Working Through: the bad news about neuroplasticity

 

A young man stomps down the hallway to my office. He’s been told to come speak to me, is more or less cooperative, though he is fuming, or “triggered” as his peers would say by an as-yet unidentified stressor. Once inside, he sits on the edge of my couch, poised to lunge should anything else graze his volatile mood. “What’s happening?” I ask. What happened? That’s the subtext and layered backstory.

Turning out his pockets, emptying upon my table a previously hidden arsenal of knives and electronica, he raves incoherently about someone who hasn’t returned his call; about someone whom he feels threatened by–an invisible oppressor, spreading ‘lies’ about my client. Whatever’s happened has stirred old material, I surmise. The following conversation will process the present tense, assess risk for dangerous behaviors, and seek to redress a distortion or two, at least from my standpoint. Will it work? The factors in question are numerous, I figure. Much depends upon the nature of the trigger or triggers, the history of similar events in this young man’s life. The prospect of new learning, containing negative or destructive behaviors, plus installing a new and desirable response and sustaining that response will depend also upon the relationship to me, among other things. Does he trust me? Will my interventions be not only well-timed, but compassionate, insightful, true? Has he trusted people like me in his life: teachers, parents; authority figures of one sort or another?

And that’s just scratching the surface, and so it goes. The question of what contains danger, or causes meaningful change, ‘reconsolidating’ traumatic memories remains mysterious, yet to hear some speak you’d think that neuroscience of the last decade or so has at long last delivered the long awaited elixir to traumatic response. In the April issue of The Journal of the American Psychoanalytic Association, Richard Tuch challenges some of the claims made by neuroscientific researchers in recent years, especially as it pertains to the so-called reconsolidation of traumatic memory.

During a seminar, Tuch opined that emotional memories continue to exert an influence over an individual’s emotional life even after a transference (within treatment) has been ‘worked through’. Nuancing his message, Tuch stated that a more likely outcome was for a patient to learn the ability to stand apart from the experience and recognize it (an emotional memory) for what it was. In shorthand: to develop an observing ego. A student challenged this modest assertion, citing “breakthrough” research which proclaims the discovery of the brain’s ability to delete specific, emotional memories, as well as non-conscious beliefs and schemas, at the level of physical neuronal synapses. Indeed, some studies have demonstrated how retriggered memories can undergo a process of “reconsolidation” if, during a critical period, a subject is given a protein-blocking agent, or is presented with new data that contradicts the conditioned response. I even cited some of this research myself to support ideas proselytized in Working Through Rehab, my incendiary critique of adolescent drug treatment. Recent discoveries in research have been hailed as provided evidence of the mind’s flexibility, or “plasticity”, suggesting renewed hope for meaningfully curative responses to trauma.

The problem, as Tuch writes, is that such research involves a particular kind of memory that is readily subject to operant conditioning: the kind of memory that is short-term and responsive to a simple stimulus, such as an accident, or a stimulus that can be simulated in a controlled, experimental setting. Take the work of Daniella Schiller (et al), whose 2010 paper, “Preventing (blocking) the return of fear in humans using reconsolidation update mechanisms”, has been among the sources influencing the new enthusiasm about neuroplasticity. I detailed (though later edited down) the specifics of Schiller’s consolidation experiments in Working Through Rehab. In her study, human subjects took part in what may seem to have been an old-fashioned behavioral experiment: individuals were shown colored squares (CS) paired with electric shocks to the wrists, while physiological reactions were measured via skin conductance response technology (SCR). On the following day the group of subjects was to undergo an extinction exercise wherein the CS would be paired with no shock. The experiment called for a control group to be given a CS ‘reminder’—a CS paired with a shock—ten minutes prior to the extinction exercise, where the CS is paired with no shock. Follow me so far? The ten minute window between exercises was dubbed a reconsolidation window, as in an opportunity to contradict data, delete previous responses; demonstrate plasticity, and so on. Then, on the day after that, another trial experiment was conducted, with subjects exposed to the CS again, again without the accompanying shock. The control group subjects consistently exhibited no SCR, in contrast to their counterparts who had not received the CS reminder and extinction exercise.

This led to some interesting, and again—influential—interpretations. Gorman and Roose (2011) point to the study as an indicator that timing (just timing?) of interventions (from their standpoint, interpretations, not instruction per se) must exist in proximity to reactivation of trauma material in order to block consolidation of maladaptive response, and to allow for a re-writing of a traumatic narrative through a therapeutic discourse. In 2012, when I was writing my book, I thought this a worthwhile assertion, but today it seems overreaching, and in retrospect, I wish I’d waited upon the sober skepticism of Richard Tuch: “Whether these findings can be extended to include memories that are the product of the sort of ‘cumulative trauma’ typically responsible for the disturbances we see in our offices seems highly unlikely,” he writes. Furthermore, the so-called reconsolidation efforts described in the research follow soon after the memory-producing experience, reinforcing the heuristic belief that proximity of feedback to a stimulus is essential to learning.

Or, as I put it to a parent recently: “if Jonny speaks out of turn in class one day, you don’t wait several days, or ‘when the time is right’ to admonish the behavior. You address the behavior in the here and now.” That’s a tenet of teaching, not to mention operant conditioning: to address children quickly and succinctly about what’s happening, as defined in strictly behavioral terms, ignoring psychodynamics. Outside the academic or experimental realm, matters seem different: emotions count in so far as they exist, though they are avoided. Memory counts. Relationships matter, and time is somehow a fuzzier element between people. The emotional context of these moments is anxiety—the fear that accompanies complex memory, the interaction of projections and introjections, the unconscious. I can think of many words to describe the mind. Complex is one of them. The word plastic is not yet among my favorites.

 

Gorman, J.M., & Roose, S.P. (2011). The neurobiology of fear memory retention and psychoanalytic theory. Journal of the American Psychoanalytic Association. 59: 1201-1219.

Schiller, D., Monfils, M.H, Raio, C.M., Johnson, D.C., LeDoux, J.E., & Phelps, E.A. (2010). Blocking the return of fear in humans using reconsolidation update mechanisms. Nature. 463: 49-53

Tuch, Richard (2015). Brief Communication: problems applying neuroscientific research to the clinical setting. Journal of the American Psychoanalytic Association. 63: 311-316.

Advertisements

Leave a comment

Filed under Uncategorized

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s