Memory-Altering Drugs: Shifting the Paradigm of Informed Consent

Tenenbaum, Evelyn M.; Reese, Brian

doi:10.1080/15265160701518649

Cited by 26 publications

(10 citation statements)

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“…Propranolol has been administered to individuals immediately after experiencing a traumatic event (Pitman et al 2002), and also to PTSD patients immediately after they recall traumatic memories (Brunet et al 2008), blocking the emotional response to the memory and, in both studies, leading to decreased emotional responsivity during subsequent recollections. Although promising, this treatment has initiated heated debate regarding the legal and ethical issues associated with “memory dampening,” as it has been called (Kolber 2006; Tenenbaum & Reese 2007).…”

Section: Memory Reconsolidationmentioning

confidence: 99%

Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science

et al. 2014

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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 (event) 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: (1) reactivating old memories; (2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and (3) 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.

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Section: Memory Reconsolidationmentioning

confidence: 99%

Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science

et al. 2014

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“…It has also been suggested that the blunted affect of a rape victim who was administered prophylactic medication in the emergency room may lead a jury to find the person's testimony unconvincing, thus weakening the case against the perpetrator in court [52]. In discussing the pros and cons of chemoprophylaxis in the context of providing such testimony, it must once again be remembered that the purpose of this intervention is to prevent PTSD.…”

Section: Legal Ramificationsmentioning

confidence: 99%

Preventing Post Traumatic Stress Disorder: Are Drugs the Answer?

Fletcher

Creamer

Forbes

2010

Aust N Z J Psychiatry

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In the field of traumatic stress, chemoprophylaxis is a term that is often used but rarely well understood. There has been no shortage of debate on the issue, but few rigorous studies to ground the discussion. The purpose of the current paper is to explore the issues surrounding this contentious area. Databases including PubMed, PsychArticles and Web of Knowledge were searched using the key words 'chemo or pharmaco', 'prevention or prophylaxis', and 'PTSD or post-traumatic stress'. Relevant journals and reference lists of the papers obtained through this search were scanned for additional references. Studies that investigated the use of pharmacotherapy to prevent the onset of post-traumatic stress disorder were considered for this paper. Studies that examined the treatment of established PTSD were excluded. A total of 15 empirical studies were included in the review (including five randomized controlled trials), and twice as many non-data-driven papers. Evidence for the prophylactic use of alcohol, morphine, propranolol, and hydrocortisone is presented, followed by a discussion of the many challenges of using pharmacological interventions in this context. While attention to this issue has increased in recent times, the dearth of empirical data has done little to further the field. Larger studies are indicated following small trials with medications such as propranolol and hydrocortisone. There remain a number of ethical and practical questions to be answered before the widespread use of chemoprophylaxis can be recommended.

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“…This is further complicated by the need to obtain informed consent from an individual who has very recently experienced a traumatic event. Tenenbaum and Reese (2007) further assert that the use of memory-attenuating drugs under such circumstances calls for informed consent to be expanded to encompass awareness that such treatment may mean the patient would be ineffective in aiding a criminal investigation, advocating for social change, or bearing witness in a legal trial. This call for a high threshold of informed consent speaks to the fundamental imperative to respect a patient's autonomy.…”

Section: Informed Consent and Autonomymentioning

confidence: 98%

Overview of Bioethical Issues in Contemporary PTSD Treatment and Research: Considering Priorities for Future Empirical Ethics Investigation

Jain

Nazarian

Weitlauf

et al. 2011

AJOB Primary Research

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The last decade has seen a surge in biomedical research advancing the evidence base for the effective clinical management and study of posttraumatic stress disorder (PTSD). The authors review the literature describing ethical issues in conducting PTSD research; controversies over the role of preventive pharmacotherapy for PTSD; and ethical quandaries in the identification, treatment, or empirical investigation of PTSD in postdisaster settings. Findings are synthesized within an ethics framework that utilizes major constructs in the biomedical literature: beneficence/nonmaleficence, informed consent, and autonomy. Gaps and weaknesses in the current evidence base are highlighted. The authors conclude by considering priorities for future empirical ethics investigation in this field.

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Memory-Altering Drugs: Shifting the Paradigm of Informed Consent

Cited by 26 publications

References 1 publication

Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science

Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science

Preventing Post Traumatic Stress Disorder: Are Drugs the Answer?

Overview of Bioethical Issues in Contemporary PTSD Treatment and Research: Considering Priorities for Future Empirical Ethics Investigation

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