In 2004 I wrote a paper describing how catharsis can transform painful and uncomfortable emotions permanently. Last weekend I attended the annual Psychotherapy Networker Symposium in Washington DC and learned how research has confirmed a biological basis for this healing transformation. Actually, this revolutionary news has been leaking out for a few years, but has yet to to be fully assimilated by some therapists and schools of therapy. Let me share what I know.
As described in my book and posts on healing, when we encounter or even anticipate encountering things our brain regards as dangerous, we experience feelings with visceral intensity. Permanent healing requires two conditions simultaneously: 1) That we experience the feeling fully and consciously, and 2) That we find ourselves in a context of safety and empathic connection. Following Freud, who first described this process in 1893, I have maintained the term, catharsis. I have also noted that this process takes place in minutes following conscious evocation of the original emotion.
Back in 2004, LeDoux and others were saying that memory templates of danger are laid down permanently in the emotional brain, in the amygdala, to be precise. What I and others surmised was that the amygdala still recognized danger as before, but healing by catharsis caused the visceral reaction to be inhibited by signals from the cortex.
Now it turns out that those original traces of danger lodged in our emotional brain can actually be erased, not just inhibited, but permanently erased. Moreover, the transformative processes that Freud and many others since have described is exactly the one that causes this erasure. When we fully re-experience painful and uncomfortable emotions in a context of safety and empathic connection, over the course of a few minutes, they are erased and no longer trigger the old visceral reaction. This doesn’t mean we forget the story of what happened, only that the recognition of alarm and danger in our emotional brain is erased.
Scientists have worked out many of the precise details of this process in both animal and human experiments. What happens is that when emotional memories are accessed, that is, remembered, for a period of time, they become unlocked and subject to change. This openness to new information lasts from about 10 minutes after reactivation of the memory till about 5 hours later, then whatever information is current is again locked down. Neuroscientists call this re-opening of locked memory, “reconsolidation,” since most of the time, the old memory is reinforced or reconsolidated by a new encounter with the old danger. However, when the context at the time of re-experiencing the emotion is opposite to the original one, then the amygdala can lock in the new information and will no longer recognize the situation as dangerous. Researchers in this field including LeDoux, Schiller, Nader and many others have shown this effect in multiple animal species and in humans. In fact, the same phenomenon can apply to other kinds of learning as well.
This is really a very smart way for evolution to handle recognition of danger. When a baby animal hears a predator’s call in the distance, it is good to be afraid. A new encounter with that ominous sound would naturally reinforce the previous learning. But what if the original encounter was of a baby bobcat with an owl, capable of attacking a small animal but not a grown one. In a new encounter in which the now-grown bobcat hears the call of an owl, the context is quite different and the bobcat could unlearn the original fear.
Here’s what happens with humans. In early life, we may learn to be afraid, let’s say, of being vulnerable. If we consistently avoid feeling vulnerable, then the old learning stays in place because we avoid having to retrieve the memory. If, for some reason, we allow ourselves to feel vulnerable, our caution and mistrust are likely to trigger others to distance. Then we feel as if we were right to avoid vulnerability and the old fear is reinforced. Think of how many family patterns are repeated over and over, causing relearning of the same old lessons. On the other hand, when we purposely engineer the situation so that the old fear is encountered in a context that is opposite to the original one, we can actually erase a trigger, even one that has been there for years. This is what happens regularly when therapy has a transformative effect.
But now things get a bit confusing. The mechanism whereby emotional reactions are not erased but counteracted by learning in the thinking brain does still exist. It is not permanent, and requires reinforcement along the way, but it does help reduce reactivity to triggers that have not been erased. So there are two ways to loosen the grip of our triggers and dysfunctional patterns. One is permanent and works directly in the emotional brain and the other requires ongoing reinforcement utilizing the cerebral cortex.
Proponents of “exposure therapy” have always thought that it worked by the second mechanism described above. Patients would learn to counteract their reactions to triggers. Exposure therapy was assumed to follow the same mechanism as rodent experiments where, with repeated presentation of reminders of past shocks, the animals will eventually learn not to react. This learning does work, but eventually fades and requires reinforcement. That is why practitioners of exposure therapy insist on multiple repetitions of the same distressing memories and risk re-traumatizing their PTSD patients (See my recent post on PTSD). By and large, the exposure therapy camp still holds to this model.
Meanwhile, following pioneering efforts by Bruce Ecker, the originator of Coherence Therapy, other camps such as Eye Movement Desensitization and Reprocessing therapy (EMDR), Emotion Focused Therapy, (EFT), Accelerated Experiential Dynamic Psychotherapy (AEDP), gestalt therapy, and more, are embracing the new research on reconsolidation and what is often called “transformational change.” The hallmarks of transformational change in humans are the same ones identified by animal researchers: 1) the same triggers no longer produce the old reaction, 2) pathological symptoms aimed at avoiding the painful feeling melt away, and 3) The change is maintained permanently without further thought or effort.
But I have a question. When exposure therapists re-activate a painful memory in a context of safety and empathic connection, doesn’t catharsis happen then, too? Aren’t these just the conditions required for transformational change? I think they are. I believe much of the time, in actual sessions, exposure therapy and other less explicitly experiential therapies, psychoanalysis among others, keep emotional memory active during the 10 minute to 5 hour window and create a context of safety and empathic connection.
Of course, this may or may not happen in sessions of any brand. When the therapist and patient get too intellectual or somehow get away too from from feelings, the transformative effect can be lost. In addition, in exposure therapy in particular, too much insistence on repetition can become traumatic in itself.
How are exposure therapists reacting to this new knowledge? Many seem to worry that traumatic memories are so deeply entrenched that transformative change couldn’t work. (It does work, I have seen it many times.) Some also worry that helping people recall their trauma in a visceral way will be re-traumatizing. (When it is done in safety, is completely voluntary and is done with an empathic witness, this does not happen.) If these worries are preventing exposure therapists from learning to recognize and make use of the recently discovered ability to erase triggers, it shows how important it is for all therapists to exit from their silos and learn from each other.
So I am hoping that all therapists are taking interest in the new science of transformative change, learning to recognize when it is happening, and how to enhance the process. Here is link to a good starting point for exploring this new knowledge. Also, see my earlier post on catharsis, the universal mechanism of healing. I’m working on incorporating this new clarity in my practice. I’ll keep you posted about practical applications beyond what is already the basis of many of the posts here.