TIFT #100: Clinical Memory Reconsolidation: The Earliest Description

My first experience of memory reconsolidation (MR) was dramatic, so much so that it triggered a career-long drive to understand therapeutic action. But I was not alone, nor the first. The same remarkable phenomenon was the beginning of psychotherapy as we know it.

When. Breuer told Freud about healing his hysterical patient, Freud, having worked with trauma survivors at La Salpêtrière, had the instinct to realize that this was something special. In 1893, he and Breuer published a description of the phenomenon. Here is what they said:

“We found to our great surprise at first, that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect…”

Activation of the old pattern

 MR requires two conditions that must be met simultaneously. Freud and Breuer clearly understood the first requirement, neural activation of the old, troublesome experience or pattern. The recall of previously unavailable memories was an indication that activation had taken place, but the presence of the “accompanying affect” was proof, though indirect, that it was taking place in those deep limbic structures where MR rewrites stored procedural memory.

To be more precise, affect refers to bodily changes, such as tears, that are the most direct and quickest manifestations of the mind’s response to the identification of a potential threat, which takes place automatically and outside of consciousness in places such as the amygdala. As the first visible evidence of a response driven by unconscious emotion, affect is often the best clinical indicator that the first requirement of MR is in play.

 The reason these memories were so dramatic was that they had been dissociated. That meant the neural networks holding those dreaded traumatic memories had stayed sequestered and had not been accessed in years. As a result, when they finally came to consciousness, the recall was intensely vivid. It was as if the events had just happened. In clinical work, this kind of recall and healing is particularly intense. In Freud and Breuer’s cases, the emotional drama, followed by rapid resolution of florid symptoms, fully warranted comparing it to the Greek theatrical experience of catharsis.

In my own clinical experience, two instances stand out, the one that first got me interested in therapeutic action and a second more recently. Both involved recall of previously dissociated traumatic memories, which, once brought to light, healed permanently over the course of a few hours. The only known explanation of such an enduring clinical result is MR.

The striking circumstances of Freud’s and Breuer’s discovery were probably necessary to arouse Freud’s attention, but may also have been unfortunate because they led to an emphasis on the intense expression of emotion. Later, therapies in which clients were simply encouraged to “let out” powerful feelings failed to bring much benefit and gave catharsis a bad reputation. What led practitioners astray was the fact that activation of memories was only half of the story. MR does not take place unless a second requirement is also met.

The second requirement for MR, disconfirming information

Freud and Breuer were good victorian scientists, which is why they missed the second requirement. In their day, scientists were seen as objective observers who had no direct influence on the phenomena being observed. They hadn’t heard yet of Heisenberg’s Uncertainty Principle, that the act of observation affects the thing being observed. Since then we have all learned that our presence is important, but why? The second requirement for MR is to supply disconfirming information that reaches into the limbic system and causes “prediction error” by showing how the old schemas or rules need to be revised. When new, disconfirming information collides with existing assumptions the resulting prediction error triggers a period of volatility for about 5 hours, during which the old procedural memory can be rewritten in the light of the new information.

In Freud and Breuer’s trauma cases, the new information was nonverbal. It was the power of their calm, empathically attuned, manner and tone of voice that communicated to their patients’ limbic selves that the danger was over. The trauma was past and could now be experienced as a terrible but distant memory. Freud and Breuer did not realize the importance of the supportive and empathic care they gave. The limbic system, especially in cases of abuse, remains suspicious of facile words and is not likely to take in and process reassurance unless it is fully authentic and heartfelt. Words and gestures that fail to reach limbic structures will not succeed in causing the prediction error needed to trigger MR. Fortunately, Freud’s and Breuer’s curative results suggest that their nonverbally conveyed, disconfirming information was, in fact, attuned and genuine.

Formulating what therapy needs to do

As a consequence of his wish to be objective, Freud first formulated psychotherapy as “making the unconscious conscious,” leaving himself out of the equation. That worked for dissociative patients and is alive today as a part of trauma therapy, but it still fails to recognize the need for a disconfirming “antidote” communicated in a way that can be accessed and processed in the limbic system.

Modern therapies may also run into the clinical problem that the unconscious can be brought into consciousness as an abstract, intellectualized idea, torn away from its emotional roots. When that happens, unconscious emotion deep in the limbic system is de-activated, which extinguishes the first requirement of MR. In other words, intellectualization can block the action of MR by shutting down the required limbic activation. Understanding the two requirements of MR shows why making the unconscious conscious is not enough. Therapies that only address one requirement simply don’t work, nor do attempts that fail to fulfill both requirements with full adequacy. Nature is rigorous! At the end of this post, I’ll share an offer to access a simplified yet sophisticated way to fulfill both with full adequacy. In the meantime, I want to talk a bit more about how the limbic system is a special place, both familiar and alien to our conscious lives.

The limbic system processes information in its own way

Like the generative AI modeled after it, the limbic system uses associative logic to draw conclusions. Using associations, defined only as positive and negative, the limbic mind works with something more like metaphor to match patterns and make comparisons. Where formal logic cares about the precise ways “things” are related, the limbic mind does not. It does its work via fuzzy, nonspecific positive and negative relationships between chunks of unstructured data encoded in neural networks.

Maybe it helps to picture how we form grammatically correct sentences. It is probably by pattern matching. Somewhere outside of consciousness, we formulate strings of words and compare them to past strings, some of which led to good feeling and some not, to determine which are likely to sound right. The result is rapid and accurate, but vastly different from diagramming sentences or identifying adjectives and participles to arrive at the same conclusion.

So the mind doesn’t worry much about whether a situation today is identical to one long ago or somehow similar. It just takes note of a relationship between the two and how they connect with unconscious emotion. If there are a lot of similar items, and especially if they are related to strong emotions, the response will tend to be that the present situation should be responded to as it was in the past. In contrast, formal logic takes note of precisely how they are the same or different and whether the similarity implies the need for a particular interpretation. It is probably because associative logic has a built-in fuzziness that our Default Mode Network often works all night to sort out complex relationships. On the other hand, a system that sees similarities in milliseconds, even if not very precisely, will, in many cases, do a better job of protecting us from imminent danger.

The art of psychotherapy is using our intuition and empathy to understand and know how to communicate with our client’s limbic system. It is different from the words and ideas we use in scientific discourse. It is more like poetry, but with more elements than just words. Those elements are the kinds of “information” that can reach into the limbic system and speak it’s “language.” And that is where the action of MR is located. That’s why metaphor, tone of voice, new experiences, and sometimes even ideas, can comprise the critical new information that leads to disconfirming old assumptions and creating transformative moments, that is, on condition that the old pattern is simultaneously in a neurologically active state.

As Promised:  Here is the new way we have developed to teach and practice MR. It's a simple, yet sophisticated set of five questions designed to achieve accurate empathy. Click here for access. 

 Jeffery Smith MD

Photo Credit:  Jaceck Dylag, Unsplash