Memory, Fear, and the Brain, Part III: Using memory to treat people with P.T.S.D.

PTSD rates “This is the most exciting prospect I think I have ever seen for treating people with severe anxiety-based disease. It isn’t easy to banish demons caused by war, trauma, and rape.” Edna Foa, the director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania Medical School was speaking to Michael Specter, author of the New Yorker article, “Partial Recall—Can neuroscience help us rewrite our most traumatic memories?” (May 19, 2014). Foa is one of the nation’s leading experts on the psychopathology of anxiety disorders.

Specter writes, “Freud argued that repressed memories, blocked unconsciously were like infections, capable of deepening and festering unless they were brought to the conscious mind and resolved. Many psychiatrists have taken the opposite approach. ‘Some say we could reignite a trauma by asking people to deal with the memory,’ according to Foa. ‘In this thinking, keeping the memory suppressed was actually better. That was a strong belief in the early era of psychiatry: Put it behind you. Don’t deal with it. Go on with your life. The idea behind counseling was to soothe the patient, to find ways to make him as comfortable as possible.’

“In the past decade researchers have determined that, while the original memory may be inhibited, it doesn’t vanish. The idea of rewriting memories, rather than destroying them, appealed to Foa. But she added that reconsolidation (if an old memory is to be recalled, it has to retrace the pathways in which it originated. Under certain circumstances the memory seems to change.) raises a paradox: in order to update our most painful memories, we have to revisit them. That is never easy. Foa described a patient who was raped more than a decade ago, by her boyfriend and several of his friends. She suffered badly from P.T.S.D., found it impossible to maintain relationships, and had recently entered therapy. ‘Instead of asking herself what actually happened, she would immediately say it was all her fault. She always said: ‘I didn’t fight them. If I had, they would have stopped.’

“’But she never dealt with it, and that is why she had P.T.S.D.,’ Foa went on. ‘We asked her to tell the story of that New Year’s Eve and repeat it many times.’ As people work through the story again and again, they learn to distinguish between remembering what happened in the past and actually being back there. For people with P.T.S.D. this distinction is not easy to make. The next step was to bring those memories to the surface—and when, finally, the woman did that she realized her terror and her rape were not her fault.

“Reconsolidation has already been shown to help treat drug addiction. Addicts are compelled by the same persistent emotional memories that drive other disorders. ‘The biggest problem for most addicts is how to deal with relapse,’ Daniela Schiller told me. ‘Let’s say somebody is drug-free and then goes and hangs out with friends at a park. A cue associated with his drug use might induce a craving that will cause him to seek the drug.’ Reconsolidation presents a chance to disrupt that process; you don’t lose the memory—you just lose the pleasant feeling it creates.

“The idea is simple enough: you cannot be addicted to a desire that you don’t remember. Jonathan Lee, a behavioral neuroscientist, has put that notion to a test. He used Pavlovian conditioning to induce cravings in rats by pairing light with a narcotic. The next time he showed the animals the light, they automatically reached for the drug. But when Lee interrupted the process of reconsolidation the association disappeared. Other researchers have had similar success with human addicts. Once again, timing was critical: the effect worked only if extinction training took place within ten minutes of retrieving the old memory. ‘If you block that association, you can erase the craving,’ Schiller said. ‘This is the first time we have seen a treatment like that lead to a cessation of addiction.’ Even six months later, the addicts showed no sign of relapse, suggesting, as with Schiller’s work, that when fearful memories are disturbed at the right moment the fear may be gone for good.”

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