Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about (...) therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components – autobiographical memories, semantic structures, and emotional responses – supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: reactivating old memories; engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed. (shrink)

Thus the radical character of Hume's causal theory lies far more in its denial of externality to necessary causal connection than in any change he made in the character or status of the connection. It is obvious Hume did not mean his sceptical denial of the "reality" of the causal connection to imply that there is no association or connection between causes and effects. For to him the anarchy of chance, or "liberty," was the only alternative to the truth of (...) causal necessity; and his own "habit" necessity is designed to account for the fact that the universe and human life are not in reality anarchic. Yet in making causal connection a matter of mental association Hume came very close to subverting the idea of necessity despite himself. Had he developed his notion that necessity consists in the unopposable habit our minds form of passing from the idea of the cause to the idea of its effect, he might have seen that causal theory can be divested altogether of the idea of necessity without loss of order and regularity on either the mental or physical levels. Even though he did not do so, Hume's idea of necessity based on habit seems a somewhat attenuated version of causal necessity, since habit is not an inexorable force, and past conjunctions of a given cause and its effect in our experience do not in the least imply that future conjunctions will be the same. For when we anticipate the issue of an effect similar to past effects because the cause is similar to past causes, it is only by a mental presumption that we do so, a "determination of the mind to pass from one object to its usual attendant.". (shrink)

In this response to commentaries on our target article, we highlight and clarify a variety of issues and respond to several comments, challenges, and misconceptions. Topics covered include the mechanisms of enduring change, the nature of memory, the conditions in which memories are updated, the role of emotional arousal in change, and current limitations in our understanding of the neural basis of change in psychotherapy. It is our hope that through research stimulated by this exchange the latter may be advanced.