Memory reconsolidation in psychotherapy for severe perfectionism within borderline personality

Abstract

Objective(s): For a case of severe perfectionism, comorbid with complex trauma symptomatology including suicidality, self-harming, and other markers of borderline personality, we demonstrate the use of the empirically confirmed process identified in memory reconsolidation (MR) research for the unlearning and nullification, or "erasure," of emotional and behavioral responses driven by learned expectations and mental models. MR has been proposed as a transtheoretical, unifying mechanism underlying profound psychotherapeutic change. The therapist (first author), under the second author's supervision, used a varied set of clinical skills woven together through a focus on the MR process. Results: The result was a depotentiation of underlying, traumatic emotional learnings and near-total disappearance of perfectionistic and self-harming behaviors, urges and attitudes after 1 year of therapy. Conclusions: Implications of this case are discussed in terms of symptom generation by implicit emotional learnings and MR as a promising framework for advancing the effectiveness and unification of psychotherapy.

Reconsolidation behavioral updating of human emotional memory: A comprehensive review and unified analysis of successes, replication failures, and clinical translation

“…An extensive clinical literature already exists documenting (a) the moment-to-moment creation of the EIPA's three critical experiences, and (b) verification of prompt appearance of unambiguous markers of emotional memory annulment [12][13][14][15]47] (and for an extensive listing of published case examples indexed by symptom, see https://bit.ly/2tKXdyX; for a list of case examples from diverse systems of psychotherapy, see https://bit.ly/15Z00HQ). Those numerous demonstrations suggest that EIPA facilitation has been found to be not only feasible but actually versatile and effective in nullifying a wide range of negative emotional learnings and their symptomatic forms of expression.…”

“…For example, [12] shows deliberate facilitation for two cases, one dispelling a long-term feeling of terror and intense somatic disturbances (with session videos available for viewing) and the other, a lifelong disposition to a prolonged mood of angry resentment. Deliberate facilitation in another, particularly complex case [47] dispelled several primary features of borderline personality, including extreme compulsive perfectionism, emotional volatility, self-harming behaviors, and suicidality. Fortuitous facilitation is shown in a collection of four therapy cases dispelling symptoms of depression, post-traumatic panic attacks, affect avoidance, shame, and avoidance of emotional intimacy causing loss of relationships [14] (pp.…”

“…If a psychotherapy recipient's specific long-term emotional memory contents and their symptomatic expressions suddenly cease to be re-evoked by the cues and contexts that consistently had been evoking them, and this disappearance persists long-term with no further preventative measures, the only tenable scientific explanation is emotional memory annulment by the MR mechanism. Numerous clinical case examples of that kind have been documented in detail [12][13][14][15]47], showing that the cessation of emotional memory reactivation and expression begins immediately following the same set of experiences that Section 4 reports is present in each of the studies in Table 1. One such clinical case example is presented below in Section 6.2.…”

“…• Early but extensive clinical applications of the behavioral updating process (described in Section 6 below), including numerous cases documented in detail in peerreviewed articles [12,13,15,46,47], indicate both its effectiveness and its applicability for a much wider range of clinical symptoms than has so far been documented for the pharmacological approach.…”

Reply to Beckers, McIntosh and Chambers on the verification of ‘preventing the return of fear using retrieval-extinction in humans’

“…The retrieval-extinction procedure has further been shown to be effective in clinical populations, including heroin addicts (Xue et al, 2012), tobacco smokers (Germeroth et al, 2017), and PTSD (Vermes et al, 2020) and phobia patients (Bjorkstrand et al, 2016;Maples-Keller et al 2017), with long-lasting effects (Bjorkstrand et al, 2017). Some forms of therapy, such as coherence therapy, are built on the principles of memory reconsolidation updating and are designed to maximally optimize this process (Lane et al, 2015;Gray et al, 2019;Vaz and Ecker, 2020).…”