The Affective Origin and Treatment of Recurrent Maladaptive Patterns

Recurrent maladaptive patterns (RMPs) have been a foundational concept in psychodynamic therapy (PDT) and psychoanalysis for over a century. Typically associated with character pathology (i.e., personality disorders), they highlight the remarkable correspondences frequently observed between relationship patterns in a person’s family of origin, their current adult relationships, and the transference relationship with the therapist. These patterns can be understood as an expression of schemas and therefore share a common conceptual foundation with other major psychotherapy modalities. Yet, the centrality of affect in the origin/development of these maladaptive patterns and their treatment may not be widely appreciated among practitioners of PDT or any other modality. The basic thesis of this chapter is that RMPs as described in the PDT literature could potentially become more widely recognized, understood, and treated in an integrated manner if their developmental and affective origin were more generally appreciated. Doing so would not only improve interpersonal functioning but could also alter the affective dysfunction that predisposes to the development of symptoms that are a common reason for seeking treatment. Consistent with newer developments in psychodynamic theory grounded in observations from early childhood development, this chapter briefly reconsiders the fundamental elements of RMPs, including unconscious processes, development, conflict, defenses, and mechanisms of change from the perspective of affective science and computational neuroscience. In so doing, the goals are to broaden appreciation of the importance and ubiquity of RMPs by explaining them in nonclinical language, to increase the likelihood of enduring change by promoting an integrative approach to their treatment focusing on new emotional experiences in meaningful contexts and to facilitate research that can potentially establish the benefits of such an approach.

Memory Reconsolidation as a Common Change Process

Memory reconsolidation is considered as a common change process that exists across the major individual therapeutic modalities that are aimed at promoting and sustaining long- term, enduring change. The integrative memory model is reviewed in terms of how it may provide the field of psychotherapy integration with a description of a process that all individual therapies seek to achieve. First, the change mechanisms underlying each of the major therapeutic approaches including behavioral, cognitive-behavioral, psychodynamic and emotion-focused therapies are examined to determine the degree to which they describe a memory reconsolidation process. Next, some of the newer, modern integrative therapeutic approaches are reviewed to consider whether they too are promoting a memory reconsolidation process, although not necessarily naming it as such. The memory reconsolidation model and its constituent elements are then examined in depth to determine the degree to which the various therapy models promote and encourage relative aspects of the memory reconsolidation process. Finally, a potentially clarifying definition of terms is proposed and future research is suggested that would help the field determine the degree to which memory reconsolidation is a common change process and if so, how it can best be promoted.

Erasing Problematic Emotional Learnings

This chapter examines how the effectiveness and unification of psychotherapy are advanced by neuroscientists’ findings on memory reconsolidation, the brain’s innate mechanism for profound unlearning. Research relevant to psychotherapy is reviewed and mapped unambiguously into a clinical methodology of transformational change, the therapeutic reconsolidation process (TRP), applicable to all symptoms arising from memory contents. The TRP is defined as a set of experiences required by the brain, allowing implementation by any suitable experiential techniques, without dictating particular forms of therapy. Detection of TRP fulfillment in published case studies from diverse therapy systems suggests that the TRP provides psychotherapy unification and, functioning as both a specific and a common factor, may be responsible for transformational change occurring in any therapy sessions, which would confirm and advance the “corrective experience” paradigm. A coherence therapy case example serves to demonstrate TRP implementation, and research priorities are suggested.

Autobiographical Memory and the Self-Concept

Autobiographical memory plays a central role in one’s conceptualization of the self. It does so not only by storing the content of one’s life history, but also by providing the memories that are used to construct who we are and what we hope to become. Based on theories and evidence from cognitive neuroscience, the authors of this chapter discuss the contents and organization of autobiographical memory and the neural mechanisms that support the retrieval of autobiographical memories. They also cover core self-related functions served by this type of memory. The chapter closes by considering how the cognitive neuroscience of autobiographical memory and its self-related functions can provide insight into mechanisms of enduring change.

Neuroscience of Enduring Change and Psychotherapy

The model of enduring change in psychotherapy featuring memory reconsolidation and emotional arousal was based on recent neuroscientific advances that were presented originally from a predominantly psychological perspective. This chapter translates the components and processes of the model into evidence-based neural systems terms. This neural circuitry model highlights what is known and not known and where new research is most urgently needed. The authors then consider the research agenda, emphasizing what they consider to be the most important knowledge gaps. The basic science research agenda focuses on a variety of topics pertaining to memory and memory reconsolidation as well as interactions between emotion and memory. The clinical science research agenda focuses on the most pressing issues pertaining to the processes and mechanisms contributing to enduring change in psychotherapy. The potential exists to develop a new taxonomy of clinical interventions based on what problems are being targeted, how intractable they are, and how long-lasting the intervention needs to be.

Emotion-Focused Therapy

This chapter provides an overview of the theory and practice of emotion-focused therapy (EFT), while giving special attention to the neuropsychological perspectives that help explain this approach to treatment. The authors elaborate how emotion theory is a fundamental part of the approach and discuss how this theory informs the treatment principles or ways of understanding emotional processing. They discuss how EFT focuses on accessing and utilizing adaptive emotions to promote transformation of maladaptive emotion structures and show how this promotes changing painful memories from the past by a process of memory reconsolidation. In addition, they refer to the outcome and process research of this approach and outline the principles of clinical practice.

The Role of Language in the Construction of Emotion and Memory

Language is known to play an important role in communicating our thoughts, memories, and emotions. This chapter proposes that the role of language extends much more deeply to further shape and constitutively create these mental phenomena. Research on emotion has shown that language can powerfully influence experiences and perceptions that are affective or emotional. Research on memory, too, has also shown that language can be used to shape autobiographical experiences. The authors organize this work by the many forms and aspects that language may take such as rich narratives, specific emotion words, words that focus on the situation versus words that focus on the body, and even words that convey psychological distance from grammatical tense and pronoun usage. They describe a constructionist theoretical model to understand how language shapes emotion and memory in terms of psychological and neural mechanisms. Their model integrates with recent predictive coding models of neural processing. Finally, the chapter relates this work to clinical and translational models of therapeutic change.

What Is a Memory That It Can Be Changed?

This chapter provides an overview of current thinking about certain aspects of memory, in particular, those most relevant in the clinic. It briefly sketches some early history and then discusses those features of memory that are important in understanding what is going on when one changes one’s mind. Major conclusions include (a) there are multiple forms of memory, governed by unique rules—some forms are relatively easy to change; others, less so; (b) reactivating a memory can enable change in that memory, but the conditions governing this remain unclear; (c) memory and emotion interact, affecting the likelihood of a memory being formed, or reformed, after reactivation; and (d) prediction is at the core of what all forms of memory do.

Neuroscience of Enduring Change and Psychotherapy

This chapter explores the historical background behind the creation of this volume. We discuss the intellectual issues at the core of a foundational review article written in 2015 that provided the proximal inspiration for this book. These issues were explored in greater depth at a conference held in Tucson, Arizona, in September 2017, at which many of the authors of this volume came together to discuss basic science and clinical perspectives on memory, emotion, the interaction between the two and the mechanisms that lead to enduring change in different psychotherapy modalities. This introductory chapter briefly describes the organization of the book and highlights some of the key themes raised in each of the chapters.

A Computational Neuroscience Perspective on the Change Process in Psychotherapy

The application of computational neuroscience models to mental disorders has given rise to the emerging field of computational psychiatry. To date, however, there has been limited application of this approach to understanding the change process in psychotherapy. This chapter reviews leading approaches in computational neuroscience: predictive coding, active inference, and reinforcement learning. We then provide examples of how these complimentary approaches can be used to model a range of clinical phenomena and associated clinical interventions, including those associated with emotional awareness, specific phobia, maladaptive self-related beliefs, maladaptive repetitive behavior patterns, and the role of re-experiencing negative affect in the therapeutic process. The authors illustrate how this perspective can provide additional insights into the nature of the types of memories (cast as parameters in computational models) that maintain psychopathology, how they may be instantiated in the brain, and how new experiences in psychotherapy can alter/update these memories in a manner that can be quantitatively modeled. The authors conclude that the computational perspective represents a unique level of description that compliments that of the integrated memory model in a synergistic and informative manner.