 3 to 6 hours, but when an added, specific feature of the same environment was of special significance to a mouse, attracting strong attention, the same synapses mapping spatial memory lasted for days, or about 20 times longer.

7. Homosynaptic plasticity: A particular synapse becomes stronger (“facilitation,” “potentiation”) or weaker (“depression”) because of activity in the presynaptic and postsynaptic neurons of that very synapse.

8. Heterosynaptic plasticity: Change in a synapse's strength occurs due to activity in one or more modulatory interneurons that act on the presynaptic and/or postsynaptic neurons of the synapse, and not due to activity in the presynaptic or postsynaptic neurons themselves.

9. Other possible reasons for nonextinction of prosymptom positions include a variable ratio schedule of learning, which is the learning schedule most immune to extinction (Field, Tonneau, Ahearn, & Hineline, 1996); higher-order conditioning (Gewirtz & Davis, 2000), which could be largely immune to perceived disconfirmation; and redundant conditioning, in which multiple percepts, each a conditioned stimulus, tend to occur concurrently, again creating immunity to perceived disconfirmation.

10. It should be noted that there are two differences between the memory-changing procedure used by Frenkel et al. (2005) and that of coherence therapy: (a) The procedure of Frenkel et al. was designed for reconsolidation of a postive alteration (up-regulation, strengthening) of a conditioned response memory by a concurrent experience, whereas the procedure in coherence therapy is designed to use the same mechanism of reactivation–labilization–concurrent experience–reconsolidation for a major down-regulation or weakening of the strength of a prosymptom implicit memory. Our unified model awaits demonstration of a down-regulatory version of the Frenkel et al. use of a real-life episode. (b) The concurrent experience used by Frenkel et al. (2005) was entirely unrelated to the target memory in both content and context, and operated to strengthen the target memory purely through endogenous biochemical effects. In contrast, the concurrent experience used in coherence therapy is, by design, a phenomenological experience strongly related to the content and context of the target memory and is change-inducing through experiential disconfirmation of the target memory.

11. In a small minority of cases, the client's prosymptom position does not require transformation because, upon becoming conscious, the client recognizes that it serves his or her best interests just as it is. For example, the unconscious prosymptom position generating a graduate student's serious procrastination of course assignments was a refusal to pursue a program and a career that had been chosen by his parents and was not his true calling. He did not change this position (other than to make it conscious); rather, he resigned from the program. Ecker and Hulley (1996) term this reverse resolution.

12. Symptoms dispelled by coherence therapy include depression, anxiety, panic, agoraphobia, low self-worth, attachment problems, sequelae of childhood abuse, sexual problems, food/eating/weight problems, rage, attention deficit, complicated bereavement, fidgeting, codependency, underachievement, procrastination, and a wide range of interpersonal, couple, and family problems.