volume 3, issue 1 (2015) ISSN 2202-7653
international journal of neuropsychotherapy Volume 3 issue 1 - 2015
Volume 3 - 2015
Aims & Scope
The International Journal of Neuropsychotherapy (IJNPT) is an
open access, online journal that considers manuscripts on all aspects
of integrative, biopsychosocial issues related to psychotherapy. IJNPT
aims to explore the neurological or other biological underpinnings of
mental states and disorders to advance the therapeutic practice of
psychotherapy.
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with the best research from around the world to raise awareness of
the neuropsychotherapy perspective to mental health interventions.
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ii INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
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Volume 3 Issue 1 (2015)
 international journal of neuropsychotherapy Volume 3 issue 1 - 2015

Table of Contents

Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01
Pieter Rossouw

Memory Reconsolidation Understood and Misunderstood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02

Bruce Ecker.

Neuropsychotherapy: Defining the Emerging Paradigm of Neurobiologically Informed

Psychotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Matthew Dahlitz.

Russian Psychology and Neuropsychotherapy: Comparative Analysis. . . . . . . . . . . . . . . . . . . . . . 70

Maria I. Kostyanaya

The Development of Memory: Implications for Learning and Education. . . . . . . . . . . . . . . . . . . . 89

Pieter Rossouw

Social Deficit Hyperactivity Disorder (SDHD): A Sibling of ADHD? . . . . . . . . . . . . . . . . . . . . . . . . . 92

Sandy Laurens & Pieter Rossouw

EDITORIAL TEAM
CHIEF EDITOR ADVISORY BOARD
Matthew Dahlitz
Pieter Rossouw, Ph.D. (Chair)
ASSOCIATE EDITOR Jack C. Anchin, Ph.D.
Richard Hill
Malek Bajbouj M.D.
MANAGING EDITOR Louis J Cozolino, Ph.D.
Geoff Hall Todd E Feinberg M.D.
Stanley Keleman, Ph.D. hc SK
Jeffrey J. Magnavita, Ph.D., ABPP
PUBLISHER Iain McGilchrist, M.D., MRCPsych
Dahlitz Media
Georg Northoff, M.D., M.A., Ph.D.
Allan N. Schore, Ph.D
Mark Solms Ph.D.
Paul G. Swingle, Ph.D.
Jonathan H. Turner, Ph.D.
David Van Nuys, Ph.D..
DISCLAIMER
The International Journal of Neuropsychotherapy (IJNPT) ISSN 2202-7653, is an open access online journal published by Dahlitz Media Pty
Ltd. The publisher makes every effort to ensure the accuracy of all the information contained in this publication. However, the publisher, and its
agents, make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the information
herein. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of, or endorsed
by, the publisher. The accuracy of the information in this journal should be independently verified with primary sources of information. The
publisher shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever
or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the information in this journal.

Our mission is to provide researchers, educators and clinicians with the best research from around the world to raise aware-
ness of the neuropsychotherapy perspective to mental health interventions.
For further information about this journal and submission details please go to
www.neuropsychotherapist.com/submissionscall/

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) iii

editorial

We are excited to release this edition of the International Journal of Neuropsychotherapy as we enter our
third year since the launch. The global uptake of applied brain based research is in line with the post decade of
the brain phase as well as shifts in traditional treatment modalities like the shift towards the neural underpin-
nings in Cognitive Behavioural Therapies - the “fourth wave” of CBT; the focus on the neural basis of Accep-
tance and Commitment Therapy and focus on the neuroscience of analytical therapies to name a few.
The field of psychotherapy and psychological research has entered a phase that focuses on the interplay
between neuroscientific underpinnings and practical applications to enhance outcomes for the ever growing
demand to find workable strategies to effectively address patterns of unwellness.
One of the key variables that inform the development of a well-integrated person (neural system) is our
education systems. In this volume we discuss the pitfalls of a fear based education system and implications
of such an approach on individual neural development as well as societies in general and call for a stronger
research agenda to address this from neural perspective. We hope this will add to the debate and research in
this domain.
Neuroscience research should always be mindful of its ultimate focus – the wellness of societies and im-
provement of mental wellbeing. The words of Nobel laureate, Erik Kandel comes to mind:
Patient care is our most important responsibility. That is why we are here. Never let patient care take a sec-
ondary role. Patient welfare is the ultimate goal of biological science and it is the engine that drives the whole
scientific enterprise.
Neuroscience opens amazing new opportunities to benefit you clients – utilise it, do it justice and enjoy the
future!” (Kandel, E. R., 2006. In Search of Memory. The Emergence of a new Science of Mind. New York, NY:
W.W. Norton)

Pieter Rossouw
Chief Editor
Summer 2015

1 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

theory

memory reconsolidation
understood and misunderstood

Bruce Ecker
Coherence Psychology Institute

Abstract
Memory reconsolidation is the brain’s natural, neural process that can produce transformational change: the
full, permanent elimination of an acquired behavior or emotional response. This article identifies and examines
10 common misconceptions regarding memory reconsolidation research findings and their translation into
clinical practice. The research findings are poised to drive significant advancements in both the theory and
practice of psychotherapy, but these benefits depend on an accurate understanding of how memory reconsol-
idation functions, and misconceptions have been proliferating. This article also proposes a unified model of
reconsolidation and extinction phenomena based on the brain’s well-established requirement of memory mis-
match (prediction error) for reconsolidation to be triggered. A reinterpretation of numerous studies published
without reference to the mismatch requirement shows how the mismatch requirement and mismatch relativity
(MRMR) model can account for diverse empirical findings, reveal unrecognized dynamics of memory change,
and generate predictions testable by further research.

Keywords: memory reconsolidation, psychotherapy, memory mismatch, prediction error, erasure

Author information: Acknowledgements

Bruce Ecker, MA, LMFT
Codirector, Coherence Psychology Institute
3640 Grand Avenue, Suite 209
Oakland, California 94610 USA
Tel: 510-452-2820
Fax: 510-465-9980
Email: bruce.ecker@coherenceinstitute.org
The author gratefully acknowledges neuroscientist
Alejandro Delorenzi, psychotherapists Robin Ticic
and David Feinstein, and two anonymous reviewers
for reading earlier manuscripts and offering numerous
suggestions that improved this article, and psychologist
Sara K. Bridges for valuable advice.

Cite as: Ecker, B. (2015). Memory reconsolidation understood and misunderstood. International Journal
of Neuropsychotherapy, 3(1), 2–46. doi: 10.12744/ijnpt.2015.0002-0046

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 2

 Extensive research by neuroscientists since the late cific common factors theory and the almost 80-year-
1990s has found that the brain is innately equipped long “dodo bird verdict” that has appeared to limit all
with a potent process, known as memory reconsolida- therapy systems to the same modest level of efficacy.
tion, that can fundamentally modify or erase a target- Understanding memory reconsolidation involves
ed, specific learning, even complex human emotional learning some new ways of thinking that differ from
learnings formed subcortically, outside of awareness familiar concepts of psychotherapeutic change and
(Pine, Mendelsohn, & Dudai, 2014; for reviews see, may even seem counterintuitive initially. Therefore,
e.g., Agren, 2014; Reichelt & Lee, 2013). Such learn- various aspects of the reconsolidation framework are
ings are found to underlie and drive most of the prob- susceptible to misconceptions. I have been observ-
lems and symptoms addressed in psychotherapy and ing misconceptions as they have developed for nearly
counseling (Toomey & Ecker, 2007; Ecker & Toomey, a decade as of this writing, and they are increasing
2008), so the relevance and value of memory recon- as awareness of the importance of reconsolidation
solidation for the clinical field are profound. builds at an accelerating pace. In fact, sizable concep-
To describe a particular learning as “erased” means tual errors are being propagated widely in articles by
that its behavioral, emotional, cognitive, and somatic science journalists in the popular media, in articles by
manifestations disappear completely, and no further psychologists in peer-reviewed journals, in posts by
effort of any kind is required to maintain this nulli- psychotherapists in online clinical discussion groups,
fication permanently. Such lasting, transformation- and, surprisingly, even in articles and talks by some
al change is the therapeutic ideal. There is growing neuroscientists involved in reconsolidation research
evidence that in erasure, the neural encoding of the (Ecker, 2014).
target learning is nullified (Clem & Huganir, 2010; Thus there is a growing need for a clear map of the
Debiec, Díaz-Mataix, Bush, Doyère, & LeDoux, 2010; new territory, showing where the path of understand-
Díaz-Mataix,  Debiec, LeDoux, & Doyère, 2011; Ja- ing branches off into the various misunderstandings
rome et al., 2012). The discovery of an erasure pro- of memory reconsolidation. This article is an attempt
cess was something of an upheaval, reversing a firmly to provide such a guide. For the clinical field to fully
established conclusion, based on nearly a century of utilize the potential of memory reconsolidation for
research, that subcortical emotional learnings were major advances, a clear and accurate understanding
indelible for the lifetime of the individual (LeDoux, of it is necessary. Knowledge communities such as the
Romanski, & Xagoraris, 1989; Milner, Squire, & Kan- clinical field can and historically do make collective
del, 1998). errors in the development of new knowledge, lock-
I began studying reconsolidation research findings ing onto limiting, polarized, or oversimplified notions
in 2005, at about the 20-year point of my psychother- that become unchallengeable for decades until, final-
apy practice. Neuroscientists’ densely technical ac- ly, a corrective movement forms. Reconsolidation is
counts of their studies have been comprehensible to too important to fumble and delay in that way.
me, for the most part, thanks to my first career of 14 Understanding how memory reconsolidation can
years as a research physicist, and it quickly became ap- be utilized in psychotherapy (Ecker et al., 2012) is
parent to me that knowledge of reconsolidation could considerably simpler than understanding memory
drive the evolution of the field of psychotherapy in reconsolidation research findings, so many clinicians
major ways. The process that brings about erasure is so may choose to focus on the former and pass on the
fundamental for potent, effective psychotherapy, and latter. The explanations of research findings in this
so sweeping in the advances that it delivers to the clin- article are for those with an appetite for more rigor-
ical field, that I refocused my clinical career on trans- ous insights into how memory reconsolidation works.
lating reconsolidation research into clinical practice. Though memory reconsolidation is a complex phe-
This has produced a versatile, integrative methodolo- nomenon, and there is still much for researchers to
gy of psychotherapy and a conceptual framework that discover about the fine points of how it functions, its
maps out how knowledge of reconsolidation creates main features now appear to be fairly well established,
four major advances for the clinical field (Ecker, 2011; particularly as regards its behavioral and experien-
Ecker, Ticic, & Hulley, 2012, 2013a,b). These advances tial aspects, which are of primary interest to mental
are: a new level of effectiveness for individual clini- health clinicians.
cians, the deep unification of seemingly diverse meth-
ods and systems of psychotherapy, clarification of the This article covers the following common miscon-
much-debated role of attachment in the therapeutic ceptions regarding the major features of reconsolida-
process, and a decisive breakthrough beyond nonspe- tion research findings and their translation into clin-
ical practice:
3 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
Misconception 1. Th
 e reconsolidation process is trig-
gered by the reactivation of a target
learning or memory.
Misconception 2. Th
 e disruption of reconsolidation is
what erases a target learning.
Misconception 3. E
 rasure is brought about during the
reconsolidation window by a pro-
cess of extinction. Reconsolidation
is an enhancement of extinction.
Misconception 4. A
 nxiety, phobias and PTSD are
the symptoms that memory recon-
solidation could help to dispel in
psychotherapy, but more research
must be done before it is clear how
reconsolidation can be utilized
clinically.
Misconception 5. Emotional arousal is inherently
necessary for inducing the recon-
solidation process.
Misconception 6. W
 hat is erased in therapy is the
negative emotion that became as-
sociated with certain event mem-
ories, and this negative emotion is
erased by inducing positive emo-
tional responses to replace it.
Misconception 7. Th
 e much older concept of correc-
tive emotional experience already
covers everything now being de-
scribed as reconsolidation and era-
sure.
Misconception 8. To induce memory reconsolida-
tion, therapists must follow a set
protocol derived from laboratory
studies.
Misconception 9. A
 long-standing emotional reaction
or behavior sometimes ceases per-
manently in psychotherapy with-
out guiding the steps that bring
about erasure through reconsoli-
dation, and this shows that recon-
solidation isn’t the only process of
transformational change.
Misconception 10. C
 arrying out the steps required for
reconsolidation and erasure some-
times fails to bring about a trans-
formational change, which means
that the reconsolidation process
isn’t effective for some emotional
learnings.
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
The discussion of those topics will at some points
(such as in the section on Misconception 3) go be-
yond a review of research findings to propose a new
interpretation of the findings. Before delving into the
misconception topics, however, a short overview is
needed to provide the context that will make discus-
sion of the misconceptions meaningful. In attempt-
ing to clarify both the reconsolidation research find-
ings and their application to clinical work, this article
spans a wide range of material, which in places may
be more technical and laboratory focused than some
clinical readers find useful. Clinical readers can skip
ahead at such points.
Memory Reconsolidation in Context
Memory reconsolidation is the brain’s innate pro-
cess for fundamentally revising an existing learning
and the acquired behavioral responses and/or state of
mind maintained by that learning. In the reconsolida-
tion process, a target learning is first rendered revis-
able at the level of its neural encoding, and then revi-
sion of its encoding is brought about either through
new learning or chemical agents (for reviews see
Agren, 2014; Reichelt & Lee, 2013). Through suitably
designed new learning, the target learning’s manifes-
tation can be strengthened, weakened, altered in its
details, or completely nullified and canceled (erased).
Erasure through new learning during the reconsolida-
tion process is the true unlearning of the target learn-
ing. When erasure through new learning is carried out
in psychotherapy, the client experiences a profound
release from the grip of a distressing acquired re-
sponse (Ecker et al., 2012). The use of chemical agents
to produce erasure is described later in this article.
In order to see the full significance of memory
reconsolidation for psychotherapy, it is necessary to
recognize the extensive role of learning and memory
in shaping each person’s unique patterns of behavior,
emotion, thoughts, and somatic experience. Among
the many types of learning and the many types of
memory, the type responsible for the great majority of
the problems and symptoms that bring people to psy-
chotherapy is implicit emotional learning—especially
the implicit learning of vulnerabilities and sufferings
that are urgent to avoid, and how to avoid them. These
learnings form usually with no awareness of learning
anything, and they form in the presence of strong
emotion, which greatly enhances their power and du-
rability (McGaugh, 1989; McGaugh & Roozendaal,
2002; Roozendaal, McEwen, & Chattarji, 2009).
For example, if a small child consistently receives
frightening anger from a parent in response to the
child expressing needs, the child learns not to express
Volume 3 Issue 1 (2015) 4
or even feel needs or distress and not to expect un- formed. Researchers too have observed that “A unique
derstanding or comfort from others. This learning can feature of preferences [the authors use that term to
occur with no representation in conscious thoughts denote compelling, emotionally complex avoidances
or conceptualization, entirely in the implicit learning and attractions] is that they remain relatively stable
system. The child configures him- or herself according over one’s lifetime. This resilience has also been ob-
to this adaptive learning in order to minimize suffer- served experimentally, where . . . acquired preferences
ing in that family environment. Later in life, however, appear to be resistant to extinction training protocols”
this same learned pattern has life-shaping, extremely (Pine et al., 2014, p. 1). The life-constraining grip of
costly personal consequences. The learnings in this ex- such patterns is the bane of psychotherapists and their
ample are very well-defined, yet they form and operate clients, yet that very tenacity is a survival-positive re-
with no conscious awareness of the learned pattern or sult of natural selection. In the course of evolution, se-
its self-protective, coherent emotional purpose and lection pressures crafted the brain so that any learning
necessity. From outside of awareness these learnings accompanied by strong emotion becomes encoded
shape the child’s and later the adult’s behavior, so the by enhanced, exceptionally durable synapses due to
individual is completely unaware of living according the emotion-related hormones that influence synapse
to these specific learnings. The neural circuits encod- formation (McGaugh, 1989; McGaugh & Roozendaal,
ing these learnings are mainly in subcortical regions of 2002; Roozendaal et al., 2009).
implicit memory that store implicit, tacit, emotionally So durable are implicit emotional learnings that
urgent, procedural knowledge, not mainly in neocor- they continue to function and drive responses even
tical regions of explicit memory that store conscious, during states of amnesia and are only temporarily
episodic, autobiographical, declarative knowledge suppressed, not erased, by the process of extinction
(Schore, 2003). (nonreinforcement of a reactivated, learned expecta-
As in the example above, the vast majority of the tion). Psychologists and neuroscientists have amassed
unwanted moods, emotions, behaviors, and thoughts extensive evidence that even after complete extinction
that people seek to change in psychotherapy are found of an emotionally learned response, the extinguished
to arise from implicit emotional learnings, not in response is easily retriggered in various ways. This re-
awareness (Toomey & Ecker, 2007). Common clinical vealed that extinction training does not result in the
phenomena that express implicit emotional learnings unlearning, elimination, or erasure of the suppressed,
include insecure attachment patterns, family of origin original learning (making the term “extinction” some-
rules and roles, unresolved emotional issues, com- thing of a misnomer, suggesting as it does a perma-
pulsive behaviors or emotional reactions in response nent disappearance). Rather, the research found that
to an external or internal trigger, panic and anxiety extinction training forms a separate, second learning
attacks, depression, low self-esteem, fear of intimacy, that competes against, but does not change, the orig-
sexual inhibition, traumatic memory and posttrau- inal learning (see, e.g., Bouton, 2004; Foa & McNally,
matic stress symptoms, procrastination, and many 1996; Milner et al., 1998; Myers & Davis, 2002). The
others. learning formed by extinction training of a fear re-
Of course, some psychological and behavioral sponse is encoded in the brain’s prefrontal cortex, a
symptoms are not caused by emotional learnings— region that can suppress and temporarily override the
for example, hypothyroidism-induced depression, nearby subcortical amygdala, which plays a central
autism, and biochemical addiction—but it is implicit role in storing and reactivating fear-based learnings
emotional learnings that therapists and their clients (Milad & Quirk, 2002; Phelps, Delgado, Nearing, &
are working to overcome in most cases. There are also LeDoux, 2004; Santini, Ge, Ren, de Ortiz, & Quirk,
genetic or biochemical factors that may contribute to 2004; Quirk, Likhtik, Pelletier, & Pare, 2003).
mood disturbances, but it is nevertheless the individ- Many decades of studying extinction led research-
ual’s implicit emotional learnings that are largely re- ers to the conclusion that implicit emotional learnings
sponsible for triggering specific bouts of emotional are permanent and indelible for the lifetime of the in-
instability (Toomey & Ecker, 2009). dividual once they have been installed in long-term
It is the tenacity of implicit emotional learnings, memory circuits through the process of consolidation
more than their ubiquity, that is the real clinical chal- (reviewed in McGaugh, 2000). There appeared to ex-
lenge. On a daily basis, psychotherapists encounter the ist no form of neuroplasticity capable of unlocking the
extreme durability of original emotional learnings that synapses of consolidated implicit memory circuits.
fully maintain their chokehold decades after they first The tenet of indelibility reached its peak influence
with the publication of a research article on extinc-
5 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
tion studies by neuroscientists LeDoux, Romanski,
and Xagoraris (1989) titled “Indelibility of Subcorti-
cal Emotional Memories.” The indelibility model soon
entered the literature of psychotherapy when van der
Kolk (1994) published in the Harvard Review of Psy-
chiatry his seminal article “The Body Keeps the Score:
Memory and the Evolving Psychobiology of Post-
traumatic Stress,” in which there was a section titled
“Emotional memories are forever.” The conclusion
that implicit emotional learnings persist for a lifetime
meant that people could never become fundamentally
free of flare-ups of childhood emotional conditioning.
The worst experiences in an individual’s past could at
any time become reactivated and seize his or her state
of mind or behavior in the present.
Then, several studies published from 1997 to 2000
suddenly overturned the model of irreversible mem-
ory consolidation and indelibility. Actually, a handful
of earlier studies published from 1968 to 1982 had re-
ported observations of the disappearance of well con-
solidated emotional learnings (Judge & Quartermain,
1982; Lewis, 1979; Lewis, Bregman, & Mahan, 1972;
Lewis & Bregman, 1973; Mactutus, Riccio, & Ferek,
1979; Misanin, Miller, & Lewis, 1968; Richardson,
Riccio, & Mowrey, 1982; Rubin, 1976; Rubin, Fried, &
Franks, 1969). However, these unexplained challenges
to the prevailing model of irreversible consolidation
were seen as anomalies and received scant attention
from memory researchers and clinicians at the time.
At the end of the 1990s, however, neuroscientists in
several different laboratories resumed studying the ef-
fects of reactivating an established emotional learning
(Nader, Schafe, & LeDoux, 2000; Przybyslawski, Rou-
llet, & Sara, 1999; Przybyslawski & Sara, 1997; Roullet
& Sara, 1998; Sara, 2000; Sekiguchi, Yamada, & Suzu-
ki, 1997). Using sophisticated new techniques as well
as the field’s advanced knowledge of exactly where in
the brain certain emotional learnings form and are
stored in memory, researchers again demonstrated
the full elimination of any expression of a target learn-
ing. In addition, they demonstrated that such erasure
of the learning became possible because consolidated,
locked memory synapses had returned to a deconsol-
idated, unlocked, unstable or “labile” state, allowing
erasure of the learning by chemical agents that disrupt
only synapses that are in an unstable, nonconsolidat-
ed condition. The longstanding tenet of irreversible
consolidation was disconfirmed.
The destabilized state of deconsolidation was
found to exist only soon after the target learning had
been reactivated by a suitable cue or reminder. Yet,
long after such a reactivation, an implicit learning is
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
found to be once again in a stable, consolidated state.
Thus the detection of a deconsolidated, destabilized
state of memory soon after its reactivation implied the
existence of a natural process of reconsolidation, the
relocking of the synapses of a destabilized memory,
returning the memory to stability. Subsequent studies
found that the labile state of deconsolidation lasts for
about five hours—a period widely known now as the
reconsolidation window—during which the unstable
target learning can be modified or erased (Duvarci &
Nader, 2004; Pedreira, Pérez-Cuesta, & Maldonado,
2002; Pedreira & Maldonado, 2003; Walker, Brake-
field, Hobson, & Stickgold, 2003).
If, following the reactivation and destabilization
of a target learning, there is no new learning and no
chemical treatment, then after its reconsolidation
(that is, more than about five hours later) the tar-
get learning is found to have increased strength of
expression (e.g., Forcato, Fernandeza, & Pedreira,
2014; Inda, Muravieva, & Alberini, 2011; Rossato,
Bevilaqua, Medina, Izquierdo, & Cammarota, 2006;
Stollhoff, Menzel, & Eisenhardt, 2005). For that rea-
son, researchers regard reconsolidation as having two
biological functions: (a) It preferentially strengthens
recent learnings that are most frequently reactivated
and destabilized, and (b) it allows new learning ex-
periences to update (strengthen, weaken, modify, or
nullify) an existing learning. The latter function is
the one utilized for bringing about nullification and
transformational change in psychotherapy. When a
learned, unwanted emotional reaction is erased, there
is no loss of memory of events in one’s life (as shown
by Kindt, Soeter, & Vervliet, 2009, and as illustrated
by a clinical example later in this article). There is ev-
idence that the destabilization/restabilization process
and the updating/erasure process occur through dif-
ferent molecular and cellular processes (Jarome et al.,
2012; Lee et al., 2008).
With that background, we can now examine the
misconceptions of the reconsolidation process listed
above.
Ten Common Misconceptions
Misconception 1: The Reconsolidation Process Is
Triggered by the Reactivation of a Target Learning
or Memory
As noted earlier, in the reconsolidation discovery
studies of 1997 to 2000, a state of deconsolidation
was found to exist only soon after the target learning
had been reactivated by a suitable cue or reminder.
This observation was interpreted by the researchers to
Volume 3 Issue 1 (2015) 6
mean that each reactivation of a target learning de- clinical application are not obscured.
consolidates its neural circuits, launching the recon- What, then, is the second step that must accom-
solidation process. pany reactivation? Pedreira et al. (2004), followed by
That conclusion may have been sensible based on all of the studies listed in Table 1, have shown that in
the initial few studies, but it turned out to be incorrect. order to induce reconsolidation, reactivation must be
Pedreira, Pérez-Cuesta, and Maldonado (2004) were accompanied or followed soon by what researchers
first to show that reactivation alone does not bring term a mismatch experience or prediction error expe-
about deconsolidation and reconsolidation. They con- rience. This is an experience of something distinctly
cluded, “at odds with the usual view, retrieval per se discrepant with what the reactivated target memory
is unable to induce labilization of the old memory” “knows” or expects—a surprising new learning con-
(p. 581), and they demonstrated that what the brain sisting of anything from a superfluous but salient nov-
requires to trigger the reconsolidation process is re- elty element to a direct contradiction of what is known
activation plus another critical experience, described according to the target learning. It makes sense from
below. Subsequently, this same two-step requirement an evolutionary perspective that deconsolidation and
has been demonstrated in at least 22 other studies that reconsolidation, being the brain’s process for updating
I have tallied as of this writing. They are listed in Table learnings and memories, would be triggered only by
1. In the discovery studies of 1997 to 2000, researchers new information that is at odds with the contents of
had fulfilled this two-step requirement without aware- an existing learning (Lee, 2009). Lee wrote, “reconsol-
ness of doing so, as shown later in this section. idation is triggered by a violation of expectation based
The early interpretation that reactivation by itself upon prior learning, whether such a violation is qual-
produces deconsolidation spread widely among both itative (the outcome not occurring at all) or quanti-
neuroscientists and science journalists and became a tative (the magnitude of the outcome not being fully
reconsolidation meme. Despite the post-2004 piling predicted)” (p. 417). It would be biologically costly,
up of decisive evidence revealing that this original with no benefit, if the brain launched the complex
conclusion was incorrect, it has continued to be as- neurochemical process of reconsolidation when there
serted in new writings by not only science journalists is no new knowledge requiring a memory update. The
but also by some prominent researchers who were studies listed in Table 1 have shown that the brain
involved in the original studies, as well as by many evolved so as to launch de/reconsolidation only when
later reconsolidation researchers. As of this writing, an experience of something discrepant with a reactivat-
more than 10 years since the mismatch requirement ed, learned expectation or model of reality signals the
was first detected and published, new research articles need for an update of that existing knowledge. This em-
continue to be published that lack any consideration pirical finding of a critical role of mismatch or predic-
of the mismatch requirement’s role in the reported re- tion error can be regarded as a neurobiological valida-
sults (e.g., Wood et al., 2015). tion of a central feature of the learning models of both
Piaget (1955) and Rescorla and Wagner (1972).
It is perhaps understandable that science journal-
ists would latch on to and continue to spread the mis- Thus, what shifts a particular learning into a de-
conception that reactivation in itself destabilizes the consolidated, destabilized state, allowing its expres-
reactivated learning, if they were unaware of what the sion to be modified or erased by new learning during
ongoing research was revealing. It is less clear why an approximately five-hour window, is not simply re-
the error would continue to be voiced by researchers. activation of that learning, but the experience of that
From my point of view as a clinician observer witness- reactivated learning encountering a mismatch or pre-
ing this situation unfold for almost a decade, I can- diction error. As stated by Agren (2014) in reviewing
not escape the impression that many reconsolidation research on reconsolidation of emotional learnings in
researchers appear unaware of sizable amounts of re- humans, “it would appear that prediction error is vital
search published in their own area of specialization. for a reactivation of memory to trigger a reconsolida-
Some of the more significant reconsolidation research tion process” (p. 73). Likewise, Delorenzi et al. (2014)
articles, such as that of Schiller et al. (2010), assert commented, “strong evidence supports the view that
that reactivation induces reconsolidation and refer- reconsolidation depends on detecting mismatches
ence none of the studies in Table 1 that have shown between actual and expected experiences” (p. 309).
that view to be incorrect. Commenting here on this Exton-McGuinness, Lee, and Reichelt (2015) review
situation is hopefully warranted by the importance of the role of prediction errors in memory reconsolida-
assuring that research findings critically important for tion studies and sum up their position by stating, “We
propose that a prediction error signal . . . is necessary
7 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
Table 1
Studies demonstrating that both memory reactivation and memory mismatch (prediction error) are necessary for
inducing memory destabilization (deconsolidation) and reconsolidation, and that memory reactivation alone is
insufficient.

Year Authors Species Memory type Design and findings

2004 Pedreira et al. Crab Contextual fear Reactivated learned expectation of visual threat must be
memory sharply disconfirmed for memory to be disrupted by cy-
cloheximide.
2005 Frenkel et al. Crab Contextual fear New experience modifies memory expression only if preced-
memory ed by a memory mismatch experience.
2005 Galluccio Human Operant condi- Memory is erased only by being reactivated along with a
tioning novel contingency.
2005 Rodriguez- Rat Taste recognition Novel taste following reactivation allows memory disruption
Ortiz et al. memory by anisomycin.
2006 Morris et al. Rat Spatial memory Reactivation allows disruption of original memory by aniso-
of escape from mycin only if learned safe position has been changed, creating
danger mismatch of expectation.
2006 Rossato et al. Rat Spatial memory Reactivation allows disruption of original memory by aniso-
of escape from mycin only if learned safe position has been changed, creating
danger mismatch of expectation.
2007 Forcato et al. Human Declarative Memory of syllable pairings learned visually is destabilized
memory and impaired by new learning only if, after reactivation by
presentation of context, presentation of a syllable to be paired
does not occur as expected, creating mismatch.
2007 Rossato et al. Rat Object recogni- Memory is disrupted by anisomycin only if reactivated in
tion memory presence of novel object.
2008 Rodriguez- Rat Spatial memory Reactivation allows disruption of original memory by aniso-
Ortiz et al. of escape from mycin only if learned safe position has been changed, creating
danger mismatch of expectation.
2009 Forcato et al. Human Declarative Memory of syllable pairings learned visually is labilized and
memory lost only if reactivation is followed by learning revised novel
pairings.
2009 Pérez-Cuesta Crab Contextual fear Reactivated learned expectation of visual threat must be
& Maldonado memory sharply disconfirmed for memory to be disrupted by cy-
cloheximide.
2009 Winters et al. Rat Object recogni- Memory is disrupted by MK-801 only if reactivated in pres-
tion memory ence of novel contextual features.
2010 Forcato et al. Human Declarative Memory of syllable pairings learned visually destabilizes and
memory incorporates new information only if, after reactivation, the
expected opportunity to match syllables does not occur, creat-
ing mismatch.
2011 Coccoz et al. Human Declarative Memory of syllable pairings learned visually destabilizes,
memory allowing a mild stressor to strengthen memory, only if, after
reactivation, the expected opportunity to match syllables does
not occur, creating mismatch.
2012 Caffaro et al. Crab Contextual fear New experience modifies memory expression only if preced-
memory ed by a memory mismatch experience.
2012 Sevenster et Human Associative fear Reactivated fear memory is erased by propranolol only if
al. memory (classical prediction error is also experienced.
conditioning)
2013 Balderas et al. Rat Object recogni- Only if memory updating is required does reactivation trig-
tion memory ger memory destabilization and reconsolidation, allowing
memory disruption by anisomycin.
2013 Barreiro et al. Crab Contextual fear Only if memory reactivation is followed by unexpected, mis-
memory matching experience is the memory eliminated by glutamate
antagonist.

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 8

Table 1 cont.

2013 Díaz-Mataix Rat Associative fear Reactivated fear memory is erased by anisomycin only if pre-
et al. memory (classical diction error is also experienced.
conditioning)
2013 Reichelt et al. Rat Goal-tracking Target memory reactivated with prediction error was destabi-
memory lized and then disrupted by MK-801, but not if brain’s predic-
tion error signal was blocked.
2013 Sevenster et Human Associative fear Reactivated fear memory is destabilized, allowing disruption
al. memory (classical by propranolol, only if prediction-error-driven relearning is
conditioning) also experienced.
2014 Exton- Rat Instrumental Memory for lever pressing for sucrose pellet was disrupted by
McGuinness memory (operant MK-801 only if the reinforcement schedule during reactiva-
et al. conditioning) tion was changed from fixed to variable ratio, creating predic-
tion error.
2014 Sevenster et Human Associative fear Reactivated fear memory is destabilized, allowing disruption
al. memory (classical by propranolol, only if prediction-error-driven relearning is
conditioning) also experienced, and termination of prediction error termi-
nates destabilzation.

for destabilisation and subsequent reconsolidation of occurs when the blue light is turned off with no shock
a memory” (p. 375). That is the research finding that having been experienced. Only then are perceptions
translates into major advances for the psychotherapy discrepant with what the target learning “knows.”
field (Ecker, 2011; Ecker et al., 2012, 2013a,b). Now the synapses encoding the target learning unlock
For those advances to materialize, it is necessary for into a modifiable state, because now it is definite that
clinicians to understand well what the brain regards as no shock occurred as expected while the blue light
an experience of mismatch or prediction error. Mis- was on.
conceptions abound on this point as well. The follow- Understanding the mismatch requirement allows
ing example shows the meaning of mismatch at the us to interpret correctly the results of various studies
basic level of classical conditioning in the laboratory, that were misinterpreted by the researchers because
as demonstrated by Pedreira et al. (2004) and other they analyzed their studies without reference to the
studies listed in Table 1. Clinically relevant learnings mismatch requirement. The simple logic of the situa-
are often far more complex, and the guiding of mis- tion, as stated by Agren (2014), is that “the studies that
match experiences in psychotherapy looks very differ- have shown effects of reconsolidation . . . must some-
ent, as a rule, from the laboratory instances described how have induced a prediction error” (p. 80). Ecker et
in this article, but the principles of mismatch are use- al. (2012) articulated the same principle: “Whenever
fully clarified at this basic level. the markers of erasure of a learning are observed, both
Consider a target learning that was created by sev- reactivation and a mismatch of that learning must
eral repetitions of turning on a blue light and deliver- have taken place, unlocking its synapses, or erasure
ing a mild electric shock several seconds later, during could not have resulted. This logic can serve as a use-
the last half-second of the light being on. Subsequent- ful guide for identifying the critical steps of process in
ly, if the blue light is turned on again, the learned both the experiments of researchers and the sessions
expectation of the shock is reactivated immediately, of psychotherapists” (p. 23).
along with fear and the physiological expressions of Therefore, identifying the presence or absence of
fear, such as a mouse’s freezing or a human’s change mismatch in each of the many published studies of
of skin conductance. However, this reactivation does reconsolidation that lacks consideration of the mis-
not deconsolidate and destabilize the memory circuits match requirement is an exercise necessary for bring-
of this learned association of light and shock, because ing the field of reconsolidation research to maturity
no mismatch experience has occurred as yet. While from its present fragmented condition. The remain-
the blue light stays on without any shock being deliv- der of this section begins that unifying exercise by
ered, a mismatch or prediction error has not occurred describing several key studies, analyzing the presence
because the shock might still occur. The target learn- or absence of mismatch in them, and reinterpreting
ing is in a state of expectancy of the shock. Mismatch their results accordingly. This analysis of mismatch in

9 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

published studies yields instructive insights into how requirement in their interpretation of results. Instead,
mismatch may function. they concluded incorrectly that the particular type of
The study by Nader, Schafe, and LeDoux (2000), memory under study was not subject to reconsolida-
which repeated the basic design of some other early tion. Subsequently, other studies successfully demon-
studies (Przybyslawski et al., 1997, 1999; Roullet et strated reconsolidation for those types of memory
al., 1998), is often regarded as the one that brought (see, e.g., Wang, Ostlund, Nader, & Balleine, 2005).
the initial research to a tipping point of establishing All 23 studies listed in Table 1 have shown that re-
the reconsolidation phenomenon conclusively. Nad- activation alone does not launch the reconsolidation
er et al. used the same classical conditioning proce- process, but reactivation plus mismatch does. This
dure as described in the example just above, but with point was particularly emphasized by Forcato, Arg-
an audible tone rather than a blue light. They taught ibay, Pedreira, and Maldonado (2009) in titling their
rats to expect a shock during the last half-second of a article, “Human Reconsolidation Does Not Always
30-s tone. Later, their procedure accomplished mem- Occur When a Memory Is Retrieved,” and by Seven-
ory reactivation with the onset of the 30-s tone, and ster, Beckers, and Kindt (2012), who titled theirs “Re-
it accomplished memory mismatch with the offset of trieval Per Se Is Not Sufficient to Trigger Reconsol-
the tone with no shock occurring, triggering destabi- idation of Human Fear Memory.” The latter authors
lization of the target learning and launching the re- characterized their next published study by stating,
consolidation process. However, the researchers were “we show in humans that prediction error is (i) a nec-
unaware of the mismatch requirement (which was essary condition for reconsolidation of associative
discovered four years later by Pedreira et al., 2004) or fear memory and (ii) determined by the interaction
of the crucial role of this mismatch in triggering de- between original learning and retrieval” (Sevenster,
consolidation of the target learning. It was by chance Beckers, & Kindt, 2013, p. 830).
that their procedure happened to include the needed Reconsolidation can also be triggered by a mis-
mismatch. Memory erasure resulted from anisomy- match of when events are expected to occur, with
cin administered soon after that mismatch experience no change in what occurs, as demonstrated by Díaz-
(but not when administered 6 hr later, when the re- Mataix, Ruiz Martinez, Schafe, LeDoux, and Doyère
consolidation window was no longer open), confirm- (2013). On Day 1 in their study, rats heard a 60-s tone
ing that memory destabilization (deconsolidation) and received a momentary electrical shock at the 30-s
had occurred, because anisomycin destroys only non- point, midway through the tone. For each rat this was
consolidated synapses. repeated 10 times to create a reliable conditioned re-
Understandably but erroneously, Nader et al. con- sponse of fear to the tone. On Day 2, each rat heard
cluded that memory reactivation was sufficient for the tone and received the shock again just once, re-
triggering destabilization. If their design had includ- activating the learned association of tone and shock.
ed reactivation by the tone together with the expect- The shock occurred at the same 30-s point for some
ed shock, eliminating the mismatch of expectations, rats, but for others it occurred at the 10-s point. Im-
no deconsolidation or erasure would have occurred. mediately after this reactivation experience, research-
Such failure to achieve destabilization of a reactivat- ers administered a chemical agent (anisomycin) that
ed target learning has been reported in many studies disrupts nonconsolidated memory circuits. On Day
(e.g., Bos, Becker, & Kindt, 2014; Cammarota, Bev- 3, the tone was played again for each of the rats five
ilaqua, Medina, & Izquierdo, 2004; Hernandez & Kel- times with no accompanying shock, and the strength
ley, 2004; Mileusnic, Lancashire, & Rose, 2005; Wood of fear responses was measured. Rats that had un-
et al., 2015), and we can now recognize that this fail- changed shock timing on Day 2 reacted with fear on
ure was due to an absence of mismatch or prediction Day 3 fully as strongly as they had done on Day 2, in-
error in the procedure used. (For example, as report- dicating that anisomycin had no effect and, therefore,
ed by Hernandez and Kelley in 2004, a rat’s memo- that the reactivation without mismatch on Day 2 had
ry that pressing a certain lever brings a sugar reward not destabilized the target learning. In contrast, rats
was indeed reactivated when the rat was once again whose shock timing had been changed on Day 2 re-
placed in the chamber with the lever, pressed it, and acted on Day 3 with only half as many fear responses
received a sugar pellet, but this reactivation provided as on Day 2, indicating that anisomycin had signifi-
the expected reinforcement and entailed no experi- cantly impaired the target learning and, therefore, that
ence of prediction error, so memory destabilization the reactivation with timing mismatch on Day 2 had
did not occur.) In these studies, too, the researchers indeed destabilized the target learning.
made no mention of a mismatch or prediction error
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 10
 This important finding that temporal mismatches and actual timing. (The discussion of results provided
trigger reconsolidation will figure significantly in oth- by Monfils et al. does not refer to the concept of mis-
er discussions later in this article. Díaz-Mataix et al. match or prediction error, however.)
did identify the prediction error that played a critical The key role of a temporal mismatch in induc-
role in their procedure, and they concluded from their ing destabilization in both Monfils et al. (2009) and
observations that new information must accompany Díaz-Mataix et al. (2013) makes it clear that the brain
reactivation in order to destabilize the target learning.learns the temporal features of new emotional expe-
That conclusion corroborates what was demonstrated riences no less than it learns other characteristics,
in at least sixteen prior studies listed in Table 1, so it
and that mismatches of timing can be highly effective
unclear why Díaz-Mataix et al. describe their finding for inducing reconsolidation in cases where the tar-
as though it is a new discovery and cite only one of get learning has distinct temporal structure. In other
prior studies (Sevenster et al., 2012). recent research, networks of dedicated “time cells” in
A target learning that has been destabilized by mis- the hippocampus have been found to measure and
match can be erased not only by chemical agents, but remember time intervals (Jacobs, Allen, Nguyen, &
also by a counterlearning experience with no use of Fortin, 2013; MacDonald, Lepage, Eden, & Eichen-
chemical agents. It is this endogenous approach that baum, 2011; Naya & Suzuki, 2011; Paz et al., 2010).
is most desirable for psychotherapeutic use and which The important observations made by Monfils et al.
has been applied extensively in that context (Ecker et (2009) will be revisited and utilized later in this arti-
al., 2012). In laboratory studies, endogenous erasure cle to address fundamental questions of what governs
or modification of a target learning has been demon- whether reconsolidation or extinction occurs and
strated with both animal and human subjects (e.g., why extinction fails to produce erasure. It is notewor-
Galluccio, 2005; Liu et al., 2014; Monfils, Cowansage, thy too that the erasure procedure used by Monfils
Klann, & LeDoux, 2009; Schiller et al. 2010; Steinfurth et al. was subsequently adapted for use with human
et al., 2014; Walker et al., 2003; Xue et al., 2012). subjects by Schiller et al. (2010), who demonstrated
Monfils et al. (2009) used three pairings of a 20-s au- the first endogenous erasure of a fear learning in hu-
dio tone (the conditioned stimulus, CS) and half-sec- mans in a controlled study. The Appendix to this arti-
ond footshock (unconditioned stimulus, US), with 3 cle provides a detailed examination of the mismatches
min between pairings, to train rats to respond to the involved in their procedure.
tone with fear. One day later, the target learning was Fulfillment of the mismatch requirement is evi-
reactivated by the CS/tone, but there was no accom- dent in the successful inducing of reconsolidation in
panying US/shock, which is a mismatch of the expec- a wide range of experimental procedures. For exam-
tation of the US. So far, the procedure is basically the ple, an associative fear learning can be triggered into
same as that of Nader et al. (2000), described above, reconsolidation by a reexperiencing of only the un-
but rather than disrupt the target learning chemically conditioned stimulus (US) without the conditioned
at this point, Monfils et al. continued to present the stimulus (CS) (Díaz-Mataix et al., 2011;  Liu et al.,
CS without US repeatedly. CS2, the second tone, was 2014). The target learning, consisting of experienc-
presented 10 min or 1 hr after the first one, but then ing first the CS followed by the US, is mismatched if
additional CS tones came at 3-min intervals, for a to- the US occurs without the CS. That mismatch con-
tal of 19 CSs. That procedure successfully and robustly sists of both the absence of the expected CS and also,
erased the rats’ learned fear of the tone. importantly, a change in the expected temporal se-
Note that if the initial 10-min or 1-hr interval had quence of events, because the target learning expects
been a 3-min period like all of the ensuing intervals, the US to occur after the CS, not without the prior
the repetitive CS counterlearning procedure would occurrence of the CS. Another example is the case of
have been a standard multitrial extinction training, having two different co-occurring CSs, both of which
which is well known not to bring about erasure. Thus have been paired with the same US.  Debiec,  Díaz-
the longer interval between CS1 and CS2 was critically Mataix,  Bush,  Doyère, and  LeDoux (2013) showed
important for achieving erasure through reconsolida- that reexposure to either one of the CSs can trigger the
tion rather than suppression through extinction. The reconsolidation of the memory of the other. Here the
fact that erasure occurred implies that the target learn- expected co-occurrence of both CSs is mismatched
ing was destabilized and erasable during the series of when only one CS is presented. None of the authors
CSs, which in turn implies that the longer interval referenced in this paragraph explained their results in
from CS1 to CS2 resulted in a mismatch of expected terms of the mismatch requirement, however. They

11 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

discussed their results as though the triggering of re- The results found by Suzuki et al. (2004) can serve
consolidation can be attributed to reactivation alone. to illustrate the further research possibilities that be-
Even researchers who are well aware of the mis- come apparent as a result of asking the question: If the
match/prediction error requirement can overlook mismatch requirement is responsible for experimen-
the occurrence of mismatch in their own procedures. tal observations, what are those observations showing
For example, Pine et al. (2014) provided an ingenious about how mismatch functions under various circum-
and intricate demonstration that reconsolidation oc- stances? Suzuki et al. taught rats to fear a test chamber
curs for complex, unconscious emotional learnings (context/CS) by placing each rat in the chamber for
in humans—and in doing so they have supplied the 2.5 min and then administering a 2-s footshock (US).
strongest empirical support to date for the anecdotal Rats in one group received just one shock; those in
clinical observations reported by Ecker et al. (2012, another group received three shocks separated by 30
2013a,b)—but they commented, “Our results seem s. All rats were removed from the context/CS 30 s af-
to counter a recent theory that new learning (or the ter their final footshock. Then, either 1 day, 1 week, 3
generation of a prediction error) is required during weeks, or 8 weeks later, immediately after administra-
reactivation in order to trigger reconsolidation. . . . tion of anisomycin, rats were placed in the context/
Here, no new learning took place during the remind- CS for various amounts of time and then removed
er” (p. 11). However, the “reminder” (reactivation) with no shock, in order to reactivate the fear learning
that they used for triggering reconsolidation on Day and disrupt it if it had been destabilized by the reac-
2 of their procedure contained three distinct temporal tivation. One day later their fear level was measured
mismatches relative to the original learning on Day during a 3-min reexposure back in the context/CS.
1: a reversal of overall sequence, an overall duration This procedure resulted in the following findings:
of the series of trials that was one-fourth as long, and For fear memory created by a single context-shock
the introduction of a 10-min delay within the over- pairing, a 1-min shock-free reexposure to the context did
all sequence. Thus, due to these temporal mismatches not destabilize the fear learning, but a 3-min reexposure
of the original learning, its reactivation was actually did destabilize it if memory age was 1 day, 1 week, or 3
accompanied by an abundance of new learning, trig- weeks. The implication is that a 1-min shock-free re-
gering destabilization and reconsolidation. As noted exposure did not create a mismatch experience, but a
above, we know from Díaz-Mataix et al. (2013) that 3-min reexposure did create a mismatch. This is sug-
even a single temporal mismatch can be an effective gestive of a temporal structure in the target learning.
destabilizer. The 2.5-min period of initial exposure to the context/
As this section’s final example of how the mismatch CS fits that possibility well, because relative to that
requirement can account for diverse reconsolidation learned 2.5-min period, the 1-min reexposure could
phenomena, there have been several studies of how have been too short to be experienced as a nonrein-
the age or strength of a target learning effects the forcement, so it would not create a mismatch experi-
triggering of memory destabilization (Boccia, Blake, ence, but the 3-min reexposure would.
Acosta, & Baratti, 2006; Clem & Huganir, 2010; De- If memory age was 8 weeks, a 3-min reexposure no
biec, LeDoux, & Nader, 2002; Eisenberg & Dudai, longer caused destabilization, but a 10-min reexposure
2004; Frankland et al., 2006; Inda et al., 2011; Milekic did destabilize. This possibly implies that memory of
& Alberini, 2002; Steinfurth et al., 2014; Suzuki et al., the 2.5-min period lost definiteness over time and
2004; Winters, Tucci, & DaCosta-Furtado, 2009). Re- therefore required a longer reexposure for decisive
viewing all results of these studies is beyond the scope nonreinforcement and mismatch to be experienced.
of the present article, other than to summarize that, For fear memory created by three context-shock
as a rule, stronger reactivation is required in order to pairings instead of one, a 3-min reexposure no longer
destabilize stronger or older target learnings. Some of caused destabilization, but a 10-min reexposure did de-
the studies in this area successfully destabilized both stabilize. Here the challenge is to understand how a
young and older target learnings (up to 8 weeks af- stronger fear training would alter the timing memory.
ter acquisition), but others failed to destabilize older Three 2-s shocks coming every 30 s is a grueling min-
memories. Lee (2009) commented, “it is also possible ute that might feel to a rat much longer than a minute
that all memories undergo reconsolidation regardless spent sniffing around curiously in a harmless place,
of their age, but that previous studies have failed to just as a human also experiences time periods very
use sufficiently intense memory reactivation condi- differently depending upon the presence or absence
tions for older memories” (p. 416). of pain. The prior 2.5-min duration may have been

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 12

distorted or blurred retroactively by this long, trau- happen unpredictably on any drive. That learning is
matic minute, such that the longer 10-min reexposure not mismatched or disconfirmed by an accident not
was necessary for decisive nonreinforcement and mis- happening on any one drive or on any number of
match to be experienced. drives. A safe, uneventful drive creates no prediction
The interpretations sketched above are not the only error and therefore does not induce deconsolidation,
possible ways in which the mismatch requirement so the target learning is not revised and the model has
could have resulted in the observations made by Su- not failed to apply.
zuki et al. (2004). They are offered here heuristically, This example naturally raises the question: For
by way of showing how the mismatch requirement that target learning, what would be a mismatch ex-
can be logically applied to illuminate how experimen- perience? The knowledge that a crash might happen
tal procedures interact with the inherent properties of unpredictably on any drive is true as a recognition of
the brain’s memory systems. existential reality, so no mismatch or disconfirmation
The experimental procedures discussed in this sec- of that knowledge is possible. However, that knowl-
tion in relation to the mismatch requirement illustrate edge is not the entire learning maintaining the pan-
a principle that is critical for understanding reconsol- icky dread of a fiery car crash. Some other learning is
idation phenomena: What does, or does not, constitute responsible for that emotional intensity, and it is for
a mismatch experience depends entirely on the specific elements of that learning that mismatches can be cre-
makeup of the target learning at the time of mismatch. ated. The most common form of this other learning,
That is a principle that I will refer to henceforth as though not the only possibility (see Ecker, 2003, or
mismatch relativity. It is essential for understanding Ecker & Hulley, 2000, for an account of diverse learn-
the effects of reconsolidation procedures used in both ings underlying anxiety and panic symptoms), is sup-
laboratory studies and therapy sessions. In the small pressed traumatic memory of the same or a similar
minority of reconsolidation research articles that do kind, such as a car crash, a fiery explosion, the death
address the mismatch requirement, I have never seen of high school classmates in a head-on collision, a ter-
mismatch relativity articulated explicitly; rather it is rible scare from skidding on ice on a mountain road
either tacitly assumed or asserted in an abstract man- or from being pulled along very fast at 3 years old in a
ner (as in Bos et al., 2014, and Sevenster et al., 2013, little wagon tied to the bicycle of an older sibling, and
2014; for example, Bos et al. state, “The experience of so forth. The suppressed state of the traumatic memo-
a prediction error upon reactivation critically depends ry preserves its emotionally raw, unprocessed quality,
on the interaction between the original learning of the including desperate fear and helplessness. De-sup-
fear association and the memory retrieval” [p. 6]). pression of the memory (in small enough steps to be
Mindfulness of mismatch relativity is critical for con- tolerable) reveals a set of specific elements, each of
sistent outcomes in utilizing reconsolidation in psy- which is a particular learning. It is these component
chotherapy to bring about transformational change. learnings that can now be subjected to a mismatch
Only by attending closely to the specific elements of experience. For example, the helplessness felt and
a symptom-generating emotional learning can a psy- learned in the original situation can in many cases
chotherapist reliably guide mismatch experiences that encounter a mismatch experience through the tech-
disconfirm those specific elements, as is necessary for nique of empowered reenactment, which is widely
their nullification and dissolution. used in trauma therapy to create a vivid experience
of potent self-protection in the original scene. For a
A question often asked by clinicians learning about detailed clinical example of that kind, see Ecker et al.
reconsolidation is: When my panicky therapy client (2012, pp. 86–91).
drives on the highway and the feared terrible fiery
crash doesn’t happen, that seems to be a mismatch In summary of this section, the research findings
experience, as needed to launch reconsolidation, yet on memory reconsolidation represent a nontheoreti-
it doesn’t unlock or erase the learned fear. Doesn’t cal set of instructions for bringing about transforma-
this show that the model is incorrect? To clarify this, tional change in a target learning. These instructions
we need to apply the mismatch relativity principle specify that in order for a target learning to become
and examine whether or not a mismatch experience destabilized and susceptible to being unlearned and
actually took place. That begins with examining the nullified, it must be both reactivated and subjected
detailed makeup of the target learning in question. to a mismatch or prediction error experience. The
In this case, the target learning is not that a car crash mismatch relativity principle has been introduced
happens on every drive; rather it is that a crash might here, within the exercise of analyzing the occurrence
of mismatch in published studies, to emphasize that
13 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
what is, and what is not, a mismatch experience is al-
ways defined in relation to the specific elements of the
target learning and what the target learning “knows”
or expects. This exercise of examining the role of mis-
match in published studies will continue in each of the
next two sections. (For numerous examples of creat-
ing mismatch experiences in psychotherapy, see Ecker
et al., 2012, Chapters 3–6.)
Misconception 2: The Disruption of Reconsolida-
tion Is What Erases a Target Learning
As soon as a reactivated target learning encounters
a single brief but vivid mismatch experience, the tar-
get learning is deconsolidated and for about five hours
is open to being changed or erased at the level of its
synaptic encoding. Erasure is the focus of this article,
because it is erasure that is experienced clinically as
liberating, transformational change, that is, complete
and permanent disappearance of an unwanted behav-
ior or state of mind.
As noted above, erasure of a deconsolidated target
learning has been accomplished by researchers either
by guiding new learning that nullifies the target learn-
ing or by applying chemical agents. Those two pro-
cesses of erasure are fundamentally different.
Chemical agents used for this purpose are those
that block some step in the complex cellular and mo-
lecular process by which a memory circuit restabilizes
into a consolidated state (for a review, see Reichelt &
Lee, 2013). Administered just before or after a target
learning is destabilized, these chemical agents se-
lectively act upon only deconsolidated, destabilized
memory circuits without affecting consolidated ones.
This blockage of the reconsolidation of the target
memory circuits impairs and destroys these circuits,
erasing the target learning by disrupting the very
process of reconsolidation. This disruption takes ef-
fect not immediately upon administration, but when
restabilization would normally happen, about five
hours after initial destabilization.
In contrast, erasure by new learning is understood
by researchers as de-encoding and/or reencoding
the target learning’s synapses, unlearning and nulli-
fying the prior content of that learning, but leaving
the neurons and synapses operating normally and al-
lowing the natural restabilization/reconsolidation of
the circuits to occur. This results in memory circuits
that no longer contain the target learning. Erasure by
new learning occurs through the utilization of the re-
consolidation process rather than through its disrup-
tion. One might characterize this type of erasure as
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
disrupting the content of the target learning, but the
reconsolidation process itself is not disrupted. Thus,
referring to this type of erasure as a “disruption of re-
consolidation” is a misconception and a misrepresen-
tation of the actual process.
Most of the chemical agents successfully used in
animal studies to disrupt reconsolidation are unsuit-
able for use with humans due to toxicity, side effects,
or slowness of action (Schiller & Phelps, 2011). How-
ever, with human subjects the beta-adrenergic block-
er propranolol is safe and has been tested in numer-
ous studies ranging from Pavlovian (associative) fear
conditioning to genuine PTSD conditions in clinical
trials, as reviewed by Agren (2014). Results have var-
ied widely for both associative fear conditioning and
genuine PTSD. For associative conditioning, full era-
sure by propranolol was demonstrated by Kindt et
al. (2009) and Soeter and Kindt (2011), but Bos et
al. (2014) measured no reduction of fear at all. Bos
et al. acknowledged, “The current findings clearly in-
dicate that we did not trigger reconsolidation during
memory reactivation” (p. 6). They offered the specu-
lation that the cause of the negative result appeared
to be a failure of their reactivation procedure to gen-
erate the required memory mismatch/prediction er-
ror experience, and they drew the lesson that “Future
studies may benefit from protocols that are explicitly
designed to assess and manipulate prediction error
during memory retrieval” (p. 7). For PTSD, Brunet et
al. (2011) measured a significant reduction of symp-
toms due to propranolol, but Wood et al. (2015) re-
ported no reduction of symptoms using either pro-
pranolol or mifepristone, a glucocorticoid blocker
that interferes with the neural (and other) effects of
the stress hormone cortisol. Wood et al., in discussing
various possible causes of their negative results, gave
no consideration or mention of the requirement for
memory mismatch. It seems probable that in chem-
ical disruption/PTSD studies that did achieve symp-
tom reduction, the procedure included mismatch un-
wittingly. For example, Brunet et al., unlike Woods et
al., had subjects speak out their account of a traumatic
experience to an interviewer, thus creating what trau-
ma therapists term dual focus, an experiential state in
which attention is simultaneously directed to a safe ex-
ternal environment and an internal traumatic memo-
ry. Dual focus maintains a dissociation and subjective
distance between conscious attention and the attend-
ed contents of traumatic memory, and appears to be
a critical ingredient in some trauma treatment pro-
cedures that achieve rapid, lasting depotentiation of
traumatic memory and cessation of PTSD symptoms
(see, e.g., Lee, Taylor, & Drummond, 2006). Dual fo-
Volume 3 Issue 1 (2015) 14
cus creates memory mismatch in the form of a strong Foa & McNally, 1996; Milner et al., 1998). In contrast,
perception of safety concurrent with traumatic mem- during the reconsolidation process, a target learning
ory reactivation, as well as through facilitating inter- is destabilized and rendered susceptible to being re-
nal accessing of existing personal knowledge that con- vised fundamentally by new learning, which can ei-
tradicts the contents of the traumatic memory schema ther weaken it, strengthen it, alter its details, or fully
(Ecker, 2015). nullify and erase it, and these changes are lasting, as
For clinical purposes, a natural process of erasure described earlier.
through unlearning rather than through chemical Researchers have determined that reconsolidation
agents is of course greatly preferable, as a rule. The and extinction are distinct and even possibly mutu-
clinical feasibility and effectiveness of erasure through ally exclusive processes at the behavioral, neural, and
new learning have been demonstrated for symptoms molecular levels (Duvarci & Nader, 2004; Duvarci,
and target learnings of many kinds, including but not Mamou, & Nader, 2006; Merlo, Milton, Goozée, Theo-
limited to anxiety and posttraumatic symptoms (Eck- bald, & Everitt, 2014). “Reconsolidation cannot be re-
er et al., 2012; Gray & Liotta, 2012; Xue et al., 2012). duced down to facilitated extinction” was the conclu-
Thus, in the endogenous clinical context in particular sion of Duvarci and Nader (p. 9269).
it is a misconception to describe erasure as occurring Despite those signature differences in process and
through the disruption of reconsolidation, though the effects produced, confusion about the relationship
chemical approach is exactly that. between reconsolidation and extinction nevertheless
At the opposite end of the terminology spectrum, arises because to a degree they share certain opera-
researchers sometimes use the phrase, “the enhance- tional and procedural patterns:
ment of reconsolidation.” This phrase denotes not a First, while the nullification learning that contra-
strengthening of the reconsolidation process itself, dicts and erases a destabilized target learning can have
but a strengthening of the behavioral expression of a any convenient procedural design, in many studies it
target learning that results, after its reconsolidation, has had the same design as a conventional extinction
from various procedures applied during the period of training—a series of numerous identical counter-
destabilization (for reviews, see Delorenzi et al., 2014; learning/unreinforced trials—so it can be confused
Forcato et al., 2014). The phrase therefore is essentially with and mislabeled as an extinction training, even
synonymous with “reconsolidation-induced enhance- though extinction is not actually involved.
ment of memory expression.” Here we have yet anoth-
er way in which the word reconsolidation is used by Second, extinction, like reconsolidation, begins
researchers, and again we see that for accurate under- with the two-step sequence of reactivation and nonre-
standing, readers of reconsolidation literature must inforcement (that is, a recueing of the target learning
consider carefully what an author’s phrasing actually followed by nonoccurrence of what the target learn-
is intended to mean. ing expects to happen, such as playing an audio tone
without also delivering the mild electric shock that
had previously been paired with the tone). It can be
Misconception 3: Erasure Is Brought About During confusing and difficult to see how reconsolidation and
the Reconsolidation Window by a Process of Ex- extinction are two separate phenomena if they share
tinction: Reconsolidation Is an Enhancement of Ex- the same initiating sequence of reactivation and non-
tinction reinforcement.
Reconsolidation and extinction are different phe- The main aim of this section is to dispel those two
nomena, with distinctly different effects, but miscon- confusions, as well as to review various research find-
ceptions have developed for reasons described in this ings that clarify the nature and relationship of recon-
section. solidation and extinction and their differential trig-
In the process that has been known for a century as gering. In addition, the discussion will explore these
extinction, the target learning is not revised or erased, questions: Are the empirical findings on reconsolida-
but only suppressed temporarily by new counterlearn- tion and extinction understandable entirely, or only
ing, and the new learning is encoded in its own mem- partially, in terms of the mismatch requirement and
ory circuitry that is anatomically separate from, and mismatch relativity (MRMR)? Does it prove instruc-
in competition with, the circuits of the target learning. tive to consider how the findings would have to be un-
Later, however, the target learning wins that competi- derstood in order for them to be entirely consistent
tion and reemerges into full expression (Bouton, 2004; with MRMR? The heuristic exploration of those ques-

15 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

tions in this section extends significantly the degree
to which the mismatch/prediction error requirement
has been applied, to date, to the interpretation of ex-
perimental findings.
Extinction-like procedure used for nullification
learning. As noted earlier, for inducing erasure, some
reconsolidation researchers have used a format of
nullification learning during the reconsolidation win-
dow that has the same procedural structure as classi-
cal extinction training: a series of numerous identical
counterlearning (nonreinforcement) experiences. The
result of this procedure is not extinction (temporary
suppression of the target learning), but rather the per-
manent erasure of the target learning, such that even
strong recueing (reinstatement) cannot reevoke the
target learning into expression. Nevertheless, these
researchers have unfortunately labeled this procedure
as “extinction” by naming it with such phrases as the
“memory retrieval-extinction procedure,” “extinc-
tion-induced erasure,” “extinction during reconsoli-
dation,” or other phrases containing “extinction” (e.g.,
Baker, McNally, & Richardson, 2013; Clem & Hugan-
ir, 2010; Liu et al., 2014; Monfils et al., 2009; Quirk et
al., 2010; Schiller et al., 2010; Steinfurth et al., 2014;
Xue et al., 2012). Such labeling is a source of much
misunderstanding of reconsolidation and extinction.
We are faced with these empirical facts: When a re-
petitive counterlearning procedure is applied to a tar-
get learning that is in a stable state when the procedure
begins, the result is extinction—the target learning is
suppressed but is intact and later reemerges into ex-
pression. However, when the same repetitive counter-
learning procedure is applied to a target learning that
is already in a destabilized/deconsolidated state, the
result is erasure—the target learning’s encoding is re-
written according to this new counterlearning, per-
manently nullifying the content of the target learning
(Monfils et al., 2009; Schiller et al., 2010). Thus a par-
ticular learning procedure (repetitive counterlearn-
ing) can have extremely different neurological and
behavioral effects depending on whether or not it is
carried out during the reconsolidation window. So,
any label for the erasure procedure that includes the
term “extinction” is a misnomer that invites the mis-
conception that reconsolidation utilizes and enhances
the process of extinction.
The use of repetitive counterlearning during the
reconsolidation window could more appropriately be
labeled “nullification learning,” “update learning,” or
“erasure learning,” rather than “extinction training,”
to avoid conceptual errors and confusion. However,
the “extinction” labeling has already become standard
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
among researchers who use this particular procedure
and is probably here to stay.
The great significance and usefulness of the recon-
solidation window lies in the fact that, during that
window, to unlearn is to erase, regardless of the specif-
ic form of the unlearning or nullification experience.
The repetitive counterlearning procedure is a conve-
nient protocol under the highly simplified conditions
of laboratory studies but is not suitable in general for
nullification of the far more complex emotional learn-
ings encountered in real-life psychotherapy. There is
a potentially unlimited number of formats in which
nullification learning can occur in psychotherapy (for
many examples of which, see Ecker et al., 2012).
The triggering of reconsolidation versus extinc-
tion. As already described, both reconsolidation and
extinction begin with the two-step sequence of re-
activation and nonreinforcement, that is, a recueing
of the target learning followed by nonoccurrence of
what the target learning expects to happen. What,
then, determines whether reconsolidation or extinc-
tion is the result?
We know that the experience of mismatch (pre-
diction error) is what triggers destabilization and
reconsolidation, as discussed earlier. This seems to
imply that when memory reactivation plus nonrein-
forcement create a mismatch experience, reconsol-
idation is triggered, whereas when reactivation plus
nonreinforcement occur without creating a mismatch
experience, the extinction process begins. Therefore,
in order to understand what causes the triggering of
reconsolidation versus extinction, it may be necessary
to understand why reactivation with nonreinforce-
ment creates mismatch in some circumstances but not
in others. With that question in mind, it is instructive
to examine a range of instances where reconsolidation
or extinction was induced.
Many observations of the triggering of reconsol-
idation versus extinction have been made in animal
studies through reactivating a CS-US target learning
by presenting the unreinforced CS only, and then
promptly applying a chemical agent that disrupts
nonconsolidated or deconsolidated learnings but has
no effect on stable, consolidated memory circuits. The
findings of many such studies can be summarized in
terms of how the effect of reactivating a target learn-
ing with CS-only presentations depends on their time
structure. In the studies summarized here, the target
learning was formed by two or more CS-US pairings
with 100% reinforcement.
Reconsolidation is triggered. After a single brief
Volume 3 Issue 1 (2015) 16
CS presentation, there is no extinction learning and Of the many studies that have reported the kinds of
the target learning is still at full strength (Nader et al., findings summarized above, very few also addressed
2000; Eisenberg, Kobilo, Berman, & Dudai, 2003; Ja- the question of why one, or a few, or many nonrein-
rome et al., 2012; Merlo et al., 2014; Pedreira et al., forced CS reactivations have the observed effects of
2004). In this case, prompt application of a chemical triggering or not triggering the destabilization and
agent that blocks consolidation (and reconsolidation) reconsolidation of a target learning. Here the focus of
disrupts the target learning, which is found to be sig- discussion now turns to an examination of why re-
nificantly weakened or completely erased 24 hr later, activation with nonreinforcement creates mismatch
indicating that the target learning was destabilized and triggers destabilization in some circumstances
(deconsolidated) by the CS presentation, triggering and not in others.
the reconsolidation process. This implies that unrein- MRMR model of triggering reconsolidation or
forced reactivation by a single CS presentation does extinction. The critical role of mismatch in triggering
create a mismatch experience. reconsolidation was first reported by Pedreira et al.
Extinction is triggered. After a single prolonged CS (2004), as noted earlier. A mismatch exists when there
or a series of many short CS presentations, an influen- is a significant discrepancy between what is expected
tial extinction learning exists and largely suppresses and what is actually experienced. Thus reconsolida-
the target learning, so the behavioral expression of the tion and all of its complex cellular and molecular ma-
target learning is significantly diminished. In this case, chinery is an experience-driven phenomenon.
prompt application of a consolidation-blocking chem- A growing number of experimental observa-
ical agent disrupts the newly formed, not yet consol- tions require a view of mismatch as being a fluid,
idated extinction learning, and this restores the tar- dynamical quality of experience that can vary on a
get learning to full strength (see, e.g., Eisenberg et al., moment-to-moment basis with the passage of time
2003). The return of the target learning to full strength and with new experiences (see, e.g., Jarome et al.,
implies that the target learning was unaffected by the 2012; Merlo et al., 2014; Sevenster et al., 2014). The
chemical agent and therefore was not in a destabilized following paragraphs apply that dynamical view of
state when the chemical agent was administered after mismatch and offer the proposal that the reconsoli-
the single prolonged CS or the series of many short dation/extinction dichotomy may be largely or com-
CSs. This in turn implies that although the first of pletely governed by the mismatch requirement and
the many short CS presentations must have created a mismatch relativity (MRMR), as defined earlier.
mismatch experience (as in the single brief CS situa-
tion), mismatch must have been terminated promptly To explore this proposal and show that MRMR
by the ensuing CSs, restabilizing the target learning, potentially could be responsible for a wide range of
despite the fact that each CS in itself would seem to reconsolidation and extinction phenomenology, what
be a nonreinforced reactivation that should maintain follows is a discussion of how several significant re-
mismatch. These logical inferences have been corrob- search findings can be understood as being entire-
orated by several studies, described below. ly MRMR effects. The discussion shows specifically
how reactivation with nonreinforcement creates mis-
Neither reconsolidation nor extinction is trig- match, triggering destabilization, in some circum-
gered. For an intermediate number of unreinforced stances and not in others.
CS presentations, the target learning remains at full
strength and a variety of chemical interventions that Single CS-only presentation. First consider the
either disrupt or enhance reconsolidation or extinc- simplified case in which the sequence of reactivation
tion have no effect on subsequent target learning and mismatch (nonreinforcement) occurs only once
expression/ This is understood to mean that neither and is not repeated. For example, if a conditioned
reconsolidation nor extinction is underway (Flavell stimulus (CS, such as a blue light, an audio tone, or a
& Lee, 2013; Merlo et al., 2014; Sevenster, Beckers, particular physical environment) has previously been
& Kindt, 2014). Merlo et al. (2014) commented, “In paired repeatedly with a mild electrical shock (un-
the continuum of possible retrieval conditions, recon- conditioned stimulus, US) just before the CS turns
solidation and extinction processes are mutually ex- off, what happens subsequently if the CS turns on and
clusive, separated by an insensitive phase where the then turns off unreinforced (no shock), just once?
amount of CS exposure terminates the labilization of The CS turning on immediately reactivates the
the original memory, but is insufficient to trigger the target learning, generating the expectation of receiv-
formation of the extinction memory” (p. 2429). ing a shock. Several studies have shown that the time

17 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

period from CS onset to CS offset (with no US) con-
trols whether reconsolidation or extinction occurs,
and that whichever process occurs is triggered by CS
offset and does not begin before CS offset (Kirtley &
Thomas, 2010; Lee, Milton, & Everitt, 2006; Mamiya
et al., 2009; Pedreira & Maldonado, 2003; Pedreira et
al., 2004; Pérez-Cuesta & Maldonado, 2009; Suzuki et
al., 2004). In these studies, the CS onset-to-offset time
that originally created the target learning (with CS-US
pairing) was short, typically in the 1- to 5-min range.
Subsequently, CS onset and offset with no shock in-
duced reconsolidation if the CS onset-to-offset time
was less than about one hour (destabilizing the target
learning, making it revisable by new learning during
the next five hours), but it induced extinction if the
CS onset-to-offset time was more than about an hour
(that is, the target learning remained stable and a sep-
arate counterlearning formed in competition with the
target learning).
To my knowledge, researchers have not proposed
or identified a mechanism that explains the observa-
tions that short versus long periods of CS onset-to-off-
set induce reconsolidation or extinction, respectively.
If MRMR (mismatch requirement and mismatch rel-
ativity) are the cause, they would operate as follows.
Consider first the case where, after the target learn-
ing was formed by a series of CS-US pairings (100%
reinforcement), there is a single unreinforced CS re-
exposure with short duration of onset-to-offset (about
equal to the CS onset-to-offset time in the original
CS-US training), triggering reconsolidation. As noted
earlier in describing the study by Nader et al. (2000),
the absence of the expected US creates a decisive US
mismatch that destabilizes the target learning.
Next, consider the case where a single short
CS-only presentation occurs after the target learning
has been formed by a partial reinforcement schedule.
Partial reinforcement results in the subject expecting
not that the US will always occur following the CS,
but only that it might occur. In this case MRMR pre-
dicts that a single short CS-only presentation would
not constitute a decisive mismatch and would there-
fore not induce destabilization. The target learning
would remain stable, as was found to be the case by
Sevenster et al., (2014), who used a 50% reinforce-
ment schedule to create a fear learning and showed
that a single, short CS-only presentation did not in-
duce destabilization. (Learnings created by partial
reinforcement require significantly more extinction
trials to suppress, as compared with learnings created
by continuous reinforcement, because the initial trials
are not experienced as a decisive mismatch or predic-
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
tion error. This is the “partial reinforcement extinc-
tion effect”, e.g., Pittenger & Pavlik, 1988.)
A special case of learnings formed by partial rein-
forcement is single-trial learning, which again results
in the expectation that the US might occur following
the CS, not that it will always occur. Here too, a sub-
sequent single CS-only reexposure does not create a
decisive US mismatch. This was the case in a study of
conditioned taste aversion in rats reported by Eisen-
berg, Kobilo, Berman, and Dudai (2003). A single
training trial produced lasting avoidance behavior,
but a single CS-only reexposure did not destabilize
the target learning (as evidenced by no disruption of
the target learning from anisomycin administered im-
mediately after the CS reexposure). When Eisenberg
et al. used a series of two CS-US pairings to create the
target learning instead of one pairing, creating strong
US-expectancy due to the 100% reinforcement, the
same single CS-only presentation now did trigger de-
stabilization, allowing disruption by anisomycin, im-
plying that now a mismatch was created.
The foregoing examples and those below illustrate
that the principle of mismatch relativity emphasizes
a detailed consideration of all features of the target
learning, in order to predict accurately whether or not
a given reactivation procedure creates a decisive mis-
match/prediction error experience in relation to the
target learning in question. Mismatch relativity also
alerts us to understand that any given successful ex-
perimental destabilization procedure reveals not the
inherent, fundamental properties of the brain’s re-
consolidation process, but only a way of creating mis-
match relative to the particular features of the target
learning created by the researchers.
Next we have to consider why, according to MRMR,
a single long-duration, unreinforced CS causes ex-
tinction rather than reconsolidation. For example, Pe-
dreira et al. (2004) found that a 2-hr CS presentation
failed to destabilize the target learning into reconsol-
idation and instead produced an extinction learning.
The original target learning began with a 5-min expo-
sure to the CS (the training chamber), and then the
US, a simulated predator, was presented every 3 min,
15 times. The fact that a 2-hr unreinforced CS reexpo-
sure did not trigger reconsolidation means, according
to MRMR, that the 2-hr CS did not function as a mis-
match of the target learning’s 5-min exposure before
the US began to appear. Why it did not function as a
mismatch can be inferred from mismatch relativity:
Relative to the original learning experience with its
5-min CS exposure, a 2-hr CS reexposure presumably
was an experience that qualitatively differed subjec-
Volume 3 Issue 1 (2015) 18
tively from the original learning to such a degree that addressed reconsolidation and extinction having a
the 2-hr reexposure experience registered as a contex- shared initiating sequence in the case of single-trial,
tually unrelated experience, not as a mismatch or even nonreinforced CS reexposure. Next, consider the case
as a reminder of the 5-min experience encoded in of a series of numerous identical counterlearning ex-
the target learning. Thus the experience of mismatch, periences of reactivation and nonreinforcement, that
which would have occurred with CS offset for some is, the classical extinction procedure. It is well known
time after the 5-min point, no longer occurred with that the multitrial extinction procedure does not de-
CS offset at the 2-hr point. Due to the relativity of mis-
stabilize or erase the target learning, yet, as discussed
match, an experience that is too greatly dissimilar to above, a single short CS-only trial does do so (for a
the original learning experience does not function as a target learning created by multiple CS-US presenta-
reminder or mismatch of it, so the target learning does tions). This raises the question: Given that the first
not destabilize, which causes the new learning driven CS-only presentation mismatches and destabilizes,
by the unreinforced CS to form separately as an ex- how does the state of the target memory evolve with
tinction learning. each successive CS-only presentation, such that there
This example suggests the possibility that the pres- is no destabilization and no erasure resulting from the
ence or absence of mismatch can change over time series?
during CS presentation, which will figure importantly It will be assumed in what follows that the target
in the analysis of multitrial extinction below. The gen- learning was formed originally by a series of CS-US
eral principle of mismatch relativity is that experience pairings having the same time structure as in the sub-
B is a mismatch of expected experience A if B resem- sequent extinction procedure. This assumption allows
bles A enough to register as a reminder and repeti- for an unambiguous delineation of the logic of MRMR
tion of A, while also containing saliently discrepant or in this instance, but it does not limit the relevance of
novel features relative to those of A. MRMR to only these assumed conditions as a special
Testable predictions arise from the MRMR inter- case.
pretation above. For example, the original learning The question requiring an answer is this: Why does
could be created by a 2-hr CS with the US occurring the standard extinction procedure fail to destabilize
in the final minutes, with a repetition of that CS-US and then erase the target learning, given that the first
beginning 30 min later, and so on three or four times. CS-without-US in the series mismatches and desta-
Mismatch relativity predicts that now a 2-hr CS-only bilizes the target learning and the ensuing series of
reexposure would serve as a reminder and mismatch CS-without-US experiences could be expected to then
and would achieve destabilization; and perhaps now function as a nullification learning that erases the tar-
a 5-min CS reexposure without US would fail to do get learning? MRMR implies that because the result
so because the dissimilarity might be too great for of multiple-trial counterlearning is extinction rather
the short reexposure to serve as a reminder of the ex- than erasure, it must be the case that multiple-trial
tremely long duration in the target learning. counterlearning does not sustain a mismatch experi-
If the mismatch requirement and mismatch rela- ence long enough for erasure to occur. The question
tivity govern whether reconsolidation or extinction therefore becomes: Why does multiple-trial counter-
occurs, then there is no absolute time duration of un- learning not sustain a mismatch that keeps the target
reinforced CS reexposure that defines the boundary learning destabilized and allows erasure to occur, even
between the two phenomena. Rather, the time bound- though every unreinforced trial in the series seems to
ary (the largest and smallest unreinforced CS reexpo- be a mismatch of the expected CS-US pairing? The an-
sure durations that function as a mismatch and trigger swer to that question has emerged from several recent
reconsolidation) would depend on the original learn- studies (Jarome et al., 2012; Merlo et al., 2014; Seven-
ing’s CS duration. That predicted dependency of the ster et al., 2014).
reconsolidation/extinction time boundary on the time Jarome et al. (2012) paired sound and footshock to
structure of the original training serves as another test
create a learned fear of the sound in rats, and then, 1
of the MRMR model and could be directly measured day later, applied anisomycin immediately following
by extending existing studies to vary the reinforced CS
either a single unreinforced CS or two unreinforced
duration in the original learning while measuring theCSs that were separated by 1 hr. (Longer periods were
maximum and minimum unreinforced CS reexposure also tested.) On the next day, tests of fear in response
durations that trigger reconsolidation. to the CS showed that after single-CS reexposure, the
Multiple CS-only trials. The foregoing paragraphs fear learning had been largely disrupted and erased by

19 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

anisomycin, indicating destabilization had occurred,
but after the two-CS exposure there was no reduction
in fear due to anisomycin. This implies that the sec-
ond CS rapidly changed the neurological condition of
the target learning, either returning the target learn-
ing to stability (according to the standard interpreta-
tion of anisomycin’s effect) or, alternatively and more
conjecturally, launching the updating/erasure process
and thereby altering the prevailing molecular mecha-
nisms such that even though destabilization persisted,
anisomycin no longer caused disruption (T. J. Jarome,
personal communication, 24 November, 2014).
Sevenster et al. (2014) also demonstrated rapid
changes in target memory condition caused by suc-
cessive nonoccurrences of the US when it was expect-
ed according to the original training. A fear learning
was created in human subjects by pairing an image
with a wrist shock, and the effects of 0, 1, and 2 non-
reinforcements by CS-only presentations were stud-
ied. Whether the target learning was destabilized was
determined by administering propranolol, which
disrupts destabilized CS-US fear learnings in hu-
mans (Kindt et al., 2009; Soeter & Kindt, 2011). This
revealed that a single nonreinforcement functioned
as a mismatch and destabilized the target learning,
launching reconsolidation, but 0 and 2 nonreinforce-
ments did not. This indicates again, as in Jarome et al.
(2012), that a target learning destabilized by an initial
unreinforced CS presentation is restabilized by the
second unreinforced CS presentation. Here, however,
the time interval from first to second CS was 40 s rath-
er than 1 hr.
Importantly, in addition to measuring the level of
fear in response to each unreinforced CS presentation,
during each unreinforced CS presentation Sevenster
et al. (2014) also measured subjects’ subjective rating
of their US-expectancy, that is, the felt level of antic-
ipation that the shock would occur at the end of the
current 7-s CS image presentation. US-expectancy
was rated by subjects on a scale from –5 (certainty
of not happening) to 0 (uncertain) to +5 (certainty
of happening). This revealed that as the first nonre-
inforcement was about to happen, average US-expec-
tancy was strong at +3.8, which created a mismatch
experience when the US did not occur, but as the sec-
ond nonreinforcement was about to happen, average
US-expectancy had decreased sharply to 0.9, close to
the “uncertain” level and presumably too low to create
a mismatch experience when the US did not occur.
The first US nonoccurrence had created new learning
that reduced the US-expectancy created by the origi-
nal training, and it was this reduced US-expectancy
that then encountered the second US nonoccurrence.
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
The direct implication is that immediately after the
first nonoccurrence of the US when the US would be
expected on the basis of the original learning, sub-
jects were in the experience of mismatch, so the target
learning was found to be destabilized, but immediate-
ly after the second nonoccurrence of the US when it
would be expected according to the original learning,
subjects were not in an experience of mismatch, so the
target learning was found to be stable.
Thus the presence or absence of a mismatch ex-
perience evidently switches destabilization on or off,
respectively, in real time. By comparing their mea-
surements of fear and US-expectancy, Sevenster et
al. also showed that the sharp drop in self-reported
US-expectancy was not accompanied by a decrease in
physiologically measured fear. This means that with
accumulating unreinforced CS presentations, US-ex-
pectancy began to decrease, evidently returning the
target learning to stability, before there had been
enough counterlearning to initiate the formation of
an extinction learning. This is consistent with other
studies indicating that reconsolidation and extinction
are mutually exclusive phenomena (e.g., Duvarci &
Nader, 2004; Duvarci et al., 2006; Merlo et al., 2014).
Thus after two US nonoccurrences, the target learning
was stable and neither reconsolidation nor extinction
was occurring.
Observations by Merlo et al. (2014) provide fur-
ther corroboration that accumulating unreinforced
CSs switch off reconsolidation before extinction is
in effect. After 1, 4, 7, and 10 presentations of an un-
reinforced CS, Merlo et al. tested a conditioned fear
learning in rats for susceptibility to alteration by var-
ious chemical agents applied locally in the basolater-
al amygdala (BLA). After the fourth CS presentation,
the target learning was no longer chemically alterable,
meaning that it was no longer in a destabilized state
in the BLA. Furthermore, there were no behavioral or
molecular markers of extinction, so neither reconsol-
idation nor extinction was occurring. Merlo et al. in-
fer from these findings that the target learning’s state
(stable or unstable) may be reset on a moment-to-mo-
ment basis as CS-only presentations accumulate.
In light of the studies just reviewed, there is now
growing evidence indicating why the multiple-trial
counterlearning of conventional extinction training
does not sustain mismatch or destabilization and does
not erase the target learning: A target learning’s state
of destabilization and erasability evidently is main-
tained by the ongoing presence of the experience of
mismatch or prediction error and can quickly termi-
nate if the experience of mismatch or prediction error
Volume 3 Issue 1 (2015) 20
terminates. Thus the mismatch requirement first iden- destabilization occurs.)
tified by Pedreira et al. (2004) functions as a dynam- In that way, the multitrial extinction procedure
ic on/off switch. The destabilized state can be toggled destabilizes and then quickly restabilizes the target
on/off or off/on as mismatch is subjectively present/ learning before erasure can occur. With the third un-
absent or absent/present, respectively. (Destabiliza- reinforced CS, presumably there would no longer be
tion lasts for a time window of about five hours, as de- any surprise or mismatch whatsoever. With the tar-
scribed earlier, if, once destabilized, the target learn-get memory in a stable state as CS repetitions con-
ing is not further recued by additional experiences.) tinue, the target learning remains intact and the new
In this picture of dynamic mismatch bipolarity, learning created by the ongoing series of harmless CS
the principle of mismatch relativity governs how each presentations forms separately. That is the MRMR ac-
successive unreinforced CS affects the target learning. count of standard multitrial extinction.
In other words, the target learning consists of expec- Standard multitrial extinction training was con-
tations that can be revised by an individual CS in the verted into an effective erasure procedure in studies
series if that CS deviates from the expectations extant by Monfils et al. (2009) and Schiller et al. (2010), as
just prior to that CS. The evolving expectational con- described in a previous section, simply by increasing
tent of the target learning must be considered in detail the time interval between the first and second CS-only
in order to understand the effect of each successive CS. presentations. Why that seemingly minor alteration of
In short, the studies by Jarome et al. (2012), Merlo extra time in the first interval could make such a qual-
et al. (2014) and Sevenster et al. (2014) indicate that itative and drastic difference in outcome becomes ap-
MRMR principles determine the effects of the multi- parent by applying the MRMR model and examining
ple-trial extinction procedure, as follows. With a target the timing difference in terms of its mismatch effects.
learning created by CS-US pairings with continuous That exercise is carried out here next for the Monfils
(100%) reinforcement, the subject has the expectation et al. study, as this section’s final and most intricate ex-
that the US always accompanies the CS. The first CS- ample of applying the MRMR model. The Schiller et
without-US presentation is therefore a decisive mis- al. study, which had human subjects, is described in
match (that is, the nonoccurrence of the US creates the Appendix of this article.
strong surprise and a felt inability to anticipate accu- In the procedure that Monfils et al. (2009) used
rately) because the learned expectation that the US with rats, the original fear acquisition consisted of
always accompanies the CS has now encountered the three CS-US (tone-shock) pairings every 3 min, with
mismatching current perception that the US does not CS duration of 20 s, ending with a half-second shock.
always accompany the CS. This has two effects. First, On the next day, the interval between the 19 CS-on-
this strong mismatch abruptly destabilizes the target ly presentations was also 3 min, except for a longer
learning. Second, the nonoccurrence of the expected initial interval between CS1 and CS2 of 10 min or
US creates new learning that the US does not always 1 hr, both of which resulted in long-term erasure of
accompany the CS. This new learning persists and re- the learned fear, which could not be reevoked later
sults in a sharply reduced US-expectancy during the by either the CS or the US. The control group did not
second unreinforced CS presentation. The second US have the longer initial interval, making the procedure
nonoccurrence is therefore not experienced as a mis- a conventional extinction training, and for these rats
match, because now there is no surprise or prediction the learned fear was later reevoked.
error felt. Rather, there is now an experience that this
US nonoccurrence is in accord with the expectation The functioning of the erasure procedure is under-
that the US might or might not happen. This termina- stood as follows according to the MRMR model. It can
tion of mismatch terminates destabilization, because be reliably assumed, based on many other studies as
destabilization is dynamically maintained in real time described earlier, that CS1 created a US mismatch that
by the persisting experience or context of mismatch. quickly destabilized the target learning. Therefore, af-
The target learning shifts into a stable state. (Wheth- ter CS1 the target learning was open to being updat-
er the new learning created by the first US nonoccur- ed by any variations in the procedure relative to the
rence immediately updates the target learning’s mod- original training. An immediate and salient variation
el of the CS-US association is not yet known, though was the appearance of CS2 defining a 10-min or 1-hr
molecular findings by Monfils et al., 2009, and Jarome interval since CS1, far longer than the 3-min interval
et al., 2012, seem to imply that the destabilization expected based on the original acquisition training.
event does not also launch updating. Possibly, updat- The already destabilized target learning was updated
ing is launched only if mismatch saliently persists after according to that longer interval, so the timing expec-

21 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

tation going forward was now that after each colored
square there would be either 3 min or the longer time
(10 min or 1 hr). The longer interval defined by CS2
also was a mismatch of timing expectations, and that
second mismatch experience, coming while the tar-
get learning was already destabilized, would only have
made the destabilized state more robust.
However, as discussed earlier, CS2 would not cre-
ate a US mismatch as CS1 had done. Thus CS2 ended
the US mismatch while creating a timing mismatch.
Did the target learning restabilize due to the termina-
tion of US mismatch, or did it remain destabilized due
to the timing mismatch?
One indication comes from Jarome et al. (2012),
who largely replicated this situation with two CSs 1
hr apart, as described earlier. Anisomycin applied
immediately after the second CS did not reduce fear
in response to another CS 1 day later. That is usu-
ally understood as meaning that the target learning
was stable, because anisomycin disrupts a destabi-
lized memory. However, while anisomycin disrupts a
memory that is newly destabilized but not undergoing
updating, its effect on a memory during the updating
process is not known. On the cellular and molecular
level, the process that destabilizes the target learn-
ing and the process that updates/erases it appear to
be two distinct though coupled processes (Jarome et
al., 2012; Lee et al., 2008). Updating occurs through a
molecular mechanism that potentially alters the mo-
lecular processes involved in the memory’s dynamical
progression. Anisomycin is a protein synthesis block-
er. If the updating/erasure mode eliminates the pro-
tein synthesis that a nonupdating memory requires
for restabilization, then anisomycin would not have
a disruptive effect on a destabilized memory that is
undergoing updating, as Timothy J. Jarome (personal
communication, 24 November, 2014) has pointed out.
Only further research can settle the question of
whether the target learning in Monfils et al. (2009)
was stable or unstable after CS2, so here the MRMR
account must branch to follow both possibilities.
If CS2 caused restabilization due to elimination of
US mismatch, the fact that erasure then resulted from
CS3 to CS19 implies that CS3 must have destabilized
the target learning yet again. That in turn implies that
a new mismatch experience was created by CS3, which
in turn directs us to identify the procedural elements
that created that mismatch. CS3 occurred 3 min af-
ter CS2, which created another timing mismatch be-
cause an interval of 10 min or 1 hr was expected after
the updating driven by the longer interval from CS1
to CS2. This timing mismatch created by CS3 onset
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
would have redestabilized the target learning. (This is
a prediction of MRMR that could be tested by extend-
ing the Jarome et al. study to include a CS3 that occurs
3 min after CS2, and conducting molecular tests for
destabilization promptly after CS3.) Having been de-
stabilized by CS3, the target learning would then be
updated by the 3-min interval from CS3 to CS4, as
well as by CS4 itself as an experience that the CS is
harmless. The condition required for erasure to be oc-
curring is having the target learning in a destabilized
state concurrent with a fresh or freshly remembered
experience that contradicts and disconfirms the tar-
get learning’s expectations or model of how the world
functions. Erasure of the CS-US association may have
been underway following CS3, and more so when
the destabilized target learning encountered CS4.
The next 3-min interval from CS4 to CS5 would have
been as expected, ending the experience of mismatch,
which may have terminated the destabilized state and,
with it, the erasure process also. That would imply that
erasure was fully accomplished by CS1 through CS4,
and that CS5 through CS19 were not needed, which
could be tested by repeating the Monfils et al. (2009)
experiment without CS5 through CS19 and seeing
whether or not the results are unchanged.
If, on the other hand, CS2 maintained prior desta-
bilization by creating a timing mismatch, it is prob-
able that CS2 began the erasure process. Then, after
CS2, the effects of the procedure’s time intervals and
CSs would be the same as described in the previous
paragraph (with the exception that CS3 would now
maintain rather than reinitiate destabilization). Thus
the question of whether or not CS2 restabilizes the
target learning does not influence the outcome, ac-
cording to the MRMR model.
There is an additional possibility for how the up-
dating process could affect the unfolding dynamics
of the target learning. Engagement of the updating/
erasure process possibly could maintain the destabi-
lized state even without an ongoing experience of mis-
match. In order for the adaptive process of updating
to proceed, destabilization must be in effect during the
new learning that is driving the updating (otherwise
what occurs is not updating but a separate encoding of
new learning, as in extinction). Therefore, because the
adaptive success of updating depends on destabiliza-
tion, it is likely that whenever new learning during de-
stabilization is driving updating, the destabilized state
is maintained directly by molecular signals from the
updating/erasure process and is no longer dependent
on an ongoing experience of mismatch, so that updat-
ing will not be prematurely terminated by an absence
of mismatch causing a return to stability. This could
Volume 3 Issue 1 (2015) 22
be termed maintenance of destabilization by updating,
or MDU. Presumably, at the point where no further
encoding, reencoding, or de-encoding is occurring
for updating, the molecular signals driving MDU
cease, and the updated target learning then returns to
stability promptly. It is well established that a target
learning returns to stability after about five hours if
there has been destabilization but no updating (such
as by a single short CS-only presentation; Duvarci &
Nader, 2004; Pedreira et al., 2002; Pedreira & Maldo-
nado, 2003; Walker et al., 2003), but if updating has
also occurred, it is possible that restabilization occurs
through a different molecular process with a different
temporal characteristic.
If MDU is included in the MRMR framework, the
picture becomes one of memory mismatch initiating
and maintaining destabilization until memory updat-
ing is occurring, from which point destabilization is
maintained directly by the updating process and con-
tinues until updating terminates either due to satura-
tion of encoding or cessation of new learning input.
The MRMR account of the erasure procedure used
by Schiller et al. (2010; see Appendix) more strongly
requires and implies MDU. Obviously, further studies
are needed to test these possibilities and clarify how
the stability status of the target learning evolves with
each successive CS presentation in various procedural
configurations.
The above analysis of results of Monfils et al. (2009)
illustrates how assuming the results of experimental
procedures to be governed by MRMR principles can
illuminate previously unrecognized dynamics and
resolve dilemmas of interpretation and apparent in-
consistencies between studies. The foregoing MRMR
accounts are offered heuristically, to indicate the kinds
of phenomenology that are brought into consideration
by the MRMR framework.
The MRMR model has the systemic implication that
the neural and molecular processes of reconsolidation
or extinction are under the direct control of brain re-
gions and circuits that assess, detect, and signal mis-
match (prediction error) occurring between learned
expectations and currently experienced temporal,
spatial, and/or somatosensory perceptions (as well as,
in the human clinical context, attributed meanings). A
direct indication of that supervening role of mismatch
detection can be seen in the findings of Reichelt, Ex-
ton-McGuinness, and Lee (2013) and Sevenster et al.
(2014). The latter showed, as described above, that the
switching off of reconsolidation during a series of un-
reinforced CSs (reminders) can be directly attributed
to a sharp decline in US-expectancy and correspond-
23 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
ing termination of the experience of mismatch. Re-
ichelt et al. demonstrated that a successful mismatch
procedure for destabilizing goal-tracking memory in
rats, allowing chemical disruption, became ineffec-
tive as a result of impairment in the ventral tegmental
area, a brain region that is believed to be critical for
generating prediction error signals but is not a site of
memories undergoing reconsolidation. Understand-
ing how mismatch signals are generated and how they
supervene upon the machinery of reconsolidation
and extinction may prove to be particularly fruitful
for arriving at dexterous control of these phenomena.
For a discussion of prediction error signal generation
and ideas for future research, see Exton-McGuinness
et al. (2015).
In summary, from the MRMR perspective, the
triggering of reconsolidation versus extinction by
any particular reactivation procedure is to be under-
stood in terms of the presence or absence of a mis-
match (prediction error) experience at each point of
the procedure. In addition to identifying what may
control the reconsolidation/extinction dichotomy,
the MRMR model provides a new, fundamental un-
derstanding of classical extinction by identifying why
repetitive counterlearning creates a separate learning
in competition with the target learning, rather than
erasing the target learning. The MRMR account po-
tentially unifies a broad range of reconsolidation and
extinction phenomena.
Misconception 4: Anxiety, Phobias, and PTSD
Are the Symptoms That Memory Reconsolidation
Could Help to Dispel in Psychotherapy, but More
Research Must Be Done Before It Is Clear How Re-
consolidation Can Be Utilized Clinically
This section really comprises a blend of two mis-
conceptions. First is the view that for clinical use, re-
consolidation could be suitable for helping to dispel
learned fears of various kinds, with symptomology
such as PTSD, phobias, panic attacks and anxiety.
This impression probably stems from the consistent
tendency of researchers to comment in their research
articles that reconsolidation has significant potential
for treatment of PTSD and anxiety disorders. Re-
searchers have to be ultraconservative in what they
write so that everything they propose is firmly based
on what is known according to the current state of
research. Reconsolidation is relevant as a candidate
treatment only for conditions that are maintained by
memory, and for a brain researcher there is no risk
that PTSD could be unrelated to memory and there-
fore no risk of a departure from the required empiri-
Volume 3 Issue 1 (2015)
cism. Furthermore, fear is the most reliably detectable quence, having recognized from clinical observations
and measurable type of negative emotional response, that it was responsible for transformational therapeu-
so that researchers preferentially envision applications tic change (as described below). Furthermore, since
of the reconsolidation process to fear symptomology. 2006, psychotherapists have been translating recon-
Clinicians, however, regularly observe phenomenol- solidation research findings into successful therapeu-
ogy showing that an extremely wide range of other tic methodology. In 2006 I gave a keynote address to
conditions also are rooted in and driven by implicit a conference of psychologists and psychotherapists
memory (Ecker et al., 2012; Ecker & Toomey, 2008; (Ecker, 2006), describing the critical sequence of ex-
Toomey & Ecker, 2007; Schore, 2003; Siegel, 2006). periences that is required, according to reconsolida-
Nevertheless, it is not conventional practice for neu- tion research, for erasing a target emotional learning.
roscience researchers to reference that body of knowl- In that talk, a clinical case example from my practice
edge. illustrated the guiding of that sequence and the result-
In fact, reconsolidation research has already demon- ing permanent disappearance of a longstanding, in-
strated that the process applies to many types of learn- tense emotional reaction. In subsequent years, many
ing other than fear learnings—for example, appetitive articles and conference talks have presented the crit-
(pleasure) learnings (Stollhoff et al., 2005), operant ical sequence in many clinical case examples of using
(instrumental) learnings (Exton-McGuinness, Patton, it to decisively dispel a wide range of symptoms and
Sacco, & Lee, 2014; Gallucio, 2005), spatial learnings problems (e.g., Ecker, 2008, 2010, 2013; Ecker, Ticic,
(Rossato et al., 2006), object recognition learnings & Hulley, 2012, 2013a,b; Ecker & Toomey, 2008; Sib-
(Rossato et al., 2007), motor task learnings (Walker et son & Ticic, 2014).
al., 2003), taste recognition learnings (Rodriguez-Or- Note that according to current neuroscience,
tiz, De la Cruz, Gutierrez, & Bermidez-Rattoni, 2005), memory reconsolidation is the only known process
human declarative learnings (Forcato et al., 2007), and type of neuroplasticity that can produce what we
human episodic learnings (Hupbach, Gomez, Hardt, have been observing clinically: the abrupt, permanent
& Nadel, 2007), and emotionally compelling human disappearance of a strong, longstanding, involuntary
preferences (Pine, et al., 2014), among others. In fact, emotional and/or behavioral response, with no fur-
to my knowledge, as of this writing, all tested types of ther counteractive measures required. So, in psycho-
learning and memory have been found to submit to therapy we have been guiding the same well-defined
the process of reconsolidation. sequence of experiences and observing the same dis-
That is extremely good news for psychotherapy, tinctive signs of erasure as reconsolidation research-
as the learnings that underlie and drive individuals’ ers have. We have applied the process successfully to
problems and symptoms are of many different kinds the real-life, highly complex emotional learnings that
and not necessarily fear-based. Examples from my underlie and maintain symptoms of many different
own practice of non-fear-based implicit emotional types (see citations in the previous paragraph). Also,
learnings brought into direct awareness include: the successful clinical use of protocols designed to induce
expectation to be allowed no autonomy, with reliance reconsolidation and erasure have been reported by
on secrecy and lying to maintain personal power; the Högberg et al. (2011) and Xue et al. (2012). The latter
heartbreak-laden memory of father abandoning the demonstrated, in a controlled study, a strong degree
family when the client was 4 years old and the ensuing of elimination of heroin addicts’ cue-induced craving
conviction that the cause was her own deficiency; and for heroin.
the expectation of severe devaluing and derision from Thus the new era of the psychotherapy of memo-
others for any mistake or misstep, generating paralyz- ry reconsolidation is well underway. It had a curious
ing states of shame and inhibition. birth: From 1986 to 1993, my clinical colleague Laurel
The second misconception in this category is this: Hulley and I closely scrutinized the occasional thera-
In reconsolidation research articles, the authors typi- py sessions in our practices in which abrupt, liberating
cally comment that much more research must be done change had somehow occurred—the lasting cessation
before it is clear how reconsolidation can be utilized of a problematic pattern of emotion, behavior, cogni-
in psychotherapy. This is hardly the case. In reality, tion and/or somatics. Finally we identified a sequence
for over a decade before neuroscientists’ discovery in of experiences that was always present, across a wide
2004 of the sequence of experiences that triggers re- range of clients and symptoms, whenever such trans-
consolidation (Pedreira et al., 2004), psychotherapists formational change occurred. We developed a system
had been knowingly guiding clients through that se- of therapy focused on facilitating that key sequence
of experiences right from the first session of therapy,
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 24
and found that working in this way made our sessions
far more consistent in producing transformational
therapeutic breakthroughs. We began teaching this
methodology in 1993 at a workshop in Tucson, Arizo-
na, followed by our first published account of it in the
volume Depth Oriented Brief Therapy (Ecker & Hulley,
1996). Subsequently the same sequence of experiences
emerged in reconsolidation research, providing cor-
roboration of our clinical observations by empirical,
rigorous studies. It seemed remarkable that the same
process for erasing emotional learnings had been dis-
covered independently in the therapeutic domain of
subjective, experiential phenomenology and in the
laboratory domain of research on animal memory cir-
cuits. In hindsight that convergence now seems most
natural, because any process of lasting change that is
truly innate to the brain would inevitably be apparent
in both domains.
Our psychotherapy system, now known as coher-
ence therapy, guides the series of experiences required
by the brain for reconsolidation and erasure to occur,
creating transformational change (Ecker & Hulley,
2011). It is the only system of psychotherapy that ex-
plicitly calls for and maps directly onto the process
identified in reconsolidation research, but there are
many other systems of therapy in which the same pro-
cess also takes place, albeit embedded within method-
ologies conceptualized quite differently. It is clear that
no single school of psychotherapy “owns” the process
that induces memory reconsolidation, because it is a
universal process, inherent in the brain. In any therapy
sessions, the occurrence of transformational change
can now be presumed to mean that reconsolidation
and erasure of the target response have occurred,
whether or not the therapist was knowingly guiding
that process. Toward confirming that universality, we
began an ongoing project of explicitly identifying the
embedded steps of the reconsolidation and erasure
process in published case examples of various forms
of psychotherapy (Ecker et al., 2012; see Chapter 6).
Thus, knowledge of memory reconsolidation can
enhance the effectiveness of individual psychother-
apists, but more importantly, it also translates into a
unifying framework of psychotherapy integration in
which the many different systems of therapy form a
huge repertoire of ways to guide the brain’s core pro-
cess of transformational change. This framework gives
practitioners of different therapies a shared under-
standing of their action and a shared vocabulary for
their action. Of course, not all systems of psychother-
apy are equally consistent and reliable in fulfilling the any of the steps that erase a target learning. When re-
sequence required by the brain for erasure of a target searchers create a new learning to nullify and erase
learning, and this too becomes apparent through this
25 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
unified framework.
Misconception 5: Emotional Arousal Is Inherently
Necessary for Inducing the Reconsolidation Pro-
cess
Quite a few psychotherapies of focused, trans-
formational change have emerged since the 1980s,
and one of the tenets they have in common is that
the client’s engagement in therapy needs to be emo-
tional for deep, lasting change to take place. Perhaps
this important clinical tenet contributes to the view
maintained by some clinical psychologists that for in-
ducing memory reconsolidation, emotional arousal
is necessary (see, e.g., Lane, Ryan, Nadel, & Green-
berg, in press). However, the research shows that the
reconsolidation process does not inherently involve
emotional arousal. As noted earlier, successful de-
consolidation and erasure have been demonstrated
for learnings of many types, some of which have no
emotional content per se, such as neutral declara-
tive learnings (set of syllable pairings: Forcato et al.,
2009), object recognition learnings (Rossato et al.,
2007) and motor task learnings (Walker et al., 2003).
In such cases no emotional arousal is involved either
in the reactivation and mismatch of the target learn-
ing, triggering the reconsolidation process, or in the
new learning that then revises the target learning. The
brain clearly does not require emotional arousal per
se for destabilizing and erasing the existing learning.
That is a fundamental point.
If the target learning happens to have emotion-
al components, then its reactivation (the first of the
two steps required for deconsolidation) of course en-
tails an experience of that emotion. Naturally, target
learnings or schemas in psychotherapy usually are
emotional, so observable emotion accompanies reac-
tivation and is a key marker of adequate reactivation.
However, this emotional arousal is not inherent in the
reconsolidation process, and is present only because
the target learning happens to involve emotional ma-
terial. Clinical psychologists and psychotherapists
sometimes conflate the emotional nature of target
learnings in therapy with the inherent phenomenol-
ogy of the reconsolidation process, as Lane et al. (in
press) appear to do. For an accurate understanding of
memory reconsolidation this distinction is import-
ant, though from a pragmatic clinical perspective it
may seem to be hair-splitting.
Emotional arousal is not inherently required in
Volume 3 Issue 1 (2015)
a target learning, this new learning necessarily con- total of 45 sessions and was symptom-free at the end.
sists of experiences that sharply contradict the target This vignette focuses only on the particular emotional
learning’s expectations and model of the world. Prior learning that emerged in her ninth session. This learn-
to erasure, the target learning is deconsolidated by a ing had formed when she was 18 years of age and had
mismatch experience that typically consists of either become pregnant by her boyfriend while living with
an initial, brief instance of that same contradictory ex- her parents in a conservative town. She was living in
perience or some salient novelty not predicted by the shame and “desperate loneliness,” did not want the
target learning. For example, the target learning in the baby or the boyfriend, and was struggling to decide
human study by Schiller et al. (2010) was a learned about having an abortion when she had a miscarriage.
fear, specifically the classically conditioned expecta- Wanting to find the emotional learnings she had
tion that the appearance of a yellow square on a com- formed in this ordeal, I gently guided her into expe-
puter screen would be accompanied in a few seconds rientially revisiting and reinhabiting that situation
by an electric shock to the wrist. For nullification of imaginally, and voicing her thoughts and feelings in
that learned fear after it had been mismatched and present tense. This technique is often useful for bring-
destabilized by a novelty (see Appendix for details), ing the implicit meanings of the original experience
subjects were repeatedly given the contradictory ex- into explicit awareness. She seemed absorbed in the
perience of seeing a yellow square appear and disap- subjective reality of this material, and her voice was
pear with no shock occurring. The simple experience soft but somber as she said, “In this town, a girl who’s
of seeing each yellow square disappear was not an been pregnant outside of marriage is just ruined, com-
emotionally arousing experience, yet precisely for that pletely ruined.”
reason it erased the fearful expectation of the shock.
In order to elicit fully and explicitly the learning
Likewise, in psychotherapy we observe that erasure she had formed, I asked softly, “What does ‘ruined’ re-
results from a contradictory experience that sharply ally mean? What’s going to happen to you now?”
disconfirms the target learning, and we observe that
in some cases the contradictory experience is not in After a silence, in an even quieter voice she said,
itself emotionally arousing, even though the target “The rest of my life as a woman is ruined. I’ll nev-
learning is strongly emotional. This is possible because er marry, and I’ll never have children.” There it was,
the target of unlearning and nullification is the target the specific learning she had formed. According to
learning’s schema or model of reality (the semantic this learning, which had been implicit and outside of
knowledge in the target learning), not the emotions awareness for decades, having sex had results that had
generated by that model. This important point is illus- ruined the rest of her life. Immediately I understood
trated by the following case vignette from my psycho- that this dire model of her future was a potent source
therapy practice, which shows successful nullification of both her depression and her sexual aversion.
and erasure of an emotional target learning resulting With this clarity about the makeup of this target
from a contradictory knowledge that is not emotional. learning, I saw a possible way to create a contradicto-
The client, a married woman, aged 50 and the ry experience: use of the brain’s automatic detection
mother of one child, sought therapy to dispel her aver- of mismatches, a background process that is always
sion to sexuality with her husband, her depression, scanning current conscious experience. So in reply to
and her panic attacks, all of which had been afflicting her words, I said, “Please say that again.”
her for at least a decade. I was using coherence ther- Somberly, and clearly feeling the emotional reality
apy, in which the nonconscious, implicit emotional of the words, she said again, “The rest of my life as a
learnings that underlie and drive a given symptom are woman is ruined. I’ll never marry, and I’ll never have
first brought into direct, explicit awareness, and then children.” As soon as she spoke the words this time,
subjected to the process of memory reconsolidation her wider conscious knowledge networks registered
and erasure, creating transformational change. this information, which was new to her conscious
Session by session, into explicit awareness was networks though it was old in her implicit memory
emerging a complex array of underlying, implicit system. Her head made an abrupt movement, and in
emotional learnings, some of which involved trau- a sharper, louder voice she said with obvious surprise,
matic memories from various developmental stages of “Wait—that’s not true! I did marry! I did have a child!”
her life. In her first session I found that she would dis- This first encounter between the target learning
sociate and become glazed and wooden in response and vivid contradictory knowledge was the mismatch
to even a small step of interior exploration. She had a experience or prediction error needed for deconsol-

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 26

idating the target learning. This both-at-once expe- the much earlier one, reimmersing her in the complex
rience of the target learning and vivid contradictory emotional miseries that accompanied that pregnancy
knowledge is termed a juxtaposition experience in co- and the miscarriage. She said, “Ohhh—that’s an amaz-
herence therapy to emphasize the simultaneous acti- ing insight.”
vation of the two as copresent conscious experiences. After that session, her longstanding depressed
Note that in this instance, the mismatching knowl- mood was gone and did not return. This confirmed
edge—“I did marry! I did have a child!”—was familiar, that the targeted learning had been producing that
ordinary knowledge that was very real to her experi- mood, and that erasure or dissolution of that learn-
entially, as real and certain as her own existence, but ing had been accomplished—meaning that “I’ll never
it was not inherently emotional in quality. It would marry, I’ll never have children” no longer felt real or
not normally induce emotional arousal by itself. For true in any memory network. Her depressed mood
successful mismatch, the knowledge or experience had been the conscious surface of the unconscious de-
utilized must feel decisively real to the person on the spair and grief generated by the target learning.
basis of his or her own living experience, but that That session was also the beginning of the end of
does not require this mismatching knowledge to be her sexual aversion, which was dispelled after sever-
emotionally arousing in itself, even though the target al more sessions that revealed a number of other ep-
learning is strongly emotional. (As noted above, the isodes in her life where great suffering had resulted
emotional quality of the target learning is extraneous from or accompanied sex. Finally she no longer felt
and incidental to the reconsolidation process, not in- any urge to avoid her husband’s overtures, though she
herent in it.) did feel vulnerable and cautious about entering into a
Presumably the neural encoding maintaining “My new level of sexuality with him. Those of course were
life as a woman is ruined, I’ll never marry, I’ll never natural, appropriate feelings, and I coached her on ex-
have children” was now rapidly destabilizing, opening pressing to him her need for him to sensitively honor
that set of learned meanings to being rewritten and her pace and her cues.
erased by the knowledge, “I did marry! I did have a Her panics attacks proved to be based in yet other
child! My life isn’t ruined!” emotional learnings. They ceased after the discovery
She said in almost a whisper, “That just feels huge.” and dissolution of those other learnings through jux-
Then her head tipped back against the top of her taposition experiences tailored to them.
chair, and she gazed at the ceiling with blinking eyes. The main purpose of the case vignette above is to
Then her eyes closed, and after about ten seconds she show that the disconfirming knowledge or experience
said, “I feel tingling and buzzing all over my body. It’s used for creating a mismatch experience and then nul-
weird—I can feel the skin between my toes. It’s huge, lifying the target learning does not necessarily have to
it’s huge.” Internally she was repeatedly beholding and be emotional in itself. The vignette also illustrates the
marveling at the new realization, which served as the lifelong durability of original emotional implicit learn-
several repetitions of it needed for rewriting the now ings or schemas, as well as their dissociated, encapsu-
deconsolidated target learning. For good measure, I lated state, which keeps them insulated from and im-
soon created an explicit, out-loud repetition by jok- mune to new experiences and new knowledge formed
ingly saying, “I’m seeing an image of you running later in life. By being retrieved into conscious, explicit
down the street waving your arms and shouting, ‘I did awareness, emotional implicit learnings become fully
get married! I did have a child! My life wasn’t ruined!’” available for contact with other, disconfirming knowl-
She laughed heartily at that, but even before I said it, edge that can induce transformational change through
her mood had shifted into a happy lilt that I had never juxtaposition (mismatch) experiences.
seen in her before. Her contradictory knowledge was
not emotional in itself, but the liberating effect of its Thus, for consistently guiding decisive change
use in the reconsolidation process certainly was. through the reconsolidation process in therapy, the
required reactivation of a target learning has to be its
I then reminded her that in our previous session reactivation as a conscious, explicit experience of the
she had raised a major question: “Why did I start feel- retrieved, specific elements of the target model (such
ing unbearable sadness and depression when I became as “I’ll never marry or have children, so my life as a
pregnant with my son 13 years ago?” I asked her, “Does woman is ruined”), not merely the retriggering of a
today’s session help you see why?” Her eyes widened still nonconscious, unretrieved implicit schema. Such
with this further powerful realization that the later implicit learnings are often retriggered in day-to-day
pregnancy had reevoked her emotional memory of

27 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

life without conscious awareness, and often life also
provides strong disconfirmations, but because the
schema remains outside of awareness, there is no jux-
taposition experience—no conscious coexperiencing
of both the old and new knowledge of what’s real—
and therefore no change takes place.
In psychotherapy, when an implicit schema main-
taining symptom production becomes a conscious,
explicit experience, the schema continues to feel sub-
jectively completely real and compelling, and it per-
sists in driving symptom production. This continues
until the schema encounters a mismatch and discon-
firmation experience, creating the conscious juxta-
position described above. Then abruptly the schema
can lose its feeling of emotional realness and its power
to control behavior or state of mind, and symptoms
cease. Now the schema is not retriggered by situations
and cues that formerly triggered it. I and other practi-
tioners of coherence therapy have observed this clini-
cal phenomenology many, many times (Ecker & Hul-
ley, 1996; Ecker & Toomey, 2008; Ecker et al., 2012).
Thus, conscious, subjective awareness and attention
appear to function as the arena where separate, differ-
ing schemas (learnings, knowings, representations of
reality) can come into mutual contact and undergo a
combined semantic evaluation that allows for a revi-
sion of one schema by the other through the reconsol-
idation process.
Our clinical observations suggest that the brain
and mind appear to operate according to a metarule
that allows dissociated schemas to differ but requires
consistency between schemas that are experienced
concurrently in the same field of awareness (Ecker
& Hulley, 2011). Guiding a juxtaposition experience
cooperates with this metarule in order to transform
a symptom-generating schema. When two mutually
contradictory schemas are juxtaposed consciously,
the schema that more comprehensively or credibly
models reality, and therefore more usefully predicts
how the world will behave, reveals the other schema
to be false, and the falsified one is immediately trans-
formed accordingly. Maximizing predictive power is
well known to be a primary function and organizing
principle of the brain (Clark, 2013; de-Wit, Machilsen,
& Putzeys, 2010; Friston, 2010).
The previous paragraph emphasizes that a con-
scious, vividly experienced juxtaposition is found to
be critically important in the psychotherapeutic uti-
lization of memory reconsolidation. That emphasis
could appear to be at odds with recent research and re-
cent reviews of research: Delorenzi et al. (2014), Pine
et al. (2014), and Santoyo-Zedillo, Rodriguez-Ortiz,
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
Chavez-Marchetta, Bermudez-Rattoni, & Balderas
(2014) have demonstrated that a target learning can
be reactivated without coming into conscious aware-
ness or behavioral expression, and that even under
such conditions a mismatch/prediction error can then
take place and destabilize the target learning, allowing
it to be updated by new learning or disrupted chem-
ically. How can these findings be reconciled with the
clinical picture, in which the unconscious learnings
maintaining symptoms are not dissolved until they
come into conscious juxtaposition with contradictory
knowledge?
There are several dynamics that might provide an-
swers to that question (Ecker & Toomey, 2008). First
and foremost, researchers have shown that the stron-
ger and/or older the target learning is, the stronger
must be the reactivation in order for destabilization to
occur (Frankland et al., 2006; Suzuki et al., 2004). The
target learnings in psychotherapy typically are both
very old and also very strong, as they involve (and
were formed in the presence of) intense emotion and
urgent contingencies. Reactivation that produces con-
scious, bodily felt emotion, expectations, and mean-
ings (as facilitated in therapy) is much stronger than
reactivation that remains outside of awareness, which
may be why conscious juxtaposition is observed to be
necessary for achieving transformational change in
therapy.
Another relevant dynamic is the active suppres-
sion and dissociation of emotional learnings that have
strongly distressing content, which is the case for
many of the target learnings that figure significantly
in psychotherapy. Such active, self-protective suppres-
sion and dissociation could insulate these noncon-
scious, implicit learnings from direct juxtaposition
with contradictory experiences in everyday life, pre-
venting them from being updated. That insulation is
removed in therapy by gently and gradually bringing
these learnings into conscious awareness, allowing
juxtapositions and transformational change to occur.
There is yet another reason why the versatile clin-
ical utilization of memory reconsolidation requires
first bringing a target learning into conscious expe-
rience. Researchers know the detailed makeup of the
target learning, having created it themselves. This
knowledge allows them accurately to reactivate and
mismatch the target learning, destabilizing it, and
also to then conduct new learning designed precisely
to nullify and erase it. In sharp contrast, clinicians are
in the dark at the start of therapy, with no knowledge
of the makeup of the target learning driving symptom
production. Therefore it is only by bringing the target
Volume 3 Issue 1 (2015) 28
learning into explicit awareness and verbalization that lems are of course not limited to negative emotions,
its makeup can be known, and only then and not be- but can also be behaviors, thoughts, dissociated states,
fore can the therapist design and guide experiences of somatic sensations or conditions, or any combination
mismatch and nullification learning. of these. In any case, the target for erasure is not the
In summary, this section began by explaining that manifested symptom or problem. The target is the
the reconsolidation and erasure process does not in- learned implicit schema or semantic structure that
herently involve or require emotion in either the target underlies and drives production of the symptom.
learning or the new learning that is juxtaposed with Erasure occurs when the target schema is activated
and nullifies it. In psychotherapy, however, the target as a conscious, explicit experience and is directly dis-
learnings usually are richly emotional, so emotional confirmed by a concurrent, vivid experience of con-
arousal accompanies the therapeutic reconsolidation tradictory knowledge. In other words, erasure does
process as a rule, but this presence of emotion should not occur simply through evoking a nonsymptomatic
not be conflated with the intrinsic nature of the recon- state when normally the symptom would be occur-
solidation process. The examination of juxtaposition ring (with one important exception, discussed at the
phenomenology then continued into a clarification of end of this section). The occurrence of a symptom
why therapeutically effective juxtapositions have to be does not in itself bring the underlying, symptom-gen-
conscious experiences, even though reconsolidation erating schema into conscious, foreground awareness,
research has shown that under special laboratory con- as is necessary for guiding the erasure process in ther-
ditions, the process can take place outside of aware- apy, so methods for evoking a nonsymptomatic state
ness. are not likely to disconfirm the underlying schema.
The woman in our example might arrive at a session
in a depressed mood, and there are techniques of so-
Misconception 6: What Is Erased in Therapy Is the matic therapy, positive psychology, or mindfulness
Negative Emotion That Became Associated With practice that could be used to shift her into a depres-
Certain Event Memories, and This Negative Emo- sion-free sense of well-being. However, that would
tion Is Erased by Inducing Positive or Neutral Emo- not disconfirm and dissolve the underlying implicit
tional Responses to Replace It schema maintaining her depression, “I’ll never marry
or have children, so my life as a woman is ruined.” Her
As the clinical example in the previous section
depression would therefore recur.
shows, what is erased through the reconsolidation
process is a specific, learned schema or model or tem- An example of the misconception that nega-
tive emotion is erased by inducing positive or neu-
plate of reality, verbalized in the example as “I’ll nev-
er marry or have children, so my life as a woman is tral emotion is the view of Lane et al. (in press) that
ruined.” That schema was the target for erasure, and “changing emotion with emotion” characterizes how
the mismatch that deconsolidated and then nullified it the system of psychotherapy known as emotion-fo-
consisted of experiencing a sharp disconfirmation of cused therapy carries out reconsolidation and erasure.
that specific schema. With dissolution of the schema, Rather, “changing old model with new model” is the
the negative emotions that it was generating (despair, core phenomenology of erasure through reconsolida-
grief, and depression) disappeared, though those emo- tion in any system of therapy. Emotions then change
tions were not themselves the target for mismatch or as a derivative effect of change in semantic structures
erasure, and the mismatch did not consist of creating (models, rules, and attributed meanings), just as in
a positive or neutral emotion instead of despair and our example the client’s depression disappeared as a
depression. direct result of dissolution of her target schema. In
therapy, mismatch consists of, and erasure results
Notice also that the client’s negative emotion was
from, a direct, unmistakable perception that reality
arising directly from her existing model of the rest of
is fundamentally different from what one currently
her life, not from episodic memory (event memory)
knows and expects reality to be.
of the traumatic pregnancy and miscarriage. In other
words, the traumatic experience resulted in her model There is one important exception to the rule that
(which is semantic memory), and that model in turn lasting change does not result from evoking a non-
generated and maintained her emotional symptoms. symptomatic state when normally the symptom
Erasure of that model caused no loss of autobiograph- would be occurring. The exception is target learn-
ical memory. ings that consist of a learned expectation of having a
strongly problematic response in a particular kind of
Therapy clients’ unwanted symptoms and prob-
situation. Perhaps the most common instance of this
29 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
is the “fear of fear” that typically accompanies or even
largely maintains phobias. In such cases there is a pri-
mary learned fear, such as a terror of bees stemming
from a traumatic experience of being attacked by a
swarm of bees in childhood, as well as a secondary
learned, fearful expectation of suffering intense fear
if a bee appears. The primary learning is the fearful
expectation of being painfully stung by bees; the sec-
ondary learning is the fearful expectation of feeling
terrorized by any bee. That secondary fear of fear is
often the major force maintaining a phobia.
The expectation of feeling intense fear if a bee ap-
pears can be mismatched, disconfirmed, nullified and
erased by using techniques that allow the person to
encounter a bee in photos or imagination without
feeling any fear. The absence of the expected terror is
the mismatch experience. Clinically such techniques
are found to dispel longstanding phobias abruptly and
permanently (see, e.g., Gray & Liotta, 2012). Howev-
er, guiding a therapy client into a neutral or positive
emotion instead of the usual problematic emotion
brings about lasting change only when the problem-
atic emotion arises from a learned expectation of ex-
periencing the problematic emotion, as in fear of fear.
This is a special case that does not apply in the great
majority of clinical cases.
Misconception 7: The Much Older Concept of Cor-
rective Emotional Experience Already Covers Ev-
erything Now Being Described as Reconsolidation
and Erasure
The familiar concept of the corrective emotional
experience, introduced by Alexander & French (1946),
denotes a therapy client’s experiencing of something
that was needed in earlier stages of development for
well-being or healthy development but was missing:
some new experience that could significantly undo
and repair the effects produced by harmful experi-
ences in the past. Most often this concept is applied
in attachment-focused therapies, where it is typically
understood as implying that the therapist’s empathy
and nonjudgmental acceptance can create corrective
emotional experiences of interpersonal relationship
that repair early interpersonal traumas and the pat-
terns of insecure attachment learned in those ordeals.
What, then, is the relationship between the concept
of the corrective emotional experience as it is widely
understood, and the process of profound unlearning
through memory reconsolidation? Are they the same,
or are there significant differences? Is the reconsolida-
tion framework just old wine in a new bottle?
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
To answer that question, we have to translate it into
more specific terms: Does the guiding of a corrective
emotional experience automatically and inherently
include the creation of the juxtaposition (mismatch)
experience that is required for erasure through mem-
ory reconsolidation?
The answer to that question is no: corrective emo-
tional experiences do not necessarily include juxta-
position experiences. In a juxtaposition experience,
the client lucidly experiences both the problematic
original learning or schema and a contradictory, dis-
confirming new learning in the same field of aware-
ness—not just the desired new experience by itself. In
widespread clinical practice, corrective emotional ex-
periences often consist of the desired new experience
by itself.
Both therapists and clients are prone to what I have
described as a counteractive tendency or reflex (Eck-
er, 2006, 2008; Ecker et al., 2012), an urge to avoid
and suppress unwanted states of mind by building up
preferred states of mind. Corrective emotional expe-
riences are all too easily shaped by the counteractive
tendency: the client’s attention is fully engaged in the
desirable new experience and disengaged or dissoci-
ated from the unwanted reaction or ego-state and its
core schema. This disconnection from the problemat-
ic target schema during a corrective emotional expe-
rience is the very opposite of the explicit, foreground,
experiential awareness of that schema that is needed
for reliably guiding juxtaposition and transformation-
al change. Corrective emotional experiences struc-
tured in that counteractive, one-sided manner can feel
deeply meaningful and satisfying in the moment, but
they cannot result in lasting change if the core schema
underlying the problem remains intact, as it does if
it is not being subjected to a juxtaposition that dis-
solves it. In short, as widely carried out by clinicians,
a corrective emotional experience might supply the
material for one side of a potential juxtaposition ex-
perience but does not inherently access and reactivate
the other side—the emotional learning underlying the
problem—to actually create the juxtaposition.
On the other hand, if we regard juxtaposition ex-
periences to be the true corrective emotional experi-
ences, then we have a definition that does inherent-
ly call for all of the ingredients needed for inducing
memory reconsolidation and a lasting transforma-
tion of the emotional learning maintaining unwant-
ed emotions, behaviors, thoughts, and somatics. A
therapist who understands that reconsolidation and
transformational change require juxtaposition guides
a one-sided corrective emotional experience into be-
Volume 3 Issue 1 (2015) 30
coming a two-sided juxtaposition experience by elic-
iting concurrent, direct awareness of the problematic
learning that is thereby disconfirmed by the desired
new experience.
For example, a client accidentally knocks over a
small clock in the therapist’s office and apologizes anx-
iously and profusely. The therapist says with a relaxed,
warm smile, “It’s really OK. To me that’s a very small
thing and not a problem at all. Little accidents like that
happen for all of us, including me. Can you see that
I’m not at all upset?” The client takes this in and feels
much relieved to recognize that with the therapist he
is safe from negative judgments, anger, humiliation, or
rejection over such things. Probably most therapists
would regard that as a corrective emotional experience
for this person. However, if the insecure attachment
learnings underlying the client’s fearful apology have
not yet been made conscious and explicit, this new ex-
perience is not being juxtaposed with those learnings,
so transformational change is not occurring. In order
for that positive new experience to help bring about
transformational change, the therapist has to guide
the client into experiential, embodied awareness and
verbalization of the underlying target learning, such
as, “Mom’s rage and disgust at me for any accident or
mistake mean I’m worthless if do anything wrong,
and I expect anyone else to react to me that way too.”
Then the therapist guides a juxtaposition experience,
for example by saying empathically, “All along you’re
expecting that anyone would go into rage and disgust
at you for any little thing you do wrong, just as Mom
did so many times, and yet here you’re having an ex-
perience of me feeling it’s really no big deal at all that
you accidentally knocked over this little clock. Can
you hold both of those at once, and see what that feels
like?” That explicit, experiential juxtaposition gives
the new experience its maximum influence toward ac-
tual unlearning and dissolution of the target learning.
New experiences that can disconfirm and dissolve
existing problematic schemas arise not only in the
form of the therapist’s responses, but also in the course
of the client’s daily life, and these are fully as useful for
juxtaposition as the client’s experience of the therapist.
(For a detailed case example, see Ecker et al., 2012, pp.
43–61.)
As a final comment on this topic of how the re-
consolidation framework illuminates the concept of
corrective emotional experiences, the drawbacks of
the term “corrective” are worth noting. The term im-
plies that the client’s existing learnings and respons-
es, formed in earlier life experiences, are “incorrect.”
However, when we bring these existing learnings into
31 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
awareness and verbalization in therapy, making their
content explicit, it always becomes apparent that the
client’s implicit emotional learning system did its job
faithfully and properly in (a) forming those learn-
ings adaptively in response to what was subjectively
experienced, and (b) maintaining and utilizing those
learnings ever since they were formed until the pres-
ent day, however many decades that may be. Emotion-
al implicit learnings are specially formed so as not to
fade out for the life of the individual, as noted earlier.
To describe a therapy client’s core beliefs or schemas
as incorrect, maladaptive or pathogenic is actually to
accuse the process of natural selection of having those
attributes, because a person’s persistent beliefs and
schemas exist due to the proper functioning—not the
malfunctioning—of the emotional brain.
Misconception 8: To Induce Memory Reconsolida-
tion and Erasure, Therapists Must Follow a Set Pro-
tocol Derived From Laboratory Studies
Memory reconsolidation research tells us that a
well-defined sequence of experiences is required by
the brain in order to destabilize a target learning and
then unlearn and eliminate it: the target learning must
first be reactivated into conscious awareness, then de-
stabilized by a mismatching experience, then updated
and reencoded by new learning that nullifies it. That
is a sequence of three experiences, but each is defined
without reference to any particular procedure for
bringing it about. Researchers and clinicians are free
to devise any suitable means for creating those experi-
ences, and the creative possibilities are unlimited. The
brain does not care what concrete conditions or pro-
cedures induce those experiences. Hundreds of stud-
ies of reconsolidation have been published by neuro-
scientists as of this writing, and across them there is a
great diversity of concrete procedures used.
Likewise, many clinical methods for guiding the
critical sequence of experiences have been described
by Ecker et al. (2012), who propose that the 3-step
sequence is the core process shared by many differ-
ent-seeming therapy systems that produce trans-
formational change. Thus, as noted earlier, memory
reconsolidation serves as a new framework of psycho-
therapy integration, and within that framework, the
many therapies of transformational change are seen
as a broad range of methods for guiding the one core
process, giving clinicians great versatility in how they
do so. Current neuroscience is consistent with that
picture, in the sense that reconsolidation is the brain’s
only known process for eliminating (not merely sup-
Volume 3 Issue 1 (2015)
pressing) an established learned emotional response.
Thus the view that a set protocol is dictated by the
memory reconsolidation process could not be further
from the reality.
Misconception 9: A Long-Standing Emotional Re-
action or Behavior Sometimes Ceases Permanently
in Psychotherapy Without Guiding the Steps That
Bring About Erasure Through Reconsolidation,
and This Shows That Reconsolidation Is Not the
Only Process of Transformational Change
As implied in the previous section, various ther-
apy systems involve concepts and methodology that
make no reference to memory reconsolidation or the
sequence of experiences required by the brain to in-
duce it, yet their methodologies do result in that se-
quence of experiences occurring with some degree of
consistency, resulting in transformational change. A
close examination of the moment-to-moment pro-
cess in published case studies makes the occurrence
of the required steps apparent (Ecker et al., 2012, see
pp. 126–155). Practitioners of such therapy systems
might maintain that they have not guided those ex-
periences when in fact they have done so. It is a well-
known meme in the clinical field that how therapists
conceptualize what they do, and what they actually
do, are not necessarily the same.
In my own psychotherapy practice I have occasion-
ally seen transformational change result from sessions
where I did not think the key sequence had occurred.
In such cases I have made a point of then engaging my
client in closely examining, in hindsight, the internal
events that led to the shift or breakthrough. All such
hindsight enquiries have revealed that a juxtaposition
experience in fact occurred serendipitously, without
being recognized or verbally labeled at the time. Thus
my own clinical experience suggests and upholds the
hypothesis that transformational change of an ac-
quired response is always the result of a juxtaposition
experience—that is, of the reconsolidation process—
even when there has been no explicit guiding of the
steps required for erasure.
A memorable example of such hindsight verifica-
tion of juxtaposition emerged from a colleague’s case
consultation. Her therapy client was a woman, aged
32 and married for five years, who was struggling with
her obsessive attachment to and compulsive pursuit
of the man who had been her major love through her
early twenties. This problem developed after she and
this man happened to cross paths again two years ear-
lier. There had been no physical intimacy in these two
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
years, owing solely to the man’s lack of responsiveness,
but the woman’s emotional infidelity was significant
and was causing her much guilt.
The therapist had used a number of different types
of therapy for many sessions, with little or no effect on
the client’s heavy preoccupation with her former boy-
friend. Most recently there had been several sessions
in which the therapist had an uncomfortable sense of
flailing and being ineffectual. Then the client came
into the next session and reported that a major shift
had occurred. Her preoccupation and her pursuit of
this man had stopped. This breakthrough was mys-
terious for both client and therapist. The client could
offer nothing more than to speculate, “I think what
you said sunk in somehow, that when an investment
goes badly, sometimes it’s best to cut your losses.” This
referred to an offhand, momentary comment made by
the therapist in the previous session, a comment that
seemed more like advice than therapy. It was coun-
teractive in nature (an attempt to build up a cogni-
tive understanding to override the emotionally driven
symptom), was not dwelt upon, and the focus of the
session had moved on. Yet the client indicated that the
comment had somehow led to her liberating shift.
Soon after that, the therapist consulted with me
and mentioned all of this. I suggested a way for her to
guide her client to look more closely into the process
that had occurred internally: She could ask, “If it was
new for you to hear that ending it with him could be
OK even though you had an emotional investment in
it from long ago, what were you previously believing
or expecting about how it would not be OK to end
it?” This would be using the disconfirming knowledge
to find the constructs or schema that had been dis-
confirmed, which is a reverse engineering of coher-
ence therapy’s usual process of first finding the client’s
symptom-generating schema and then, on the basis
of the details of that schema, finding vivid contradic-
tory knowledge to create a juxtaposition experience.
But when a transformational shift occurs serendipi-
tously, it is typically the disconfirming knowledge that
becomes apparent first, while the disconfirmed sche-
ma is still unknown. Subsequently the disconfirming
knowledge can be used to bring the now defunct sche-
ma into explicit awareness, as I guided the therapist to
do in this case.
My colleague then briefed me on what emerged
when she pursued, with some persistence, the enquiry
I had suggested. The offhand comment happened to
reach precisely into an unconscious schema that the
client now put into words by saying, “I was struggling
to keep my emotional investment in that relationship
Volume 3 Issue 1 (2015) 32
from being lost because I’d really put my heart and soul 1. Resistance to dissolution. In some cases, the
therapist has indeed guided the sequence of experi-
into that relationship, and on some level I felt that if it
ended, I’d be losing so much of myself that I would die ences necessary for reconsolidation and erasure, but
or just be an empty shell or ghost forever. But when the target learning does not dissolve and remains in
you said it’s OK to get out of an investment even if you force (continues to retrigger, feel real, and produce
take a loss, all of a sudden that changed, because I saw,symptoms). We will see below that in such cases, the
shift is prevented by a blockage or resistance that can
‘Oh—people do that all the time. It’s not a disaster, it’s
just practical.’ I saw that I could let go and lose that be cleared away, allowing dissolution to occur when
investment in him, and I wouldn’t turn to dust.” the sequence is guided once again. The blockage is a
separate, distinct phenomenon that does not imply a
That account points clearly to a juxtaposition expe-
fundamental failure of the reconsolidation process.
rience that had formed in response to the therapist’s
offhand comment. The woman reported also that 2. Multiple symptom-generating schemas. In
it was not a struggle to persist in not contacting the other cases, in response to the necessary sequence of
man, though she did feel “a quiet sadness” each time experiences, the target learning does dissolve and no
she would have contacted him but did not do so. The longer activates or feels real, but the symptom pro-
nonreactivation of the symptom-generating schema duced by that target learning continues to occur. This
or ego-state and the effortlessness of remaining symp- means that there is at least one other emotional learn-
tom-free are key markers of erasure and transforma- ing or schema, distinct from the one that has been
tional change. dissolved, that also produces the same symptom. It is
common for therapy clients to present a symptom or
Thus, when the steps required for reconsolidation
problem that is driven by more than one emotional
and erasure have not been overtly or deliberately guid-
schema. A symptom ceases to occur only when all of
ed in therapy and yet transformational change is ob-
its underlying emotional learnings have been nullified.
served to occur, this does not imply that a process oth-
er than reconsolidation is responsible for the change. 3. Nonimplementation. In other cases, the ther-
Extensive clinical experience indicates rather that an apist believes he or she has guided the required se-
unnoticed, nonverbalized juxtaposition experience is quence of experiences, but has not actually done so.
implicated and can probably be revealed by the type of As explained below, the necessary experiences have
inquiry illustrated in the example above. aspects that can be misperceived, particularly by cli-
nicians who are relatively new to guiding this process.
Informational and psychoeducational comments
made to a client in therapy tend to result in mere in- 4. Not based in learning. One other situation in
tellectual knowledge and therefore do not, as a rule, which the reconsolidation process can erroneously
represent an effective method for setting up the dis- appear to be failing is where the client’s problem or
confirming experiential knowledge required to create symptom is not rooted in acquired, underlying emo-
a juxtaposition experience. The example above shows tional learning. This category includes autism spec-
that juxtaposition experiences can sometimes form, trum and other conditions that have genetic causes,
unbeknownst to the therapist, even in clinical situa- or purely physiological conditions such as depression
tions where we would not imagine that they could do caused by hypothyroidism. For dispelling or moder-
so, such as in response to an offhand, commonsense ating such conditions, the memory reconsolidation
comment. process does not apply and should not be used, so it
cannot correctly be said to fail in such cases. A very
wide range of symptoms has been dispelled decisively
Misconception 10: Carrying Out the Steps Re- in therapy by the reconsolidation process (Ecker et al.,
quired for Reconsolidation and Erasure Sometimes 2012, p. 42), which shows how pervasively emotional
Fails to Bring About a Transformational Change, learnings are the underlying cause of presenting prob-
Which Means That the Reconsolidation Process Is lems.
Not Effective for Some Emotional Learnings In the case of resistance to dissolution, the erasure
In psychotherapy there are four distinct situations sequence is well fulfilled by juxtaposition experiences,
in which the reconsolidation process can appear to fail as required by the brain for dissolution of the target
to produce decisive change when actually the process learning, and yet dissolution does not occur because it
is not failing, but rather is not in fact taking place for is blocked by another, distinct dynamic. The erasure of
some specific, identifiable reason: an emotional learning is the profound unlearning and
dissolution of what has seemed to be a reality. For ex-

33 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

ample, after dissolution of an implicit emotional learn- and that world may first have to be prepared so as
ing verbalized as “Dad never talking to me or playing to make the emotional consequences of dissolution
with me means I’m unlovable and don’t matter,” the tolerable and acceptable.  At that point, the required
individual now either has no way of making sense of sequence of experiences (which is the creation of a
being neglected by Dad, or realizes emotionally that “I juxtaposition experience repeated a few times) suc-
was lovable and did matter, and yet Dad never talked cessfully dissolves the target learning maintaining the
to me or played with me.” Such alterations of personal symptom.  (For a case example illustrating this pro-
reality entail difficult emotional adjustments, partic- cess, see Ecker et al., 2012, pp. 77–86.)
ularly when the target learning is a core element of Nonimplementation of the required sequence of
a deeply vulnerable area, such as primary attachment experiences is the other situation that needs to be ex-
relationships, identity, or sense of justice, for example. amined here. Nonimplementation may be the actual
Even if the series of experiences required for dissolu- situation though the therapist believes mistakenly that
tion has occurred as required, dissolution is blocked the sequence has been fulfilled. Such cases can involve
by the emotional brain if the emotional consequenc- misperceptions of various kinds. One mistake of this
es of dissolution do not feel tolerable, whether or not kind consists of assuming that a particular procedure
those consequences are recognized consciously. or technique necessarily creates a particular subjective
Thus the unlearning and dissolution process is experience had by the client. The brain’s requirement
not governed by mechanistic neurological processes. for deconsolidating and erasing a target learning is a
Higher-order, abstract meanings that are distressing certain sequence of internal experiences, not external
can block it. For example, many times I have seen a procedures or techniques. In other words, there is an
therapy client hold back from a liberating shift be- important distinction between the procedure that is
cause of an accompanying realization that if the shift carried out visibly in the room, and the internal phe-
were to occur, it would mean that decades of life were nomenology occurring in the therapy client’s subjective
wasted by living according to unconscious, life-chok- experience. A particular procedure intended to create
ing beliefs that have turned out to be completely false. the necessary experience may or may not be success-
That abstract meaning of “life wasted” tends to pro- ful at inducing that internal experience (be it reacti-
duce initially intolerable emotional pain of grief and vation of the target learning in explicit awareness, or
injustice. If any consequences of dissolution feel un- a disconfirming mismatch of the target learning, or
workably distressing, the dissolution is blocked. the juxtaposition of the two). If the therapist does not
This unconscious blockage can be understood as a verify the quality of the client’s inner experience, he or
self-protective response to the expected consequences she might assume the experience was properly creat-
of the change. The therapist considers that such resis- ed when actually it was not created by the procedure
tance may be occurring when he or she is reasonably used. In that case it will appear that memory recon-
confident that genuine juxtaposition experiences have solidation has failed to be effective, when in fact it was
occurred (with both the target learning and contra- not properly induced in the first place.
dictory knowledge experienced concurrently and viv- The first step of the erasure sequence is the reac-
idly), yet the target learning remains in effect (contin-
tivation in conscious awareness of the target schema
ues to feel real and to generate the client’s symptoms).that underlies and generates the client’s problem or
Then the therapist’s task is to guide the client gently to
symptom. This requires the target schema to be not
only retriggered by a suitable cue, but also present
bring awareness to the specific distress that is expected
in the foreground of conscious awareness, so that the
to result from dissolution (such as disorientation, loss,
grief, pain, or fear), making dissolution too daunting specific set of meanings and expectations that make
to allow. The expected distress itself consists of mean-up the schema are lucidly and explicitly in aware-
ings, models and ego states that now become the fo- ness. This explicit awareness is facilitated through
cus of transformational change. When, as a result of specifically verbalizing this material while feeling it
this work, there is no longer any intolerable emotional emotionally and somatically.  Such conscious reacti-
consequence to dissolution, the juxtaposition experi- vation requires the implicit, nonverbal target schema
ence is repeated and dissolution readily occurs. to be integrated into conscious awareness. Typically,
In other words, the dissolution of any one emotion- however, symptom-generating schemas are fully and
al schema necessarily takes places within the whole deeply implicit and nonconscious, and in the course
ecology or network of interconnected meanings and of decades they are retriggered hundreds or thousands
models that constitute the person’s experiential world, of times without becoming conscious in the least. A
therapist might guide a retriggering by guiding the
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 34
client to revisit imaginally a recent situation that did perience for one client may fail to do so for another.
retrigger the schema and the symptom. The therapist Another aspect that can be misjudged by the thera-
might believe that this retriggering procedure has ful- pist is the matter of what is being mismatched and dis-
filled the reactivation step, though it has not done so confirmed. The target of disconfirmation needs to be
because the emotional reactivation of the schema is a core symptom-necessitating construct, or symptom
not accompanied by integrated, cognitive awareness production will be unaffected by the disconfirmation.
of the specific contents of the schema. The inner ex- Identifying suitable target constructs requires doing
perience of reactivation required for reconsolidation a thorough job in the preparation steps of finding,
has not occurred, so transformational change will not making explicit, and guiding integrated awareness
result when the remaining steps are carried out. The of the implicit learning or schema driving symptom
therapist, believing all the steps to have been fulfilled, production (the methodology for which is described
comes to the false conclusion that sometimes the re- in detail by Ecker et al., 2012, and Ecker & Hulley,
consolidation process fails to work. 2011). Symptom-generating schemas often have sev-
Similarly, a procedure that the therapist believes has eral layers. Therapists sometimes do an incomplete
created a disconfirming experience or vivid contradic- job of retrieving this material into integrated aware-
tory knowledge—the next step in the key sequence of ness, and then target a relatively superficial or even
experiences—might not have actually created the in- tangential construct. A transformational shift will not
ner experience of juxtaposition (mismatch or predic- result from a mis-targeted juxtaposition experience,
tion error) that the brain requires for unlocking syn- but that is not a failure of the reconsolidation pro-
apses, deconsolidating the target learning. There are cess to effect change. When all four of the situations
various ways in which a mistaken belief that a juxta- described in this section are navigated skillfully, the
position experience has occurred may arise. To begin therapeutic reconsolidation process is consistently ef-
with, both sides of the juxtaposition need to be richly fective in producing the distinct and verifiable mark-
experiential. That is, the client must be having her or ers of transformational change.
his own lucid experience of the felt realness of both (a)
the target schema and (b) some other personal knowl-
edge that absolutely contradicts what the target sche- Conclusion
ma “knows” or expects. Therapists may believe they The profound unlearning and cessation of acquired
are guiding a sufficiently experientially vivid state of behaviors and states of mind occurs through the pro-
mismatch, engaging the client’s limbic system in the cess of memory reconsolidation, according to the best
disconfirmation experience as is necessary, when available scientific knowledge and as extensive clini-
actually the work is too cognitive and not sufficient- cal experience bears out. A sound understanding of
ly experiential to create a true juxtaposition experi- memory reconsolidation is therefore a vital guide for
ence.  This too can give the impression that the pro- facilitating lasting, liberating change in psychotherapy
cess has been ineffective, when actually it has not been and counseling with maximum regularity. The study,
properly guided and the brain’s requirements have not practice, and effort required to arrive at a sound un-
been fulfilled. The therapist, believing that the neces- derstanding and use of memory reconsolidation and
sary conditions have been fulfilled, may conclude that avoid the various possible misconceptions are a price
the reconsolidation process has failed to work. well worth paying for the clinical effectiveness gained.
This was the case of a therapist who wrote to me It is my hope that the accounts and clarifications pro-
that in his experience, he “can offer reframes, tell Er- vided in this article will help to communicate this in-
icksonian stories, etc.; [but] simply offering and jux- valuable body of knowledge to mental health practi-
taposing a mismatch does not guarantee transforma- tioners everywhere.
tion.” He was assuming that those techniques were
creating juxtaposition experiences as required. He was
defining juxtaposition by the procedure rather than Appendix
by the quality of the client’s inner experience. In reply Understanding the Results of Schiller Et Al.
I pointed out that the contradictory knowledge that (2010) in Terms of the Memory Mismatch
creates the mismatch must be the client’s own living (Prediction Error) Requirement
experience of contradictory knowledge, not just some-
thing the client is hearing about informationally from In neuroscience research on memory reconsolida-
the therapist. I mentioned also that a procedure that tion, the erasure of a learned fear in human subjects
has successfully created an effective juxtaposition ex- was first accomplished through an endogenous be-
35 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
havioral process by Schiller, Monfils, Raio, Johnson,
LeDoux, and Phelps (2010). Previously there were at
least six published studies reporting behavioral meth-
ods of memory erasure or modification in human
subjects (Forcato et al., 2007, 2009; Galluccio, 2005;
Hupbach et al., 2007, 2009; Walker et al., 2003). By
doing the same for a learned fear—a human response
of clinical importance—Schiller et al. made the rele-
vance of memory reconsolidation to psychotherapy
very clear to science journalists and the lay public,
generating much interest.
Various aspects of the reconsolidation process el-
egantly demonstrated by Schiller et al. (2010) are of
fundamental importance, as described below. How-
ever, the authors’ discussion and interpretation of
results did not take into account major findings that
were already well documented by other researchers
regarding the brain’s requirement of a mismatch or
prediction error experience for inducing the recon-
solidation process (discussed above in the sections
on Misconceptions 1 and 3). As a result, Schiller et al.
discussed their successful procedure without identi-
fying the causes of its effectiveness. In what follows,
this procedure is examined and understood in terms
of the broader research findings. The main purpose
of this reinterpretation of the results of Schiller et al.
is to promote an accurate understanding of how the
reconsolidation process functions. The utilization of
reconsolidation in psychotherapy can yield major ad-
vances of several different kinds (Ecker et al., 2012,
2013a), but the realization of these benefits depends
on accurate understanding. The reinterpretation be-
low also illustrates the application of the mismatch
relativity principle discussed in this article’s main
text, as well as the necessity of “minding the findings”
(Ecker, Hulley, & Ticic, in press) for understanding
reconsolidation research procedures and the results of
those procedures.
In the Schiller et al. (2010) study, the fear response
to be erased was created by a training experience
on Day 1 of the procedure. Each of the adult sub-
jects viewed an electronic screen and saw a colored
square appear for 4 s, about every 15 s, for a total of 26
times. The square was yellow 16 times, a random six
of which were accompanied by a mild electric shock
to the wrist. Thus the conditioned stimulus (CS) was
a yellow square and the unconditioned stimulus (US)
was a wrist shock. The shock occurred at the very end
of the 4-s display of the square. The other 10 squares
in the series were blue, were not accompanied by any
shocks, and were randomly intermixed with the yel-
low squares. Subsequent responses to the blue squares
served as the control condition in this study.
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
Through that training experience—a classical con-
ditioning procedure—each subject learned, subcorti-
cally, the CS-US association of the yellow square and
the unpleasant shock. As the 26 presentations pro-
gressed, by using standard electrical sensors of skin
conductance the researchers detected the increasing
development of an anticipatory fear response with
each successive presentation of a yellow square. In this
way a subcortical learned fear of yellow squares was
established.
In addition to the CS-US association, the training
experience contained other features that were also
learned subcortically by the subjects, but were not dis-
cussed by Schiller et al. as learnings: A yellow square
is not always accompanied by a shock; and whenev-
er any colored square disappears, it is followed by a
blank screen for 11 s, and then by another colored
square, many times in succession.
All of those features made up the learned schema
or expectation of what happened on the screen, so it
was those three features that were predicted and ex-
pected by each subject’s implicit emotional memory.
Analyzing the results with awareness of all features of
the implicit learning proves essential for understand-
ing the erasure process and seeing the critical impor-
tance of the neglected research findings.
Each subject returned 24 hr later, on Day 2, and
underwent one of three different procedures, creating
three groups of subjects.
First group. For the main experimental test group,
each subject viewed the electronic screen and experi-
enced the following sequence:
1. a yellow square appearing just once, for 4 s as
on Day 1, with no shock (unreinforced CS pre-
sentation); followed by
2. the images and sounds of a television show ep-
isode, lasting 10 min; then
3. a random sequence of yellow and blue squares
appearing, with no shocks: 10 yellow and 11
blue squares in random order, each for 4 s ev-
ery 15 s as on Day 1.
On Day 3 (24 hr later), in order to determine
whether the CS (yellow square) still elicited a fear re-
sponse, subjects again viewed a series of shock-free
yellow and blue squares. For all subjects in this group,
fear responses no longer occurred, as indicated by the
skin conductance monitor. At a 1-year follow-up test,
again there was no fear in response to the CS. This
complete and lasting absence of responsiveness of the
target learning is what is meant by saying that it had
Volume 3 Issue 1 (2015) 36
been erased by the procedure on Day 2. would have been structurally very similar to that used
Without Experience 2, the procedure on Day 2 with rats by Monfils et al., 2009, who reported suc-
would have been a standard multitrial extinction pro- cessful erasure of a fear learning. MRMR analysis of
cedure, and the result would have been only tempo- that study is in the main text of this article.) However,
rary suppression of the learned fear response, not its the perception of TV show images and sounds would
complete and long-lasting erasure. With Experience have created a mismatch experience immediately. A
2, the procedure instead induced reconsolidation and timing mismatch would not have developed until the
next colored square appeared 10 min later, creating
erasure, which is a qualitative difference. Schiller et al.
attribute their procedure’s successful erasure to the 10- a recognizable interval significantly longer than the
min “break,” as they term it, but they provide no anal- expected 3 min. This experience of a 10-min interval
ysis of how that time interval caused the qualitative coming 10 min after destabilization would likely have
difference. However, if the procedure is examined in updated the target learning to expect a 10-min inter-
terms of the mismatch requirement and mismatch rel- val between colored squares henceforward.
ativity (MRMR) defined in the main text, the primary By the MRMR account, then, the mismatch expe-
cause of reconsolidation and erasure that becomes ap- rience that triggered destabilization and allowed era-
parent is not the 10-min break. The MRMR analysis is sure to ensue was that of the visual and audio con-
as follows. tent of the TV show, not its time duration of 10 min.
Experience 1. Seeing the CS appear induced reac- MRMR predicts that a TV show duration of 11 s (no
tivation of the learned fear (the target learning) in the extra time) instead of 10 min would also have resulted
standard manner of presenting a conditioned stimu- in erasure. This MRMR analysis challenges the con-
lus to reactivate a conditioned response. The absence clusion drawn by Schiller et al. (2010) that the time
of the US was consistent with the target learning’s duration was responsible (p. 52): “The current results
expectation that a shock may or may not accompa- also suggest that timing may have a more important
ny a yellow square. Therefore, Experience 1 was not a role in the control of fear than previously appreciated.
mismatch (prediction error) experience, so it did not . . . Our findings indicate that the timing of extinction
trigger destabilization and reconsolidation of the tar- relative to the reactivation of the memory can capital-
get learning (as was demonstrated by Sevenster et al., ize on reconsolidation mechanisms.” (Here the label-
2014, and discussed in the main text). Thus the target ing of Experience 3 as “extinction” seems a misnomer,
learning was still stable following Experience 1. since it did not produce extinction.) These consider-
ations illustrate the utility of MRMR principles for
Experience 2. Seeing and hearing the TV show identifying cause and effect in procedures that induce
was immediately a mismatch experience, because the reconsolidation or extinction.
TV show was sharply discrepant with the learned ex-
pectation that what follows any square is a blank, si- Experience 3. The series of shock-free squares,
lent screen for 11 s and then another colored square, each followed by 11 s of blank screen, began with the
and then more of the same in a long series. The ini- target learning in a destabilized condition due to Ex-
tial training consisted of partial reinforcement of the perience 2. However, as discussed in the main text in
US (shock), but it had continuous (100%) reinforce- examining standard multitrial extinction, initial de-
ment of the blank and silent screen occurring between stabilization at the start of a series of unreinforced CS
colored square presentations. The striking mismatch presentations does not guarantee that destabilization
with those expected features in Experience 2 would will persist or that erasure will take place. Therefore it
have caused rapid destabilization (deconsolidation). is necessary to examine specifically why Experience 3
This illustrates the use of a surprising novelty to cre- did erase the learned fear in this case. The examina-
ate mismatch. In addition, the continuation of the TV tion consists of tracing out the effects of every step
show for 10 min would have driven updating of the of the procedure according to MRMR principles and
destabilized target learning to expect a TV show after building an account of the accumulating effects.
any subsequent CS presentation. Here that account begins with the first unrein-
The TV show played for 10 min. If the screen had forced CS presentation (CS1) in Experience 1, in
instead been left blank for 10 min, a timing mismatch response to which the target learning became reac-
(Díaz-Mataix et al., 2013) would have been creat- tivated while remaining stable, as noted. Following
ed because the target learning expected only 11 s of this, Experience 2 destabilized the target learning by
blank screen before the next colored square appeared. mismatching the expected blank, silent screen with a
(With the screen left blank for 10 min, the procedure TV show. Experience 3 then began for some subjects

37 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

with an unreinforced CS (CS2, yellow square with target learning until the third appearance of a colored
no shock) or with a blue (non-CS) square for other square after an interval of 3 min. That 3-min interval
subjects. CS2 by itself did not constitute a mismatch was a mismatch of the previously updated expectation
of US-expectancy and did not begin to erase the tar- of a 10-min interval, and this timing mismatch both
get learning, for the same reason as in Experience 1, updated the target learning and maintained its desta-
namely that from the partial reinforcement schedule bilization until the fourth colored square. After the
during initial acquisition of the target learning, sub- fourth colored square, however, no more mismatches
jects learned to expect that the US might or might not would have occurred, and there would be no linger-
occur with any given CS. ing or fresh experience of mismatch for the rest of Ex-
Consequently, counterlearning and erasure of the perience 3. If destabilization were maintained solely
target learning would require a series of unreinforced by mismatch experiences, destabilization would have
CSs that were unmistakably more numerous than the terminated too soon for a sufficient number of CS-
largest number of contiguous unreinforced CSs in the without-US presentations to cause erasure to occur in
original training. In the latter, a random six of the 16 this procedure.
yellow squares were accompanied by shock, so the This implies that destabilization was maintained in
largest possible number of contiguous unreinforced the other possible way in the MRMR model, namely
CSs was five. (In this first group of eight subjects, sta- MDU (maintenance of destabilization by updating),
tistically the likelihood of three, four, or five contig- as hypothesized in the main text. MDU would oc-
uous unreinforced CSs occurring among them was cur through a molecular signaling pathway by which
66%, 40%, and 22%, respectively.) Therefore, since the updating process maintains destabilization inde-
erasure did take place, the target learning must have pendently of the mismatch requirement, so that up-
been in a destabilized and erasable condition after dating has sufficient time to be accomplished once
significantly more than five unreinforced CSs had oc- it begins. The MRMR account above identifies four
curred. The MRMR model has to account for that if it distinct triggers of updating prior to the fourth col-
is to be consistent with the results of this study. ored square, and that updating would have triggered
The absence of a US mismatch in the experience of MDU and maintained destabilization presumably
CS2 also occurs in the standard multitrial extinction throughout Experience 3, allowing all 10 CSs to erase
procedure and there has the effect of terminating both the target learning with the new learning that a yellow
the subject’s ongoing experience of mismatch and the square is always harmless. The necessity of invoking
state of destabilization (as described in the main text). MDU in order for the MRMR framework to account
Here, however, such termination of mismatch and de- for erasure in this study puts a priority on testing the
stabilization would not have occurred, for this reason: MDU hypothesis empirically. That would probably re-
Whereas in standard extinction the target learning’s quire detection of the separate molecular markers of
initial destabilization is due to a mismatch of US-ex- destabilization and updating after each colored square
pectancy by CS1, in this case the initial destabiliza- throughout Experiences 1, 2, and 3.
tion was due not to a mismatch of US-expectancy, Second group. For a second group of subjects,
but rather to a mismatch of the blank, silent screen Schiller et al. (2010) carried out the same procedure
expected between CS presentations in Experience 2. with one difference: On Day 2, a 6-hr delay was add-
That specific experience of mismatch was not can- ed after the 10-min TV show, between Experiences 2
celed or terminated when CS2 brought no new US and 3. On Day 3 the researchers then found that for
mismatch at the start of Experience 3, so the target these subjects, the target learning’s fear response was
learning remained destabilized. Furthermore, the ap- reevocable and had not been erased. The 6-hr delay
pearance of CS2 created a timing mismatch, as noted was slightly longer than the approximately five-hour
above. These considerations are unchanged if it was a duration of the reconsolidation window (Pedreira,
blue square that the subject saw first in Experience 3. Pérez-Cuesta, & Maldonado, 2002; Pedreira & Mal-
Following CS2 or non-CS blue square, the appear- donado, 2003; Walker et al., 2003). In other words, for
ance of a blank, silent screen would have been a mis- this group of subjects, Experience 3 was conducted
match experience because the target learning had been after the reconsolidation window had closed. The tar-
updated in Experience 2 to expect a TV show. The get learning, which was destabilized in Experience 2,
target learning was updated by this to expect either a had reconsolidated or restabilized and was no longer
blank screen or a TV show between colored squares. susceptible to being updated and erased by the series
This mismatch maintained the destabilized state of the of no-shock squares in Experience 3, so the latter now
functioned as a conventional extinction training, not
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 38
as an erasure learning, and created a separate learning
that competed with the target learning.
Third group. For a third group of subjects, on Day
2 Experiences 1 and 2 were omitted and only Expe-
rience 3 was implemented, which was a conventional
extinction training. Tests on Day 3 again showed that
the target memory’s fear response was reevocable and
had not been erased, though it had been suppressed
temporarily by extinction. This demonstrates once
again the well-established fact that extinction does not
yield erasure.
Experience 3 of the procedure had the familiar
structure of repetitive counterlearning that has long
been termed “extinction training,” but when applied
during the reconsolidation window for the first group
of subjects, its behavioral and neurological effects dif-
fered qualitatively and radically from those of extinc-
tion, as described above. It is worth repeating here the
conclusion of a study by Duvarci and Nader (2004),
“Reconsolidation cannot be reduced down to facilitat-
ed extinction” (p. 9269). Yet Schiller et al. (2010) refer
to Experience 3 of their procedure as an “extinction
training” even for the first group of subjects, and they
describe the entire 1–2–3 procedure as the “interfer-
ence of reconsolidation using extinction” (p. 50), “ex-
tinction conducted during the reconsolidation win-
dow of an old fear memory” (p. 52), and “extinction
training during reconsolidation” (p. 52). Using “ex-
tinction” terminology to refer to a learning experience
created during the reconsolidation window to erase
and replace a target learning invites much confusion
and misunderstanding of the reconsolidation pro-
cess. In light of the fundamental differences between
reconsolidation and extinction (discussed in the sec-
tion above on Misconception 3), and with a view to
facilitating widespread, accurate understanding of
that difference, it seems desirable to use terms that
clarify rather than obscure the functional role of the
learning experience in the case under consideration.
Terms such as “nullification learning,” “update learn-
ing” or “erasure learning” seem more appropriate for
functionally labeling Experience 3 in the first group of
subjects, whose learned fear was erased. (For the other
two groups of subjects, the series of no-shock yellow
squares in Experience 3 was true extinction training,
as noted above, because it was conducted outside the
reconsolidation window and was not part of a recon-
solidation process. In these cases, therefore, Step 3 is
appropriately termed an extinction training.)
tions of squares of all three colors revealed that the
However, the results of this study by Schiller et al. fear response to yellow squares no longer occurred
(2010) are so striking and significant that a growing and had been erased, but the fear response to brown
number of other researchers have adopted their pro- squares was reevoked and had not been erased. In oth-
39 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
cedure and have retained the “extinction” misnomer
(e.g., Baker et al., 2013; Clem & Huganir, 2010; Liu et
al., 2014; Quirk et al., 2010; Steinfurth et al., 2014; Xue
et al., 2012). With the persistence of that terminology,
it is especially important to recognize that there is no
inherent necessity for the erasure learning during the
reconsolidation window to have the same procedural
structure as conventional extinction (a series of many
identical countertraining experiences). The form of
erasure learnings is limited only by the creativity of
researchers and clinicians (and many examples from
the latter are detailed by Ecker et al., 2012; see also
Högberg et al., 2011; Gray & Liotta, 2012; Xue et al.,
2012).
Yet another important and elegant demonstration
described by Schiller et al. (2010) concerns the mem-
ory specificity of reconsolidation and erasure. Any
longstanding piece of emotional learning typically has
linkages to many other learnings and memories. If the
erasure process is to be clinically useful and safe in hu-
mans, it must affect only the target learning and not its
network of linkages. Destabilization of a target learn-
ing without destabilizing closely associated learn-
ings was first reported in an animal study by Debiec,
Doyère, Nader, and LeDoux (2006). Schiller et al. then
demonstrated with human subjects that reconsolida-
tion can eliminate a specific implicit learning with
surgical accuracy, leaving intact an adjacent learned
fear that was formed in the same original experience.
This was done with a separate group of subjects
who, on Day 1, underwent essentially the same initial
training experience as described above except for the
addition of squares of a third color I will call brown
(Schiller et al. did not indicate the actual third color),
37.5% of which, as with the yellow squares, were ac-
companied by a shock. In that way, subjects learned
to expect a shock in response to squares of two colors,
yellow and brown.
On Day 2, Experience 1 of the procedure described
above—memory reactivation by a single presentation
of a square with no shock—was carried out with a yel-
low square but not with a brown square. Experience 2,
the 10-min TV viewing, and Experience 3 were then
implemented as described above, with Experience 3
now including no-shock presentations of squares of all
three colors, for new learning that yellow and brown
squares are harmless.
On Day 3, another series of no-shock presenta-
Volume 3 Issue 1 (2015)
er words, only the fear learning that had received a
reactivation-and-mismatch prior to the new learning
in Experience 3 had been erased by that new learning
(though as noted, no mention of mismatch is made
by Schiller et al.). The series of shock-free squares in
Experience 3 served as erasure learning for the yellow
squares and as an extinction training for the brown
squares. The erasure of fearful expectation of a shock
for squares of one color had not spread associatively
to the other color, showing that the subcortical emo-
tional memory system is capable of great selectivity
and accuracy in destabilizing and revising learnings.
Closely adjacent implicit memories are handled inde-
pendently, as is necessary for safe clinical use of re-
consolidation.
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perspective

neuropsychotherapy:
defining the emerging paradigm of
neurobiologically informed psychotherapy

Matthew Dahlitz

Abstract
Over the past two decades, the theoretical basis and application of psychotherapy has been undergoing a
paradigm shift from a focus on higher cortical/cognitive processes to a new and growing appreciation of
affective phenomena as the locus of behaviour change. The move has been prompted by breakthroughs
in neuroscience that show bottom-up, left-hemisphere neural processes to underpin behaviour, validat-
ing affectively focused clinical practices. This paper examines the theoretical basis of this paradigm shift,
with an emphasis on Klaus Grawe’s consistency theory as central to its early description, and identifies
the specific neural underpinnings for an effective clinical application of psychotherapy as established by
contemporary neuroscience.

Keywords: neuropsychotherapy, definition, neurobiology, psychotherapy, neuroscience.

Introduction The practice of looking to neuroscience to estab-

lish empirical grounds for effective psychotherapy has
The late Klaus Grawe (1943–2005) was a leading
been gaining momentum over the past decade under
figure in the nascent field of neuropsychotherapy in
such labels as brain-based therapy (Arden & Linford,
the early 2000s (Dahlitz, 2013). His work integrated
2009), interpersonal neurobiology (Siegel, 2010), and
the latest neuroscience and clinical psychology, cul-
social neuroscience (Cacioppo, Visser, & Pickett, 2006)
minating in the publication of Neuropsychotherapy, a
among many others issuing from various individu-
meta-framework of neurobiologically informed psy-
als, groups and disciplines. The literature in English
chotherapy (Grawe, 2007). Not to be confused with
remains sparse, however, in relation to Grawe’s orig-
a second tradition stemming from northern Europe,
inal conceptualisation of neuropsychotherapy and
namely the psychotherapy of brain-injured patients by
its underpinning theoretical model. Contemporary
clinical and neuro-psychologists (Laaksonen & Ran-
theorists such as Pieter Rossouw (2014) are carrying
ta, 2013), Grawe’s conceptualisation reflects a broad
the framework of neuropsychotherapy forward with
movement that has been described as a “mental health
refined ideas of Grawe’s consistency theory (2007) and
renaissance” (Rossouw, 2013)—an emerging para-
its clinical application.
digm empowering clinicians to use neurobiological
findings to enhance therapeutic practice. Grawe grounded neuropsychotherapy in a model

Cite as: Dahlitz, M. J. (2015). Neuropsychotherapy: Defining the emerging paradigm of neurobiologi-
cally informed psychotherapy. International Journal of Neuropsychotherapy, 3(1), 47–69. doi: 10.12744/
ijnpt.2015.0047-0069

47 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

of mental functioning he termed the consistency-the- 1.1 Neural Communication
oretical model (Grawe, 2007). Drawing on earlier The human genome provides an organisational
models of basic psychological needs being serviced by map for the development of our brains, with some
psychological schemas (e.g., Epstein, 1990), he identi- designation of place and function of neurons fixed
fied constructionist-like concepts of developing men- (by means of coding genes that constitute the so called
tal schemas and related them to neural networks that “nature” part of our genetic make-up) and some func-
were identified in his extensive study of the neurosci- tional aspects subject to the influence of experience
entific literature of the time. Towards the end of his (in the form of no-coding genes that make up the so-
career he observed, “The empirical evidence suggests called “nurture” part of our genetic expression) (The
that we ought to conduct a very different form of psy- Neuropsychotherapy Institute, 2014a). Our genome,
chotherapy than what is currently practiced” (Grawe, along with epigenetic expression of genes and learn-
2007, p. 417). ing (memory formation) creates a complex neural
The current paper takes up Grawe’s observation, communication system in our brain, which is itself a
reviewing the literature to determine in what ways the complexity of synaptic/dendridic connections mod-
evidence suggests a “different form of psychothera- ulated by neurochemicals. The basics of neural com-
py”. To this end the paper considers how this theory, munication are described below.
grounded in neurobiology, informs and refines the
clinical application of psychotherapy.
Basic Nerve Cell Communication
It is intended that this paper will fill a gap in
the existing literature by disambiguating the term In the nervous system there are two main divisions
neuropsychotherapy and provide a concise reference of cells: nerve cells (neurons), and glial cells (glia).  Glial
for the neurobiological elements contributing to the cells have traditionally been recognised as a “support
meta-framework that is shaping psychotherapy today. network” for neurons, providing many essential func-
tions for the facilitation of the neural network. How-
ever, they have more recently been acknowledged to
1. Neural Underpinnings form a communication network themselves, working
in tandem with neurons (Keleman, 2012; Verkhratsky
Freud began his Project for a Scientific Psychol-
& Butt, 2007).  The function of a neuron is determined
ogy (1895/1966) at the end of the 19th century with
by where it is in the brain, how it is connected with
the intention of creating “a psychology which shall
neighbouring cells, and its individual functional char-
be a natural science” (p. 295), to discover the neural
acter.  By analogy it is like us as human individuals:
underpinnings of behaviour. Freud’s psychoanalyt-
our function in society is determined by where we are,
ic techniques were concerned with unconscious af-
who we are connected to and how we interact with
fective processes—a foreshadowing of the current
others and the environment (Cozolino, 2014).
neurobiological research into affect. In recent times
Allan Schore, with a similar passion for uncovering While there are different types of nerve cells for
foundational affective processes, has commented that different functions, it is helpful to consider a generic
“no theory of human functioning can be restricted to neuron—a model—that represents the fundamentals
only a description of psychological processes; it must of all neurons.  Figure 1 illustrates the main compo-
also be consonant with what we now know about bio- nents of the neuron (see Kandel, Schwartz, Jessell,
logical structural brain development” (2013, p. 1). This Siegelbaum, & Hudspeth, 2013, chapter 2, for a com-
resonates with Eric Kandel’s (1998) landmark paper prehensive description of neuron physiology): 
arguing that psychiatric thinking should be tethered Figure 1: Generic model of a neuron
to biological science due to the fact that
therapeutic interactions can elicit struc-
tural changes in the brain. The following
section will consider the physical struc-
tures, networks and processes that form
the neural machinery of the brain, a ma-
chinery that both informs the theory of
neuropsychotherapy and is modulated
by the practice of neuropsychotherapy.

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 48

 Neurons communicate using two processes: an more positively charged a neuron becomes, the more
electrical signal within the neuron, and chemical sig- likely it will pass a certain threshold and “fire”. Iono-
nals between neurons.  tropic receptors, such as AMPA, accept transmitters
Neurons use various chemicals, known as neu- that directly alter the receiving cell’s potential, and are
rotransmitters, to transmit signals across the very thus fast acting, whereas NMDA receptors require
small gap between cells in an area known as the syn- prior activation of the postsynaptic neuron through
aptic cleft. Most neurons can send and receive signals another channel before its ion channel can be opened
by different types of neurotransmitters, and differ- (see Grawe, 2007, pp. 36–37).
ent neurotransmitters work at different speeds (The Therefore some neurotransmitters will cause the
Neuropsychotherapy Institute, 2014a).  receiving dendrite to become more positively charged,
The schematic in Figure 2 below is a radically sim- and others will cause the dendrite to become more
plified representation of a synapse.  The upper part negatively charged.  The receiving dendrite “sums”
represents the presynaptic terminal of one cell’s axon, the incoming chemical signals to arrive at a resultant
and the lower part the postsynaptic dendrite of anoth- synaptic potential which is then communicated to
er cell.  Communication flows from the presynaptic the main body of the cell. All of these “calculations”
terminal to the dendrites of a neighbouring cell. Den- or synaptic potentials are summed at the beginning
drites are like the branches of a tree that spread out to of the axon (the axon hillock). If the resulting charge
reach other cells, and are the main areas for receiving rises above −55 mV (depolarization), an electrical
incoming signals (Kandel et al., 2013). signal flows from the axon hillock and down to the
presynaptic terminals, causing the membrane of the
each terminal to open up channels allowing calcium
Figure 2: Simplified representation of a synapse into the cell. This in turn causes the synaptic vesicles
to release their chemicals into the synaptic cleft. This
albeit simplified description of the process illustrates
the binary nature of neurotransmitters in either initi-
ating an action potential or not.
Figure 2 also shows some of the neurotransmitters
being reabsorbed into the presynaptic terminal. Such
uptake, via plasma membrane transporters, serves
two purposes: recapturing the chemicals for reuse,
and terminating the synaptic action of the cell (Kan-
del et al., 2013). Drugs used to inhibit the re-uptake of
neurotransmitters will in effect keep the neurotrans-
mitter in the vicinity of the postsynaptic dendrite, so
that when receptors are available for that particular
chemical, they will bind with it. Thus antidepressants
are designed to inhibit serotonin re-uptake, keep-
ing it in the synaptic cleft and prolonging post-syn-
aptic activation (The Neuropsychotherapy Institute,
The synaptic vesicles shown above are packets of
2014b). Another process whereby neurotransmitters
neurotransmitters that migrate to special release sites
are removed from the synaptic cleft is degradation, a
termed active zones.  These packets come to the sur-
process of chemical breakdown by enzymes where the
face of the presynaptic terminal and are released (by a
resulting molecules are taken up by the presynaptic
process known as exocytosis; Kandel et al., 2013) into
terminal. Within the presynaptic terminal the neu-
the synaptic cleft.  The chemicals diffuse across the
rotransmitter is then reassembled for reuse, and re-
gap, and some molecules are taken up by receptors on
packaged for release once again. Finally glial cells also
the opposite-facing dendrite. The receptor sites on the
remove neurotransmitters from the synaptic space
dendrite bind to specific neurotransmitters, and this
to prevent further interaction with the post-synaptic
binding will have either an inhibiting or excitatory ef-
cell.
fect on the receiving cell. This occurs via an opening
of ion channels in the membrane of the cell that essen- 1.1.1 Neurochemicals
tially produces a membrane potential in the dendrite A basic understanding of the specific neurochem-
(a positive or negative charge within the cell).  The icals that modulate the nervous system is essential

49 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

for understanding how certain pathologies are driven mitters. Some act as hormones, including enkeph-
and why certain interventions are effective. The fol- alines and endorphins.
lowing is a brief introduction to these chemicals (The E) Others including histamine and epinephrine, to-
Neuropsychotherapy Institute, 2014b): gether with over 60 more that have been identified.

A) Amino Acid Neurotransmitters (the major neu- 1.1.2 Activation Patterns and Neural Systems
rotransmitters)
A single neuron does not produce much informa-
1) Glutamates are excitatory neurotransmitters. tion on its own through its binary function of either
Receptor sites are either fast-acting ionotropic firing or not. Firing entails a certain rate, intensity
types (AMPA), which primarily activate or inhibit, and resulting neurotransmitter output at the synapse.
or slower-acting N-methyl D-aspartate (NMDA) A single neuron does not on its own “perceive” any-
types, which facilitate a strengthening of the syn- thing—perception is a group task in the world of neu-
aptic connection called long-term potentiation rons—but rather responds to specific input from oth-
(Grawe, 2007, pp. 32–40). Glutamates bind with er neurons, or directly from the environment in the
activating receptors, namely Alpha-amino-3-hy- case of sensory cells. To make sense out of the flow
droxy-5-methylisoxazole-4-proprionic acid of information coming from our sensory organs, our
(AMPA), resulting in fast activation of the postsyn- neural system is organised into a hierarchy of increas-
aptic neuron (as described above). ingly complex networks. Individual neurons, boast-
2) Gamma-aminobutyric acid (GABA) is an in- ing, on average, 10,000 connections to other neurons,
hibitory neurotransmitter. It is fast acting, binding together contribute to broader “neural net profiles”
with GABA receptors to cause an inhibiting effect that represent an aspect of brain function (such as
on the postsynaptic cell. GABA and AMPA inter- perceiving a particular sound), and these profiles in-
actions are seen across the brain and result in much tegrate with many others to form various functions of
of the fast action of our neural processes—much of our nervous system, some of which are concentrated
our thought processes and sensory input/process- in different areas of the brain (Siegel, 2012). Klaus
ing, for example. Grawe (2007) describes as a hierarchical model of in-
formation processing, based primarily on the work of
neurophysiologists David Hubel and Torsten Wiesel
B) Biogenic Amines (monoamines, more localised in (1959, 1962, 1968), who demonstrated that neurons
distribution than the amino acids and known to be could have specific activation patterns in response to
released also from non-synaptic sites) specific stimuli.
1) Catecholamines  trigger physiological changes The hierarchy of our neural system is organised
to prepare the body for physical activity such as the from sensory input to the perception of complex ob-
“fight-or-flight” response. jects/understandings to even more complex cognitive
Dopamine has many functions, including mo- and affective processes. For example, the “raw” visu-
tivation. Most dopaminergic neurons are in the al data streamed from the sensory input of the reti-
midbrain and hypothalamus. na is recognised by neurons in a fragmented fashion
whereby individual parts of the scene are processed
Norepinephrine acts as a hormone and a neu-
by neurons tuned to “recognise” small, specific ele-
rotransmitter. It increases heart rate and acts as
ments. These fragments are then assembled by more
a stress hormone affecting the amygdala.
complex neural networks involving higher-order cells
2) Indolamine is the family of neurotransmitters that recognise the assembly of the parts. At the top
that includes serotonin and melatonin (derived of the hierarchy are cells and networks in the cortex
from serotonin). that recognise the whole picture. Once this broader
5-HT (Serotonin) is involved in the regulation perception is realised, further cognitive/affective pro-
of mood, appetite, and sleep, as well as memory cesses can occur as a result of this input. The flow of
and learning. It is a major antidepressant. information is not serial but a complexity of parallel
processing that utilises feedback from various brain
C) Acetylcholine is used by only a few cell groups and regions. There is no neuron that can recognise the
is the major neurotransmitter in autonomic ganglia. complexities of an object like a chair. Only the sum-
D) Peptides form a large and diverse group of trans- mation of complex networks, with experience (neural

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 50

net profiles), can recognise a chair for what it is. Nor
is there a single area of the brain that handles a spe-
cific mental function in isolation. Just as neurons do
not perceive on their own, neural profiles activate and
integrate with other regions across the nervous system
(Siegel, 2012).
The brain is further organised into functional sys-
tems that to some extent can be identified by elements
of the physical architecture of the central nervous sys-
tem. From a single sensory input neuron, the scale of
operations increases to complex hierarchies of neural
networks that form maps representing input features
in specific areas of the cortex. These complex signals
are in turn processed within broad functional systems
of organisation according to the physical architecture
of the brain. Such functional architecture is current-
ly being mapped by the Human Connectome Project
(http://www.humanconnectomeproject.org).
Making of the Western World (2009), describes the
asymmetry of the brain and the very different natures
of the left and right hemispheres. This horizontal un-
derstanding of the mental system, as opposed to the
vertical triune perspective, gives us insight into the
distinctly different yet complimentary functions of the
two hemispheres. In short, the right hemisphere han-
dles broad attention (what we attend to comes first to
us through the right hemisphere); is good at making
connections so that we can appreciate the wholeness of
dynamic structures and relationships that change over
time; is attuned to emotion; and is empathic, intuitive,
and moral. In contrast, the left hemisphere has narrow
attention; is good at deconstructing things into parts;
and has an appreciation for static, decontextualized,
inanimate structures and abstractions. McGilchrist
summarises the “two worlds” of the hemispheres in
this way:

A well-known division of the human brain is that The brain has to attend to the world in two com-
described by neurologist Paul MacLean as the triune pletely different ways, and in so doing to bring
brain (MacLean, 1990). This evolutionary view of the two different worlds into being. In the one [that
brain describes three main regions in an evolution- of the right hemisphere], we experience—the
ary hierarchy: the primitive “reptilian” complex (the live, complex, embodied world of individu-
brainstem), the “palaeomammalian” complex (the al, always unique beings, forever in flux, a net
limbic system), and the “neomammalian” complex of interdependencies, forming and reforming
(the cortex). The reptilian complex is fully developed wholes, a world with which we are deeply con-
at birth, while the palaeomammalian complex is part- nected. In the other [that of the left hemisphere]
ly developed and continues to develop during early we “experience” our experience in a special way:
childhood, and the neomammalian complex is mostly a “re-presented” version of it, containing now
underdeveloped at birth and is the last part of the tri- static, separable, bounded, but essentially frag-
une brain to develop (The Neuropsychotherapy Insti- mented entities, grouped into classes, on which
tute, 2014c). The implications of the model are that the predictions can be based. This kind of attention
survival instincts of the palaeomammalian complex isolates, fixes and makes each thing explicit by
(the limbic system) are significantly developed during bringing it under the spotlight of attention. In
the early years of life, distinct from the later-develop- doing so it renders things inert, mechanical,
ing cognitive processes of the neomammalian com- lifeless. But it also enables us for the first time
plex (Rossouw, 2011). More sophisticated contempo- to know, and consequently to learn and to make
rary models of the brain and behaviour do not fully things. This gives us power. (McGilchrist, 2014,
support MacLean’s evolutionary model; however, the p. 31).
“bottom-up” perspective of development remains in- Allan Schore explains that the early-maturing right
structive for a corresponding bottom-up therapeutichemisphere is the locus of attachment formation and
approach (Rossouw, 2011). This bottom-up approach, essentially the gateway to affect regulation later in
as distinct from a top-down, cognitive approach, life—so much so, indeed, that developing an expanded
looks to establish safety through down-regulation of
capacity for right-hemisphere processing (an empha-
sympathetic over-arousal and activation of a state of
sis on right-brained affective skills rather than a left–
parasympathetic security, resulting in increased cor-
cognitive bias) is central to clinical expertise (Schore,
tical blood flow to the left frontal cortex for effective
2012). In a similar vein Badneoch (2008) warns ther-
activation of cognitive abilities, and limiting “looping”
apists to be grounded in right-brain engagement with
activity within the limbic system (Rossouw, 2011, p. 4)
clients or run the risk of being disengaged from the
to allow for effective new learning. regulating and integrating influence of right brain-
Iain McGilchrist, in his noteworthy book The to-right brain connection with clients. She further
Master and His Emissary: The Divided Brain and the encourages therapists to widen their window of tol-
erance (see section 1.1.6.1), be conscious of implicit
51 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
vulnerabilities, and develop mindfulness to be present
with both the client and self. There is a place for left-
brain focus when thinking about specific interven-
tions, but as McGilchrist admonishes, the left should
remain servant to the master right hemisphere.
1.1.3 Memory Formation
The formation of implicit emotional memories
lies at the heart of approach/avoidance motivational
schemata (discussed in section 1.1.5) and constitutes
a primary target for therapeutic change. It is there-
fore pertinent for the psychotherapist to understand
something of how memory is formed on a neural level
and what conditions might be necessary for change.
The hippocampus has been extensively studied
and verified as a critical component of memory for-
mation (Berger et al., 2012) but not the seat of memo-
ry storage. Various theories have been put forward as
to how the hippocampus encodes memory and pro-
duces an output that is eventually stabilised as a long-
term memory in other areas of the brain (Berger et
al., 2012), likely across the cortex (Moss, 2013; Moss
& Mahan, 2014). This structure is particularly sensi-
tive to the stress response (increased cortisol levels),
and in cases of severe violation or emotional abuse
the hippocampus has been found to atrophy, inhibit-
ing processes dependent on it such as synaptogenesis
(Rossouw, 2012a). The critical role and sensitivities of
the hippocampus become central to the formation of
psychopathology, particularly in cases of early child-
hood abuse, neglect and trauma.
It has generally been agreed that memories are dy-
namic across time, in that new memories are in a la-
bile state for a short time, when they are referred to as
short-term memory (STM), after which they become
“consolidated” into the physical structure of the brain
to form long-term memory (LTM) (Nader, 2003).
Of particular importance in the transformation of
memory from STM to LTM is the transcription factor
cAMP-response-element-binding protein (CREB) for
memory stabilisation, including for emotional memo-
ries (Alberini, Milekic, & Tronel, 2006). Until recently
it was believed that once a memory was stabilised into
LTM, especially in the case of consolidated emotional
learning, the neural circuits were fixed and the mem-
ory indelible (LeDoux, Romanski, & Xagoraris, 1989).
This view has since given way to the understanding
that memory is a dynamic process rather than a fixed
state (Alberini, 2013).
The formation of emotional memory is of partic-
ular interest in psychotherapy, as it is the right-later-
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
alised, non-verbal, implicit yet highly meaning-mak-
ing memories of this type that shape foundational
understandings of self and the world and determine
how we anticipate the future.
1.1.4 Memory Reconsolidation
Memory research has demonstrated that memory
is by nature a dynamic process to the extent that estab-
lished memories can enter states of transient instabili-
ty once reactivated and, from this state of instability, be
modified before reconsolidation to a more stable state
(Nader, 2013). An atypical isoform of protein kinase
C called M zeta (PKMζ) is thought to be critical in
sustaining LTM (Sacktor, 2008, 2010). Typically, per-
sistent action of PKMζ maintains LTM via the contin-
ual regulation of GluR2-containing AMPAR receptors
postsynaptically (Migues et al., 2010), and transient
inactivation of PKMζ results in a loss of LTM (Nader,
2013). Of special interest for the practice of psycho-
therapy is that retrieval of a consolidated memory in
juxtaposition with a prediction error or mismatch (see
Ecker, 2015) can cause the memory to enter an un-
stable state, following which a restabilisation process,
now referred to as reconsolidation, must take place
for the memory to once again become stable (assum-
ing continued PKMζ-AMPAR action) pending future
recall into a liable state under the right circumstances
(Alberini, 2011; Dudai, 2012; Lee, 2013; Nader, 2013;
Nader, Hardt, Einarsson, & Finnie, 2013). It has been
demonstrated that interrupting the reconsolidation
process can impair the consolidating memory (Nader,
2012; see also Zhao, Li, Peng, Seese, & Wang, 2011,
for an example of reconsolidation interruption using
stress, and Ecker, 2015 for the necessity of a prediction
error to be in juxtaposition with the retrieved memo-
ry to induce a liable state).
The implicit emotional memories (procedural
memory) known to contribute strongly to motiva-
tional schemata are formed in the presence of strong
emotion and stored in subcortical implicit memory
circuits where they prove to be exceptionally durable
(Roozendaal, McEwen, & Chattarji, 2009). However,
when such memory is activated and enters a liable
state—a temporarily deconsolidated state or “recon-
solidation window” that is opened up via a “mis-
match” condition and lasts from four to five hours
(Ecker, Ticic, & Hulley, 2012; Pedreira, Perez-Cuesta,
& Maldonado, 2002)—it can be radically unlearned.
The opportunity to interrupt or modify memory in
this way has obvious implications for psychotherapy,
especially in regard to those memories that make up
core motivational schemata. This “discovery of the
Volume 3 Issue 1 (2015) 52
brain’s ability to delete a specific, unwanted emotion- alisation in the deeper limbic system, giving credence
al learning, including core, non-conscious beliefs and to the theory that approach and avoidance are indeed
schemas, at the level of the physical, neural synaps- neurally independent systems.
es that encode it in emotional memory” (Ecker et al., As they relate to pleasure maximisation (approach)
2012, p. 13) can lead to the complete and permanent and pain minimisation (avoidance), approach and
elimination of psychological symptoms. avoidance schemas may seem to be opposites, like
a positive and negative charge, but are just different
1.1.5 Approach/Avoid Networks goals with different modes of operation. The approach
schema is about closing the gap between a desired
The approach and avoidance motivational systems goal and perceived reality to attain that goal which
operate independently of one another and have inde- satisfies a need. There is often progress toward a goal,
pendent neural substrates and mechanisms. They can with rewards along the way, and then attainment or
be activated in a parallel fashion, although equally not of that goal. However, the avoidance schema is
strong systems will tend to mutually inhibit each oth- about increasing the distance between something un-
er. desirable and perceived reality, often to preserve or
Basic needs have a neural foundation from birth protect a basic need—a goal frequently not achieved,
that initiates behaviour like crying, sucking, and wig- but nonetheless necessitating a state of continuous
gling the body to meet those needs (Panksepp & Biv- surveillance. When pursuing a positive goal, like
en, 2012). These genetically governed behaviours are completing a university course, it is relatively easy to
the beginning of what will develop into much more determine whether one has come closer to the goal;
personal and sophisticated motivational goals. The there are subgoals and markers (such as completing
first need that develops into an “approach” goal is the a semester) along the way to the final destination of
need for proximity of the primary attachment figure. the goal. However, avoidance goals require constant
As the infant experiences encounters with her moth- control, as well as distributed, instead of focused, at-
er, she starts to develop a repertoire of behaviours to tention. For example, a husband may be anxious to
influence the mother to meet her needs. Neural acti- avoid an argument with his wife; he has to keep vig-
vation patterns emerge that represent this and other ilant, watch what he says, be careful to read the signs
goals, and are strengthened with the help of oxytocin of a possible argument, and he can never reach the
and dopamine. Both baby and mother are rewarded by goal of avoidance because there is always the possibil-
oxytocin and dopamine release when in loving, mutu- ity that conflict may come in the future. This sort of
ally satisfying connectedness. The increasing strength avoidance is more a matter of continuous attention,
and complexity of these neural patterns continues to and often anxious tension, than simply apprehend-
form circuits that become more easily activated, lead- ing a concrete goal. Individuals with strongly formed
ing eventually to very sophisticated and spontaneously avoidance goals (or with a dominance of avoidance
activated schemas. The specific groups of motivational over approach goals) experience fewer positive emo-
schemas that develop to satisfy the basic needs of an tions and less satisfaction of need because of the dis-
individual are infinitely richer and more multifaceted proportionate amount of energy and focus invested
than what might be suggested by the classification of in avoidance. In fact, strongly developed avoidance
just a few attachment styles. As the individual grows, tendencies, both implicit and explicit, have many un-
motivational goals are shaped by his or her wider en- favourable effects on mental health, self-esteem and
vironment along with social expectations, limitations, general well being (Grawe, 2007).
and other cultural forces, shaping the neural architec- From a neuropsychotherapeutic perspective, there-
ture of personal motivational schemas. fore, therapy should aim to reduce the use of avoid-
On a physiological level, approach goals are associ- ance goals and promote more positive approach goals
ated with the left dorsolateral prefrontal cortex (PFC), to satisfy basic needs. The behaviour of depressed cli-
while avoidance is more closely aligned with the right. ents can frequently be attributed to a hyperactivation
For the processing of emotions, the left ventromedial of avoidance schemas, inhibiting approach schemas
PFC is associated with positive emotions and the right and inviting the negative impact of stress hormones
for negative emotions. These motivations and evalua- that damage the hippocampus and deactivate the an-
tions of approach/positive and avoidance/negative are terior cingulate cortex. A therapy that can weaken
in other words physiologically lateralised across the the established avoidance tendencies and gradually
brain. There are more correlations to this same later- reactivate the approach system will revitalise activity
in the anterior cingulate cortex and strengthen PFC
53 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
connections—concrete developments that will likely
result in a positive change for the client.
Neural Mechanisms of Approach and Avoidance
Learning
In a typical neural learning scenario the hypothal-
amus informs the PFC of physiological states (e.g.,
the system has a low blood sugar level), and the de-
cisions made in the PFC (e.g., getting something to
eat) are transmitted to the nucleus accumbens, which
in turn triggers a process eliciting and strengthening
behaviour (behaviour reinforcement mediated by
dopamine). The nucleus accumbens integrates in-
formation coming from the amygdala (representing
emotion), and hippocampus (location/context), and
makes a decision to activate or terminate a behaviour.
If the nucleus accumbens has given the “go” signal to
get something to eat, then the act of eating and sat-
isfying hunger releases dopamine, and the dopamine
binds with receptors involved with motor actions
and perceptions of eating. Through second-messen-
ger cascades an elevated synaptic transmissions en-
sues, and the whole network that has been activated
is strengthened, making it easier for the same net-
work to activate in the future. Dopamine is the rein-
forcing agent in this scenario and represents neural
motivation, or motivational salience in establishing
behaviour. Any behaviour that is reinforced involves
the release of dopamine. Because dopamine is essen-
tial for motivation and learning (establishing and re-
inforcing synaptic connections), in therapy, learning
must have high motivational salience to be effective.
In real terms, without the activation of the dopamine
system, substantial positive long-term learning will
not take place. Dopamine is the intrinsic motivator
and energiser of approach/avoidance schemas and
is therefore of central importance to the therapeutic
process.
1.1.6 The Social Brain
Human beings are social creatures. We collectively
form families, communities and cultures that define
us as much as we define those systems. Relationships
nurture us and shape us into who we are. In this sec-
tion I consider what Cozolino (2014) has termed the
“social brain”: those neural systems that form and per-
form within the scope of interpersonal relationships.
The social brain revolves around what Siegel calls
the middle prefrontal region that includes the insu-
la, orbitofrontal cortex, ventromedial prefrontal cor-
tex, and the anterior cingulate cortex (Siegel, 2012).
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
This region is the interface between other integrating,
planning and thoughtful parts of the cortex and the
limbic system (Siegel, 2012). The middle prefrontal
region, in conjunction with ventral vagal activation
(see discussion below), constitutes the neurophysiol-
ogy of the social system that mediates attuned com-
munication, flexible responsiveness, affect regulation,
empathy, insight, morality, and intuition (Badenoch,
2008). When the limbic system is not strongly inte-
grated with the middle prefrontal region, limbic-bi-
ased swings of emotion, fuelled by established implic-
it emotional memories to external cues, can result in
self-reinforcing loops of affective responsiveness. Hy-
pothalamic-pituitary responses match the emotional
tone of the initial response, producing changes in the
body that reinforce and intensify the emotional re-
sponse (Badenoch, 2008). On the other hand, a strong
middle prefrontal cortical influence over amygda-
la reactions (mediated by a strong GABA response)
can effectively modulate an otherwise emotionally
over-reactive response.
The most primitive functions of the social brain
are grounded in the affectively and somatically biased
right hemisphere, where subcortical “bottom-up”
processing of emotional and social information dom-
inates (Cozolino, 2014). Navigating the social world
effectively requires good integration between left and
right hemispheres as well as between cortical and sub-
cortical systems. This important concept of neural in-
tegration will be explored in section 4.
1.1.6.1 Window of Tolerance and the Ventral/
Dorsal Vagus
The “window of tolerance” (Siegel, 1999) describes
a model of autonomic arousal levels in which an op-
timal arousal zone, or window of tolerance, operates
between hyper- and hypoarousal of the autonomic
nervous system (Ogden, Minton, & Pain, 2006). This
model can also be conceptualised according to the
polyvagal theory of Porges (2011), which views the
autonomic nervous system as organised into three
levels of activation: the ventral vagus/parasympathet-
ic branch, the sympathetic branch, and the dorsal va-
gus/parasympathetic branch (Ogden et al., 2006). Of
the three, the ventral vagus is known as the “social en-
gagement system” (Porges, 2011; see Figure 3).
Maintaining arousal within the window of toler-
ance ensures integration of top-down and bottom-up
processing while keeping the social engagement sys-
tem “online” (Ogden et al., 2006). When the window
of tolerance is narrow, as can often be the case with
Volume 3 Issue 1 (2015) 54
 Figure 3: Window of tolerance in conflict—a state of internal inconsistency
from which dissatisfaction and stress arise. It
is with an induced state of controlled incongru-
ence within a system striving for consistency,
that we can effect neural, and therefore thera-
peutic, change.

2.1 Consistency Theory Model

The consistency theory (Grawe, 2004, 2007)
view of mental functioning is derived both from
broadly accepted findings that goals and sche-
mas govern mental activity and from Grawe’s
own argument that goal formation is developed
to satisfy four basic psychological needs: at-
tachment, orientation & control, avoidance of
pain/maximisation of pleasure, and self-esteem
those who have experienced trauma, there can be a enhancement. The core constructs of consis-
tendency to move into a hypo- or hyperaroused state tency and congruence are the keys to understanding
in reaction to stimuli that activate implicit traumatic the development and maintenance of both normal
memories. In such states there is reflexive defensive and pathological mental processes.
reacting, rather than prefrontally mediated integrative Consistency is described as the “compatibility of
and flexible responding to the stimuli (Siegel, 1999). many simultaneously transpiring mental processes”
Rapid oscillations between hyper- and hypoarousal (Grawe, 2007, p.170), and is a systemic demand, on
can take place in a desperate attempt to achieve regu- a neural level, for harmonious neural flow. When the
lation—a situation that has been likened to a “biphasic relationship between intrapsychic processes and states
rollercoaster” (Corrigan, Fisher, & Nutt, 2010). is harmonious, there exists a state of consistency. The
From a neuropsychotherapy perspective, the im- human nervous system strives to avoid inconsistency
portance of widening a client’s window of tolerance, and develops various mechanisms to move from a dis-
especially in the case of trauma, becomes a central sonant, inconsistent state to a more harmonious state.
goal. Achieving this will increase a capacity to tolerate Consistency regulation is predominantly unconscious
and integrate thoughts and feelings and keep the ven- and only rises to conscious awareness under excep-
tral vagal social engagement system operative. tional circumstances. The mechanisms an individu-
al uses to avoid or correct significant inconsistencies
have been termed defence mechanisms, coping strate-
2 Consistency gies, or affect regulation.
Consistency is the overarching concept of systemic Congruence, a construct that is expressed under
agreement that can be considered a “core principle of the umbrella of consistency, is the harmony or com-
mental functioning” (Grawe, 2007, p.168). The myri- patibility between motivational goals and current
ad simultaneously occurring processes in the nervous perceptions of reality. According to Powers (1973),
system function optimally only to the extent that the incongruence signals are generated from the feedback
various elements of the system remain in harmony mechanism that contrasts our perceptions with our
and are not conflicted. This is a foundational principle goals. Grawe argues that “an elevated incongruence
of neuropsychotherapy. level can be regarded . . . as a highly complex stress
state” (Grawe, 2007, p. 172).
The now famous Stroop test (Stroop, 1935) is a clas-
sic example of activating conflicting mental processes A motivational schema is a neural network devel-
and thus compromising performance speed as the oped to satisfy and protect basic needs. There are many
anterior cingulate cortex and the dorsolateral prefon- such schemas, but they may be broadly divided into
tal cortex (Milham, 2003) work through inconsistent two classes: approach schemata and avoidance sche-
patterns to arrive at a resolution. On a more complex mata (see figure 4). Approach and avoidance schemata
level, an individual’s experience of the world, inter- operate on different neural pathways (Grawe, 2007).
nal model of the world, and meeting of needs can be If an individual grows up in an environment where

55 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

needs have been met, especially during the critical
early attachment phase, then approach schemas of in-
teracting with the environment are likely to develop,
resulting in approach-oriented behaviour. Conversely,
an individual whose needs are continually threatened
and violated is likely to develop avoidance schemas
that will motivate insecure, anxious, and avoidant avoidance ultimately fail, and what was feared actu-
behaviour. Attachment theory (Bowlby, 1988, 2008)
Figure 4: Consistency-Theoretical Model (Grawe, 2007, p. 171) avoidance incongruence. To continue
furnishes a critical understanding of the foundation
of mental schemata, explaining how securely attached
children develop primarily approach motivational
schemas and insecurely attached children develop
avoidance motivational schemas.
According to consistency theory, there are three
ways the mental system can experience inconsistency:
through approach incongruence, avoidance incongru-
ence and discordance. These upset the neural harmo-
ny of the system, creating a system demand to reduce
such stress or dissonance.
Approach Incongruence: If an individual has a
tendency to use avoidance motivational schemas—
that is, if there is an established neural propensity
to avoid perceived threats to basic needs rather than
seek to satisfy those needs— he or she can experience
incongruent signals due to unfulfilled approach sche-
mas. To illustrate, consider a young woman who has
a desire to meet a man, but fear of rejection prevents
her from placing herself in situations where she may
meet a potential partner. The avoidant motivational
schema is well established to protect her from the pain
of rejection by another human being, and prioritises
the maintenance of whatever self-esteem and control
over circumstances she has. However, there is at the
same time a desire represented in another motivation-
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
al schema to approach, to apprehend, to secure a lov-
ing relationship with a partner and satisfy the need for
attachment. It is when this latter desire is suppressed
or overridden by the stronger avoidance schema that
the individual experiences approach incongruence.
Avoidance Incongruence: When attempts at
ally happens, the individual experiences
the previous illustration, if the young
woman does go to a local dance to meet
a potential partner and is, after all, re-
jected, she will experience avoidance
incongruence—the very undesired con-
sequences her avoidance schema had
motivated her to protect herself from.
Discordance: Discordance occurs
when two or more motivational sche-
mas are activated simultaneously and
are incompatible with one another. This
is not an incongruence between percep-
tion and goal but rather two incompati-
ble goals being activated simultaneous-
ly.
Incongruence and discordance, and
the affect that accompanies them, can
occur implicitly or explicitly and create inconsistency
in the system. Continual inconsistency can impair an
individual’s effective engagement with the environ-
ment and lead to increasingly avoidant tendencies,
stress, negative emotions, anxiety, and a range of seri-
ous mental difficulties, as limbic survival mechanisms
dominate to protect the individual who is descending
into a highly complex state of stress.
The consistency model conceptualises behaviour
as an attempt to attain or protect the object of basic
needs through motivational schemas that have been
shaped by earlier experiences (of attachment in par-
ticular), in a way that provides agreement with our
perception of the world and our internal model of the
world and ourselves.
There are current attempts to refine Grawe’s mod-
el so that the basic psychological needs are portrayed
in a less linear fashion and are seen as overlapping in
their neural arrangement, with the superimposition
of the basic needs yielding a higher-order construct
of “self ”. Figure 5 shows a particular refinement by
Rossouw (2014) where the higher-order construct of
“self ” emerges from the neural milieu of needs and
motivational schemata.
Volume 3 Issue 1 (2015) 56
 Figure 5:
Integrated Model of the Base Elements of the Theory of
Neuropsychotherapy (Rossouw, 2014, p. 57)
2.2 Motivational Schemas
A motivational schema is a construct, or more
concretely a neural network, developed to satisfy and
protect basic needs. Such a schema can generally be
classified in terms of either approach or avoidance
tendencies. Approach and avoidance motivation has a
long history; the concept first appeared in the writings
of Greek philosopher Democritus of Abdera (460–
370 B.C.E.), broadly seeking to explain behaviour as
directed either toward positive stimuli (approach) or
away from negative stimuli (avoidance) (Elliot, 2008).
In the full spectrum of approach–avoidance motiva-
tion there are orientating exteroceptive reflexes such
as the startle response, salivary reflex, and pain with-
drawal, but for the purposes of neuropsychotherapy
such schemata are psychological orientations toward
or away from stimuli (concrete objects/events/pos-
sibilities, or abstract subjective representations) that
57 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
may or may not have a corresponding
somatic movement or action. Further-
more, “movement toward” can represent
either gaining something positive that is
currently absent or keeping something
positive that is currently present (in
functional terms, continuing toward).
Likewise, “movement away” can rep-
resent either keeping away from some-
thing negative that is currently absent
(functionally, continuing away from) or
getting away from something negative
that is currently present (Elliot, 2008, p.
8).
The consistency theory model con-
ceptualises all behaviour as the product
of approach and avoidance motivations.
The somewhat binary nature of this view
may seem oversimplistic at first glance,
but its complexity lies in the fact that
many approach and avoidance schema-
ta can be operating in parallel (as in the
case of motivational discordance, Grawe,
2007, p. 171) and in a hierarchical man-
ner (Elliot, 2006) to service not only our
basic psychological needs, but also phys-
iological reflexes, as we navigate our ex-
periences of the world.
Hemispheric differences exist in re-
gard to approach/avoidance motivations
whereby the left hemisphere is biased to-
ward approach (positive) emotions and
the right biased toward avoidance (neg-
ative) emotions (Canli, Desmond, Zhao,
Glover & Gabrieli, 1998; Davidson 1992;
Paradiso et al., 1999).
In the neuropsychotherapy conceptualisation
of the mechanisms of change, it is the motivation-
al schemata that are the cause of distress and, con-
sequently, the target for change. They are developed
through right-lateralised implicit emotional learning
during attachment, represented by neural networks,
and changed in a therapeutic setting by intersubjec-
tive right brain-to-right brain regulation that uses
controlled incongruence to shift neural and memory
reconsolidation, thereby transforming existing neural
networks.
2.3 The Science of Affect
Of primary significance to the theoretical under-
pinnings of neuropsychotherapy is the paradigm shift
Volume 3 Issue 1 (2015)
in psychotherapy from explicit, left-brained, con- berg & Keenan, 2005). Given that clients in therapy
scious, cognitive processes to implicit, right-brained, are likely to have motivational schemata of avoidance,
unconscious, affective–relational processes (Schore, and that the therapeutic alliance directly connects
2014). For over two decades Allan Schore has been the therapist and client in a right brain-to-right brain
at the leading edge of neurobiological research on affect-regulating process, the intersubjective mecha-
emotional and social process, in particular how neu- nism of change is a core focus of neuropsychotherapy.
robiologically informed attachment theory is essen-
tially right-brained, implicit, and affective in nature
(see Schore, 2012, for a comprehensive review of this 3. Basic Psychological Needs
work). The development of a right-lateralised “social Klaus Grawe developed a view of mental function-
brain” represents the most important substrate of hu- ing that combined insights from mainstream contem-
man unconsciousness, which is fundamentally affec- porary psychology with an understanding that “the
tive in nature and the most salient focal point for ther- goals a person forms during his or her life ultimately
apeutically mediated change (Cozolino, 2014; Schore, serve the satisfaction of distinct basic needs” (Grawe,
2014). 2007, p. 169). Influenced by Seymour Epstein’s cog-
According to modern attachment theory (Schore nitive-experiential self-theory (Epstein, 1973, 1980,
& Schore, 2008), the development of the self occurs in 1991 1993, 1994, 1998; Teglasi & Epstein, 1998), Grawe
the context of attachment relationships with another defined four key psychological needs that provide the
brain and involves affect regulation through “episodes motivation for behaviour: the need for attachment,
of right-lateralized visual-facial, auditory-prosodic, the need for control/orientation, the need for plea-
and tactile-gestural nonverbal communications” be- sure/avoidance of pain, and the need for self-enhance-
tween infant and primary care giver (Schore, 2014, ment (Grawe, 2007; see also Epstein, 1994, p. 715 for
p. 389). This regulating developmental mechanism, the origins of these four needs). As outlined above,
which is primarily an implicit right brain-to-right implicit motivational schemas are designed to satis-
brain process, is central to all later aspects of devel- fy these four psychological needs via approach-driv-
opment and to social-emotional functions (Schore, en (primarily cortical processes) or avoidance-driven
1994, 2003a, b, 2012, 2014) and consequently of pri- (primarily limbic processes) behaviour in what Ep-
mary importance in the therapeutic setting. This is stein describes as an emotionally driven experiential
due to the fact that such right-lateral implicit memo- system (Epstein, 1994).
ries form an internal working model that becomes the
“nonconscious strategies of affect regulation” (Schore,
2014, p. 389)—the construct Grawe conceptualised as 3.1 Attachment
approach/avoidance motivational schemata (Grawe, John Bowlby (1973, 1988) clearly demonstrated
2007). These schemata, through early social-emotion- that the basic need for an infant is the physical prox-
al experiences, can be developed in a neurologically imity of a primary attachment figure, bringing the im-
disadvantaged manner (Watt, 2003) whereby dysreg- portance of attachment into mainstream psychology.
ulating, insecure attachment experiences create right Bowlby (1973) described the basis of this attachment
cortical-subcortical networks (Schore, 2014) that are theory into three central postulates that could be sum-
primarily negative (avoidance) affective states and en- marised like this: a) A child with an available, trusted
dure into adulthood (Grawe, 2007). caregiver will be less anxious than one without such a
In adults the right lateralized prefrontal system caregiver; b) trust or lack of trust in the availability of
represents the highest order of affect regulation, spe- the caregiver will translate into a similar expectancy
cifically activated in the therapeutic alliance, and of relationships later in life; and c) the expectations a
plays an important role in psychotherapeutic change child has of a caregiver are relatively true of the actual
via implicit communication between therapist and experiences of the caregiver.
client (Schore & Schore, 2008; Stern et al., 1998). This Bowlby referred to this theory of attachment as
process, described as “intersubjectivity” (Schore & the internal working model, a concept taken from
Schore, 2008), highlights the importance of noncon- Kenneth Craik, who proposed an organism carries
scious, nonverbal right-brain communication in the a “small-scale model” of external reality in its head
two-way process of change (a point expanded on in (Wallin, 2007, pp. 26–27). In essence, early dyadic re-
section 3.2), where the right prefrontal cortex plays a lationships, especially with primary caregivers, form
vital part in relating self with the world amid distur- implicit memories from which a child constructs
bances in such two-way personal relatedness (Feing-
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 58
schemas, or ways of understanding and interacting context of attachment, having the volition to manip-
with the world. The way parents approach their infants ulate the environment to meet his or her needs. For
shapes the very structure of their developing brains example, an infant crying when hungry has the de-
(Schore, 2012) through a resonant system of proximity sired outcome of bringing Mother who then feeds the
and gaze. As Bonnie Badenoch puts it, “What is alight child. If the child cries for food and no food comes,
in the parental brain lights up in the newborn brain. Itthere is an incongruence (the gap between what the
is as though the parent is passing on the family’s emo- child needs and what she perceives she has) within
tional legacy in regards to relationships through these the child, and with such a violation of the need for
initial firings and wirings” (Badenoch, 2008, p. 53). attachment there is a corresponding violation of the
Mary Ainsworth, a colleague of Bowlby, devel- need for control. A satisfaction of the need for con-
oped an empirical method for assessing attachment trol, on the other hand, causes a reduction in distress,
in infants called the Strange Situation Protocol, based which in turn strengthens the sense of control.
on Bowlby’s attachment theory (Ainsworth, Ble- There is a component, or an understanding, of
har, Waters, & Wall, 1978). Ainsworth observed the control that can be described as the need for orien-
behaviour patterns of young children when they were tation, that is, to be able to have an accurate appraisal
separated and then reunited with their mothers in a of a situation, and to understand what is going on. To
controlled environment. Several attachment styles gain such clarity about one’s situation, and what can
were identified to this point: secure attachment, inse- be done to improve it, is an important aspect of con-
cure-avoidant attachment, and insecure-ambivalent trol. It is a common experience in psychotherapy to
attachment (Ainsworth et al., 1978; Badenoch, 2008; see a better sense of control gained simply from un-
Grawe, 2007). Later, Mary Main and colleagues (Main derstanding a situation with greater clarity. In view of
& Solomon, 1986) identified another style they called this need for orientation, effective (disorder-specific
insecure-disorganised/disorientated attachment. and problem-specific) therapeutic interventions are
The children who were found to thrive in life were always accompanied by a more optimal satisfaction of
those children with secure attachment patterns rather the need for control.
than those with insecure patterns. Attachment pat-
terns start to form in the first months of life—a time 3.3 Pleasure Maximisation and Pain
when brain development is extremely rapid, the sym- Minimisation
pathetic nervous system is dominant, and right-hemi-
sphere limbic learning is critical (Badenoch, 2008)— Freud, in his theory of personality, postulated a
and lay a foundation for motivational schemas that single fundamental need that he characterised as the
ultimately drive behaviour. pleasure principle: the need to maximise pleasure and
minimise pain (Freud 1920/1959). Epstein consid-
ered this a core need (1994), as did Grawe (2007).
3.2 Orientation and Control The basic premise of this need is that we are mo-
According to Epstein (1990), the need for orienta-
tivated to attain pleasant experiences or states and
tion and control is the most fundamental of all humanavoid unpleasant or painful ones. These states may
needs. In accordance with Powers’ (1973) perceptu- be physical, psychological, emotional, or social. Neu-
al control theory, this need plays out in a pervasiverologically there is an automatic implicit evaluation
striving for perceptions of reality that are consistent
of experience as either “good” or “bad”, to the degree
with the individual’s goals, and this striving is a major
that there is a continual monitoring of our experi-
driver of behaviour and mental life. To attain such aences (one aspect of this process is known as feed-
back-related negativity, see Hajcak, Moser, Holroyd,
goal requires control over our environment, or at least
our perception of the environment. Grawe (2007) fur- & Simons, 2006; Nieuwenhuis, Slagter, Von Geusau,
ther explains that control, in this context, is not just
Heslenfeld, & Holroyd, 2005). Humans have a moti-
about manipulating or regulating the environment or vation to maximise experiences of the good and limit
relationships to achieve goals, but also to have a max-
the bad, even in the case of suffering “for the greater
imum number of options available to us that we are good”—the denial of some pleasures to attain some-
free to act upon. How we choose to take up the op- thing of greater worth further down the track. What
tions available to us will be determined by our moti-constitutes “good”, pleasurable, beautiful, and the like
vational schemas. is dependent upon the individual and how his or her
A sense of control begins with the infant, in the experience of things is consistent with the satisfaction

59 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

of the other basic needs. Grawe contends that the in- (McDougall, 1936, p. 224) and “the basic law of hu-
dividual is in a maximal state when his or her “current man life” (Becker, 1971, p. 66), as the only one of the
perceptions and goals are completely congruent with four needs that is distinctly human. Self-esteem has
one another, and the transpiring mental activity is been defined as “an individual’s subjective evaluation
not disturbed by any competing intentions” (2007, p. of her or his worth as a person. If a person believes
244). This maximal state, a state of pleasure, is compa- that she is a person of worth and value, then she has
rable to Mihaly Csikszentmihalyi’s concept of “flow” high self-esteem, regardless of whether her self-eval-
(1991) that describes our intrinsic motivation to align uation is validated by others or corroborated by ex-
our perception of experience with our intentions. ternal criteria” (Trzesniewski, Bonnellan, & Robins,
Just how a person will size up the world around 2013, p. 60). There has, however, been debate as to
him is dependent on both his prior experience and the importance of this construct, with some arguing
his momentary state. For example a hot drink on a that self-esteem is essential (Orth, Robins, & Wida-
very hot day may be evaluated more negatively than man, 2012) and others considering it of limited val-
an ice-cold drink, and vice versa on a cold day; this is ue in that it is likely a reflection of other processes
a state-dependent evaluation. By contrast, the experi- (Boden, Fergusson, & Horwood, 2008, Zeigler-Hill,
ence of going on a roller-coaster is likely to be far less 2013). The self-esteem that Grawe conceptualised as
state-dependent—to one individual it may be evaluat- a basic need is a global one that is secure and congru-
ed as bad and to another as good, according to each ent as opposed to unstable, narcissistic, or discrepant
individual’s prior experiences with roller-coasters. The (see Park & Crocker, 2013). It is possible, however,
relearning of taste preferences is a complex process that self-esteem is a complex construction emerging
influenced by motives such as social compliance and from more fundamental needs, closer to an outcome
positive self-evaluations, yet the same automatic eval- of self-perception than a universal basic need, indeed
uative process is in play. The development of a taste a perception that may be a culturally driven construct
for wine, for example, may be motivated by a need for that does not qualify as a “basic” need (Dahlitz &
social acceptance (attachment and self-esteem), but Rossouw, 2014).
ultimately becomes an automatic preference for wine In some cases, to preserve the greatest number
as part of the neural evaluative process. of needs, one need may be “sacrificed” for the ben-
When a situation is evaluated either positively or efit of the others. For example, the maintenance of
negatively, it triggers an approach or avoidance ten- low self-esteem may be an avoidance pattern utilised
dency, meaning that our mental activity is primed in to fulfil another need such as preventing pain or pre-
a certain direction. For example, someone who eval- venting loss of control, or to protect existing self-es-
uates New York cab drivers as bad on the basis of past teem from further degradation. An activated avoid-
negative experiences may be primed to “jump” at the ance schema may be sacrificing high self-esteem to
sudden lane changes made by the driver. Another per- attain another need, such as attachment through ac-
son with a more positive evaluation of New York cab ceptance, and being accepted, in a roundabout way,
drivers may not be startled or fearful at all at the same serves to satisfy some aspect of self-esteem. So the
sudden lane changes. This motivational priming is the tendency to self-esteem enhancement can be regard-
orientation of the motivational system to be either ed as part of the approach system, and self-esteem
more approach or more avoidant toward certain cues protection can be regarded as part of the avoidance
in our environment. system. The exact reasons for an individual maintain-
ing low self-esteem may be complex, but in context
Mental processes transpire more easily and quickly with other needs, this may very well be a compromise
when the good/bad evaluation is compatible or syn- strategy to achieve overall need fulfilment/protection
chronised with the behavioural approach–avoidance as best the individual can.
orientation. When evaluations and behavioural ori-
entations are consistent, the mental system works Those who do satisfy the need for enhanced
more efficiently and with less stress. self-esteem are characterized by better mental health.
These people will take opportunities to enhance their
self-esteem through approach motivational schemas.
3.4 Self-Esteem Enhancement Individuals with a healthy self-esteem will evaluate
themselves more positively than objective observers.
The need for self-enhancement or self-esteem has
It has also been observed that having unrealistic per-
been regarded as a fundamental function of our hu-
ceptions of self satisfies the self-esteem enhancement
manity and has been called the “master sentiment”
need, and is a good indicator of overall mental health.
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 60
Mentally healthy individuals also have a skewed per-
ception of reality with regard to themselves, often see-
ing themselves as “above average” within the gener-
al population. People with high self-esteem will also
take advantage of opportunities to further enhance
their self-esteem. Because those who have a healthy
sense of self regard themselves better than average in
a multitude of areas, striving for an absolutely realistic
self-evaluation may not be in their best interests for
mental wellbeing. Deluding oneself in the meeting of
basic needs can lead to positive feelings and in turn to
attaining a better state, a bit like a self-fulfilling proph-
ecy. Depressed individuals, however, who have a more
pessimistic view of reality, do not share this delusion
and are prone to further mental problems. Operating
out of avoidance schemas, these individuals experi-
ence life, and take on roles, in a way often detrimental
to self-esteem.
The meta-framework of neuropsychotherapy is
necessarily a multidisciplinary perspective that re-
quires the psychotherapist to have a broad under-
standing of the elements discussed here, from basic
neural communication and networks to psychological
needs and how we go about enhancing and protecting
them. The following section goes on to describe the
clinical implications and applications of this knowl-
edge.
4. Clinical Application of
Neuropsychotherapy
A focus on the neural underpinnings of behaviour
provides an opportunity in therapy for neurobiological
empathy between client and therapist, reducing any
stigma or self-blame that may have come from a pa-
thologising perspective, and allowing for better con-
ceptualisations of psychotherapeutic techniques and
theory (Grawe, 2007). The clinical application of
neuropsychotherapy focuses on strengthening clients’
resources from the core of their motivational system
to facilitate an increasingly robust approach to self and
the world (Flückiger, Wüsten, Zinbarg, & Wampold,
2009). Such approach motivation ultimately leads
to better need satisfaction and subsequent mental
well-being.
Pragmatically, this entails establishing a “safe” ther-
apeutic alliance to facilitate approach patterns that
will satisfy basic needs, down-regulate stress activa-
tion, and optimise new, positive neural connections
while reinforcing existing ones (Rossouw, 2014).
61 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
4.1 Controllable Incongruence as the Lever for
Change
From a clinical perspective it is controllable in-
congruence that becomes the mechanism of change
within the therapeutic dyad. As stated above, incon-
gruence is the discrepancy between an individual’s
perception of reality (his or her actual experience)
and beliefs, expectations, and goals (Grawe, 2007).
Such incongruence will cause inconsistency within
the mental system. Controllable incongruence is a situ-
ation of incongruence that one believes is within their
capacity to cope with—it may be a challenge, but not
an overwhelming one. Uncontrollable incongruence,
on the other hand, is a circumstance that exceeds
one’s ability to cope, or belief that one can cope, with
the mismatch between what is experienced and one’s
goals.
Uncontrollable incongruence, then, is a stressful
state that heightens arousal potentially beyond one’s
window of tolerance and, if not resolved, can result
in a hyperactivated HPA-axis cascade, releasing dam-
aging amounts of glucocorticoids into the system.
In a regulated stress response, a feedback loop will
down-regulate the HPA-axis activation and attenu-
ate the release of stress hormones (Kandel, Schwartz,
Jessell, Siegelbaum, & Hudspeth, 2013). In a state of
continued stress—as with unresolved uncontrollable
incongruence—this feedback mechanism is overrid-
den and a continued flow of glucocorticoids can in-
hibit the formation of new synapses (new learning)
while degenerating existing glutamate synapses, es-
pecially in the hippocampus, destabilising previously
formed neural connections (established learning) and
even inducing complex negative structural changes in
various brain regions (Lupien, McEwen, Gunnar, &
Heim, 2009; Popoli, Yan, McEwen, & Sanacora, 2012).
To limit such a destructive cascade of events, the in-
troduction of a sense of control can reduce arousal
and in turn restore HPA-axis regulation.
Controllable incongruence is a state in which a
stressor (the incongruence) is raising arousal levels
through sympathetic excitation and noradrenergic
activation and may exceed a certain threshold to ac-
tivate the HPA-axis, but the situation is perceived as
manageable, and feedback loops to down-regulate the
stress response in a timely manner are intact. Such a
controlled stress reaction causes a moderate amount
of adrenalin to permeate the nervous system, includ-
ing the neurons, glia, and endothelial cells, which can
facilitate a constructive response to the incongruence
in the form of learning. As adrenergic receptors are
stimulated at blood vessels and astrocytes, glucose
Volume 3 Issue 1 (2015)
release is increased with a corresponding increase in tolerance for short-term increases in inconsistency
metabolism. This metabolic increase in conjunction during therapy (Smith & Grawe, 2003). This focus on
with the release of neurotrophic factors from astro- the client’s healthy psychological attributes is in con-
cytes (Verkhratsky,& Butt, 2007) and stimulation of trast to the problem activation that is stressed in all
adrenergic receptors will help stabilize neural connec- major therapy schools, yet both play a role in explain-
tions activated when coping with the incongruence ing therapeutic change (Gassmann & Grawe, 2006).
(in a process representing existing coping strategies) “Upon starting therapy or counseling, people seeking
and also improve the facilitation of new neural con- help often feel hopeless and have given up believing
nections (new coping strategies)—the opposite to in their own problem-solving resources. It is therefore
what occurs in the uncontrollable situation. In fact, the counselor’s job to reactivate the experience of that
rising to the challenge of controlling incongruence is person’s self-effectiveness. A counselor should pick up
essential to “the formation of ever more complex and on the person’s existing strengths and skills” (Flücki-
differentiated neural circuits to an optimal expression ger, Wüsten, Zinbarg, & Wampold, 2009, p. 2). Ideally,
of [one’s] genetic potential” (Grawe, 2007, p. 222). motivational priming and resource activation should
As one continues to deal with a controllable in- be facilitated early in the therapy process and empha-
congruent situation, coping behaviour becomes more sised throughout sessions. In this atmosphere of acti-
established, and eventually such situations will no vated resources, therapy has a much greater chance of
longer elicit a stress response, as the neural networks being effective (Gassmann & Grawe, 2006).
required to effectively assess and cope with the situ- The feeling of safety within the therapeutic dyad is
ation are well established. This is a key goal of thera- of fundamental importance to attenuate the destruc-
py: to strengthen existing coping skills and facilitate tive stress responses described above and to take ad-
new ones on a neurobiological level of resilience. Such vantage of controllable incongruence as a mechanism
learning is not possible, on a neural level, in the over- of change. A client who is held in a space of trust and
whelming situation of uncontrollable incongruence security and can engage within their window of toler-
where an overabundance of cortisol is hampering, ance will be able to take advantage of the brain’s nat-
even degenerating, synaptic connections. Within the ural neuroplasticity. Research has shown that “a safe,
safety of the therapeutic alliance, however, stress re- enriched environment actually facilitates the develop-
sponses can be down-regulated to a state of optimal ment of new neural patterns, which, in turn, leads to
learning, and incongruence can be broken down into enhanced attachment and control, and stress reduc-
controllable, manageable parts to which new strate- tion. Psychotherapeutic approaches that provide safe
gies can be applied. environments will thus enhance the positive social in-
In considering how to facilitate an effective thera- teraction that is an essential element of healthy neural
peutic environment, Grawe (2007) points to what he proliferation” (Allison & Rossouw, 2013, p. 23). To es-
calls motivational priming and resource activation as tablish such a safe environment requires a down-reg-
key elements for a controllable incongruence learning ulation of avoidance motivational schemas that may
state (see also Flückiger, Caspar, Grosse Holtforth & be activated. This is essentially a bottom-up approach
Willutzki, 2009; Flückiger, & Grosse Holtforth, 2008). of dealing with the physiological stress response be-
Motivational priming is the priming of the approach fore being able to facilitate effective neural change
system via positive emotional experiences within the and proliferation (Allison & Rossouw, 2013; Rossouw,
therapy session. Such a strategy would focus on pos- 2012b, c, 2013b). The affectively focused right brain-
itive need-satisfying experiences that are compatible to-right brain therapeutic relationship, mediated via
with the client’s goals, particularly at the beginning of so-called “mirror neuron” activity, can be effective
the session, to provide some positive satisfaction of at establishing safety for a client by down-regulating
orientation/control, attachment, pain avoidance, or limbic reactivity and communicating an empathic,
self-esteem enhancement needs. Establishing an effec- supportive relationship that satisfies the basic need
tive therapeutic alliance is one example of a positive for attachment (Schore, 2012). A safe therapeutic rela-
activation of a need (attachment) that would prime the tionship creates the ideal environment for facilitating
client toward approach-orientated tendencies within neural proliferation in an integrative manner, as the
the session. Resource activation is the therapists skill nervous system is essentially a social-centric system
of identifying existing resources, characteristics, and that thrives on interpersonal love, acceptance, and se-
abilities of the client that can be positively emphasised curity (Cozolino, 2014; Schore, 2012, Siegel, 2012).
during the session in order to enhance the client’s feel- When anxiety increases, there is a decrease in cor-
ings of control or self-esteem and increase his or her tical blood flow in the left PFC and an increase in the
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 62
right PFC, inhibiting the ability of the left PFC to mod-
ulate emotional arousal. When the left PFC is engaged
and activated, as it can be in a safe therapeutic envi-
ronment, more cortical blood flows to it, allowing it to
modulate arousal generated by right cortical and lim-
bic areas (The Neuropsychotherapy Institute, 2014d).
This economy of blood flow within the central nervous
system can effectively take certain areas such as the left
PFC “offline” in order to provide a richer blood sup-
ply to more essential areas such as the right PFC and
limbic areas in times of threat or danger. This works in
much the same way that a sympathetic response can
cause peripheral shut-down to shunt more blood to
essential organs (The Neuropsychotherapy Institute,
2014d). Obviously a problem arises when the offline
system is the very system required to down-regulate
an over-reaction elicited by an overactive amygdala, in
which case the feeling of uncontrollable incongruence
only increases.
One of the ways to mitigate the problem of hav-
ing an essential control system like the PFC go offline
in times of stress is to increase its integrative connec-
tivity to those areas that need higher-order control,
such as the amygdala. Mindfulness is one practice
that can achieve this. Described as focused attention
in the present without judgment (Kabat-Zinn, 1994,
2013), mindfulness can increase mid-PFC and right
anterior insula activity and thickening, and increase
activity in the superior temporal gyrus and anterior
cingulate (Badenoch, 2008). The result is an increased
integration of these systems with the limbic system,
providing better modulatory control over amygdala
overreactions and fostering a propensity to approach
rather than avoid challenging situations (Siegel, 2012).
Such an increase in control brings previously over-
whelming situations back into the realm of control-
lable incongruence. Research suggests that meditative
practices like mindfulness not only increase the inte-
gration and plasticity of neural networks, but can also
offset ageing processes and increase our ability to be
present, attuned and compassionate with others (Bad-
enoch, 2008).
Siegel (2007) suggests another “mindful” strategy to
gain greater prefrontal management of limbic respon-
siveness that involves a change in our language. Rather
than saying, for example, “I am sad”, the self-talk that
provides more separation between the self and the
emotion would be “There is a feeling of sadness right
now.” Placing the emotion as an objectively observable
phenomenon that is apart from the “observing self ”
elicits a greater sense of control over what would oth-
erwise be an immersive emotional experience.
63 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
Whatever particular mindful strategy is utilised,
there are some common outcomes to such practices:
less dysregulation and reactivity to emotional expe-
riences; remaining present with feelings, thoughts or
actions without being distracted; the ability to label
beliefs, opinions, emotions, and expectations; and
having a nonjudgmental stance toward our experi-
ences (Badenoch, 2008; Baer, Smith, Hopkins, Kriete-
meyer, & Toney, 2006).
Motivational priming, resource activation, cre-
ating safety, and techniques like mindfulness are all
designed to bring the client into a place of optimal
learning where incongruence is perceived as with-
in the client’s window of tolerance, controllable, and
therefore an opportunity for new learning and posi-
tive change.
4.2 Two-Person Psychology
There is an emerging emphasis on “two-person”
psychology in therapy (Schore, 2003c), where right
brain-to-right brain, embodied, affective, autonom-
ic change between therapist and client becomes cen-
tral to the therapeutic process (Marks-Tarlow, 2012;
Montgomery, 2013; Schore, 2014). This places the
spotlight on the neural integration within the thera-
pist, in the sense that he or she must effectively oper-
ate out of a wide window of tolerance for the benefit
of modulating clients on both an unconscious and a
conscious level. In this context, therapy becomes less
about the left hemisphere’s desire to categorise and fix
by applying discrete therapeutic interventions, and
more about a right-hemispheric capacity for broad af-
fective awareness, empathy, and connectedness. Such
a perspective liberates the therapist from manualised
techniques of intervention, yet necessitates the critical
work of self-integration and the experientially devel-
oped intuition of attunement (see Badenoch , 2008,
2011; Marks-Tarlow, 2012, 2014 for resources to de-
velop such integration and intuition). Vertical and bi-
lateral integration of one’s own neural systems is the
first step toward an interpersonal integration within
the dyad of psychotherapy. Vertical integration is the
linking of body, limbic region, and cortex, thus in-
creasing neural connectedness and facilitating a great-
er ability to stay in touch with empathic connections
(resonance circuits). “When our middle prefrontal re-
gion is steadfast in its linkage with our limbic circuits
and bodies, the flow of nonverbal information coming
to us from our patients has a much greater chance of
being held, with empathy as the most consistent un-
derlying state. . . . Such interpersonal richness encour-
ages GABA-bearing fibers to grow from patients’ or-
bitofrontal cortex to the amygdala, calming old fears”
Volume 3 Issue 1 (2015)
(Badenoch, 2008 p. 156). Bilateral or horizontal in-
tegration (Siegel, 2007) is the effective and balanced
communication between left and right hemispheres
where the left hemisphere is receiving a complete flow
of information from subcortical and cortical regions
on the right and contributes a complimentary yet sub-
servient perception and response in accordance with
the right’s “big picture” perception. If such integration
is intact within the therapist, he or she will be better
placed to mediate a similar vertical and horizontal in-
tegration within the brain of the client.
Change within this two-person psychological sys-
tem of client and therapist is primarily a right-brained,
embodied, emotional, autonomic process within the
dyad. Such biopsychosocial processes of affect regula-
tion between therapist and client are forming the basis
for a more integrative approach to treating mind and
body. The somatic aspect of affect regulation is also
becoming increasingly important in therapy (Schore,
1994, 2003a, 2012); for example, when the ventral va-
gal-mediated social engagement system is activated
in a previously hyperaroused client by the regulat-
ing warmth and empathy of the therapist, the client’s
cortisol levels may return to the normal range while
oxytocin and opioids validate the safe connection ex-
perience (Badenoch, 2008; Sunderland, 2006). The
somatically attuned therapist will pick up cues from
the face, body posture and reflexes of the client, and
so focus on the effect of his or her own body posture,
tone of voice, gaze, and so on in an attempt to bring
the client back into a workable window of tolerance
where the right amount of arousal can elicit optimal
learning.
5. Defining Neuropsychotherapy
Many aspects to the meta-framework of
neuropsychotherapy have been outlined in this pa-
per, and reducing such a comprehensive approach to
a succinct description is no easy task. The definition
offered below is an attempt to capture the essence of
neuropsychotherapy.
Neuropsychotherapy is a neurobiologically in-
formed framework for psychotherapy that con-
ceptualises thought and behaviour as emerging
from the influence of motivational schemata
developed to preserve or enhance basic psycho-
logical needs. Therapeutic processes start from
the development of a safe and enriched environ-
ment to activate positive approach motivation-
al schemata utilising a bottom-up neurological
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
approach, and proceed from a top-down ap-
proach to facilitate long-term change in neural
architecture.
Summary
The pioneering work of Grawe introduced an ap-
proach to psychotherapy that was based on contem-
porary neuroscience (Rossouw, 2014). Shore, Siegel,
and others have also established a scientific basis to
psychotherapy with a particular emphasis on affective
development and phenomena over cognitive process-
es. The rapid, implicit emotional processing of deep-
er brain structures requires the therapist to engage in
psychotherapy that goes well beyond the traditional
cognitive–behavioural understanding. In the me-
ta-framework of neuropsychotherapy, clinical prac-
tice is informed by insight that has been gleaned by
contemporary neuroscience and related disciplines.
Grawe’s challenge that “we ought to conduct a very
different form of psychotherapy than what is current-
ly practiced” (Grawe, 2007, p. 417) is today being ad-
dressed by a more sophisticated understanding and
appreciation of the right-brained, affective, embodied,
autonomic, and implicit processes involved in psy-
chotherapeutic practice. Change is increasingly being
conceptualised as a relational-affective process within
the therapeutic dyad. The consistency theory model
has provided a sound point of reference for the dy-
namics of mental functioning, possible sources of un-
desirable processes, and effective steps toward change.
The continual development of a neuropsychotherapy
perspective in conjunction with breakthroughs in
neuroscience is even now providing clinicians with
an unprecedented theoretical and pragmatic basis for
effective client change.
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Sunderland, M. (2006). The science of parenting: How neuropsychotherapist.com/institute/ cortical-
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tionally balanced children. New York, NY: DK Pub- Trzesniewski, K. H., Donnellan, M. B., & Robins, R.
lishing. W. (2013). Development of self-esteem. In Zeigler-
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69 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

review

russian psychology and neuropsychotherapy:

comparative analysis

Maria I. Kostyanaya

“Все новое - это хорошо забытое старое”

Transliteration “Everything new is well forgotten old”
Translation “There is nothing new under the sun”
Russian proverb

Introduction
From the late 20th century until the present time, researchers in the broad field of psychological science have
been noting the need for refined intellectual frameworks to arise (Homskaya, 2010; Kandel, 1998, Rossouw,
2011; Rossouw, 2014). Western views that are presented in the following pages refer to “…the dawn of the
mental health renaissance.” (Rossouw, 2011, p. 3), which was heralded by the “…new intellectual framework
in psychiatry” (Kandel, 1998, p. 457) and the corresponding technological advances in the neurosciences. As
a result, the emerging field of brain-based care is rapidly gaining momentum - a neuroscientifically informed
therapy or neuropsychotherapy (Grawe, 2007, Rossouw, 2014).
In the early years of 20th century a group of academics in the field of psychology in Russia formed a new
school, which during the restricted times of Soviet regime received insufficient recognition on a global scale
(Kostyanaya & Rossouw, 2013). The investigators aimed at developing an “objective” approach to understand-
ing the connection between mind and brain with latest research focussed on the problem of personality, its
neural correlates and the impact of society on human mental functioning (Homskaya, 2010; Luria, 1979). Due
to the opening of the iron curtain and present-day globalisation more literature on Soviet psychological devel-
opments is being translated and is becoming available for a broader audience (see, for example multiple works
of Akhutina (2003), Akhutina & Pylaeva, 2012; Leontiev (2005a, 2005b, 2012, 2013), published in English).
This new state of affairs allows the comparative analysis of Soviet paradigms and the contemporary Western
paradigms which is the general aim of this paper.
In the first part of the paper a neuropscyhotherapeutic framework is presented, starting with an outline of
its roots and most current conceptualisations of neuropsychotherapy as a research field. The second part of the
report focuses on the development of Soviet school of psychology and its main postulates. The third part of
the report includes the comparative analysis of the two paradigms as well as a consideration for future analytic
inquiry in this area. The final part of the paper closes with a succinct conclusion.

Cite as: Kostyanaya, M. I., (2015). Russian psychology and neuropsychotherapy: Comparative analysis.
International Journal of Neuropsychotherapy, 3(1), 70–88. doi: 10.12744/ijnpt.2015.0070-0088

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 70

 Neuropsychotherapy therapeutic factors are the most powerful elements
in the outcomes of therapeutic treatments (Cozolino,
Introduction 2002; Lambert & Ogles, 2004; Smith et al., 1980). In-
The state of affairs­—a mental health stead, “the brain-based perspective” was put forward,
renaissance allowing for new and broader cross-disciplinary or a
biopsychosocial view on psychotherapeutic interven-
Several fascinating historical traces can be identi-
tions (Linford & Arden, 2009, p. 19).
fied while tracking the way in which researchers tried
to conceptualise the interaction of mind and brain in Most current investigators in the areas endorsing
human functioning and what can be done in order to biopsychosocial-spiritual view on human functioning
improve it when dysfunction occurs. As early as 1895 argue that major advances in neurobiological research
Sigmund Freud, the “father of modern psychology” within last decade have brought about “a paradigm
(Rossouw, 2011, p. 2), was challenged to explain the shift” or in other words “the mental health renais-
functioning of the mind in the terms of neural cor- sance” (Linford & Arden, 2009; Rossouw, 2010b,
relates of the brain. In his “Project for a Scientific 2011; Sulmacy, 2002). In particular, Rossouw (2010b,
Psychology” (1895) Freud intended to “furnish” psy- p. 5) states that when based on neuroscience, “talking
chology as “a natural science” while introducing the therapies” face “new challenges” and “exciting new
principle of neuronic inertia and the function of the possibilities”, while the paradigm shift was made in a
identified types of “the material particles in question” path from “the helping model forward to a recovery
or in other words neurons (pp. 355-356). Despite these model” and from “the recovery model forward to a
fundamental discoveries as well as insights into the model enhancing quality of life”.
possibilities of “talking therapies”, i.e., human external The key ideas contributing to the rise of the contem-
and internal experiences to change the brain, Freud porary mental health renaissance were pronounced in
gave way to another direction in his research inqui- the landmark article of Eric Kandel (1998), the Nobel
ry (e.g., unconsciousness, interpretation of dreams), prize winner in medicine. He stated that the devel-
leaving future researchers to bridge the link between opment of “brain sciences” prompted “a remarkable
neuroscience and psychotherapy (Rossouw, 2011). scientific revolution” and that mental health pro-
Subsequently, the debate and scientific hegemony fessionals should possess the “ability to encompass
in explaining human functioning was performed by mental and emotional life within a framework that
authors who often supported rather extreme perspec- includes biological as well as social determinants” (p.
tives. For instance, Breuer, Freud’s coeval, believed “… 467). Eric Kandel also outlined the interaction be-
there will be little said of the brain…Physical process- tween brain processes and environment via alteration
es will be discussed in the language of psychology… of gene expression and, following the strengthening
There is no alternative” (Freud, 1895, p. 356). By con- of synaptic connections, as the foundation of human
trast, years later, Hans Eysenck (1952) firmly stated beliefs, attitudes, memories, personality and dispo-
that psychotherapy is the “mere passage of time”, while sitions (Walter et al., 2009). In addition, he brought
Timothy Leary likened therapy interventions with the forward the important idea of the interaction be-
ones performed in waiting lists (Linford & Arden, tween patients’ “neuronal machineries” (p. 466) with
2009, p. 16). Thereafter, since the 1970s and the intro- the “neuronal machineries” of their psychotherapists,
duction of Prozac and the DSM-III, the “golden era for foreshadowing the function of mirror neurons - one
psychoparmacology” (Rossouw, 2011, p. 3) - the pax of the major neurobiological discoveries which is yet
medica or “medicalised psychology and psychiatry” to be thoroughly addressed in psychotherapy research
(Linford & Arden, 2009, p. 16) took its turn, leaving and practise (Rossouw, 2010a).
psychotherapy in the background. Among other most pronounced neurobiological
In response to the requirements of “empirically val- findings contributing to the enhancement of the
idated treatments” as well as the superiority of diag- quality of clients’ lives via psychotherapeutic inter-
nostic methods pertaining to that time, Aaron Beck ventions, contemporary researchers highlight the
(1976) dared to “establish indisputable evidence” (Lin- discovery of neurotransmitters and their operation,
ford & Arden, 2009, p. 17) of psychotherapeutic effica- neural plasticity, neurogenesis and bottom-up and
cy by means of cognitive-behavioural therapy (CBT). top-down regulation of mental functioning (Rossouw,
However, in the 1980s and afterwards, Beck’s focus on 2010a, 2012). As a result, new ways for bridging neu-
specific CBT techniques was criticised by researchers rosciences and psychotherapy arise, one of which is
who managed to show that the patient and common neuropsychotherapy - an emerging paradigm of care

71 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

in Australia, of which a major proponent and theo- ogy at University of Massachusetts, was the develop-
retician is Dr Pieter Rossouw at the University of ment of a unified theory of personality, which mani-
Queensland (Rossouw, 2010a, 2010b, 2011, 2012, fested itself in his cognitive-experiential self-theory of
2014). personality (2003). This theory is proposed to be com-
patible with psychodynamic and learning theories, as
well as present day views on information processing.
Theoretical foundations of The “integrative power” (pp. 159-162) of CEST derives
neuropsychotherapy from three main assumptions: 1) People tend to pro-
cess information by two independent and interactive
Definition conceptual systems; a preconscious experiential sys-
In the current literature neuropsychotherapy is tem and conscious rational system; 2) The experiential
referred to as an “increasingly popular field of re- system is emotionally driven, organised and adaptive;
search” (Walter et al., 2009, S174) as well as the “nat- 3) According to CEST, the proposed four basic needs
ural result of neurobiological research” (Rossouw, (the desire to maximise pleasure and minimise pain, the
2011, p. 3). It is also important to note, that the need for relatedness, the need to maintain the stability
term “neuropsychotherapy” has been used in dif- and coherence of a person’s conceptual system, the need
ferent countries and in rather different modalities to enhance self-esteem) are equally fundamental and
(Grawe, 2007; Judd, 1999; Kaplan-Solms & Solms, their interaction can account for paradoxical reac-
2000; Laaksonen & Ranta, 2013; Walter et al., 2009). tions. While the needs “serve as checks and balances
Generally speaking, one group of researchers relate against each other” (p. 162), maladaptive consequenc-
neuropsychotherapy to “the use of neuropsychological es occur when needs are fulfilled in a “conflictual
knowledge in the psychotherapy of persons with brain manner” (e.g., at the expense of others).
disorders” (Judd, 1999, p. 3) or, in other words, work- It is also suggested in CEST that people automat-
ing with impacts of “neurological dysfunction or syn- ically construct an implicit theory of reality which
dromes” in patients (Laaksonen & Ranta, 2013, p. 1). includes a self-theory, a world-theory, and connecting
Another group of researchers see neuropsychotherapy propositions. Additionally, the outlined basic needs
as “a specialised field of psychotherapy”, where neuro- correspond with four basic beliefs: about the benignity
logical and neuroscientific knowledge serves for guid- versus malevolence of the world; about the predictabil-
ing clients “in the process of restructuring their brains ity, controllability, and justness of the world versus its
towards higher levels of functioning and well-being” unpredictability, uncontrollability, and lack of justice;
(Rossouw, 2011, p. 3; Walter et al., 2009). the degree to which people are loving versus rejecting
In this paper the focus is on the latter conceptuali- and trustworthy versus untrustworthy, and about wor-
sation of a neuropsychotherapeutic framework, which thy versus unworthy self (p. 164).
was founded on the cognitive-experiential self-theo- Epstein and his associates proved to successful-
ry of personality (CEST) by Seymour Epstein (2003) ly test CEST assumptions predominantly by means
and developed by Klaus Grawe (2007). The most re- of adaptation the procedures used by Tversky and
cent conceptualisations of neuropsychotherapy as a Kahneman (see, for example, Epstein et al., 1992).
research field are outlined (Walter et al., 2009) with As a result, Epstein (2003, p. 176) suggests that, ac-
following future considerations. cording to CEST, the effectiveness of psychotherapy
depends of changes in the experiential system and
can be achieved in three ways: by using “the rational
Cognitive-experiential self-theory of system to correct and train the experiential system”;
personality providing “emotionally significant corrective experi-
In his principle work “Neuropsychotherapy: How ences”, and “communicating with the experiential sys-
the neurosciences inform effective psychotherapy” tem in its own medium - fantasy, imagery, metaphor,
Klaus Grawe, an outstanding Swiss researcher and concrete representations, and narratives”.
practician, mentions CEST as the theory, which “par-
ticularly intrigued” him and which served as the basis
for his consistency-theoretical model of mental func- The consistency-theoretical model of
tioning (Grawe, 2007, pp. 167-171). mental functioning
One of the main interests of Seymour Epstein The outlined postulates of Epstein’s theory of per-
(1917-2011), who was emeritus professor in psychol- sonality plus his ideas on the experiential system being

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 72

involved in human tendencies to “achieve pleasurable
outcomes and avoid unpleasurable ones” (Epstein,
2003, p. 160) were further elaborated in Grawe’s con-
sistency-theoretical model of mental functioning
(Grawe, 2007). Generally speaking, Grawe’s approach
represents the transformation of the results of neu-
roscientific research into psychotherapeutic domain
(Draguns, 2007) with the holistic perspective on cli-
ents’ functioning. This model is used by the author
both as an explanatory framework for general un-
derstanding of human mental functioning, the devel-
opment of mental disorders, as well as the necessary
neuropsychotherapeutic interventions to be imple-
mented while working with clients. The reviewers of
Grawe’s work see his approach as “an individualised
amalgamation of cognitive-behavioural, process-ex-
periential, and interpersonal techniques” (Draguns,
2007).
Consistency regulation as a basic principle
of mental functioning
Upon revision of Epstein’s conceptualisations,
Grawe (2007, pp. 165-168) suggests the consisten-
cy principle as the “very central principle of mental
functioning” which also serves as a “condition for
the effective satisfaction of the basic needs”. The term
consistency is referred to as the “compatibility of si-
multaneously transpiring neural/mental processes”
(p. 168) or to “the internal relations among intrapsy-
chic processes and states”. Striving for consistency
is regarded by Grawe as “the ultimate moving force
in neural/mental functioning” and, therefore, as a
“highest or pervasive regulatory principle” (p. 173).
In broad terms, Grawe argues that consistency regu-
lation provides us with understanding of human men-
tal functioning and has to be considered in its context
of goal-oriented activity towards fulfilment of basic
needs. Therefore, the consistency regulation and need
satisfaction are “intrinsically interlinked” (p. 169) by
the “connecting construct” of congruence or a person’s
“compatibility of current motivational goals and actu-
al perceptions”.
Principal elements of the consistency-
theoretical model of mental functioning:
Basic human needs, motivational sche-
mas, incongruence, discordance
Despite his chief emphasis on neuroscientific un- According to Grawe, the basic needs provide neu-
derpinnings of human mental functioning, Grawe ropsychotherapists with the criteria for measurement
suggests the following question as fundamental for of consistency in individuals. In the model, basic
73 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
effective neuropsychotherapy: “What is it that moves
this person?” (p. 164). The focus on motivational as-
pects of clients’ lives allows neuropsychotherapists
to perform personalised therapeutic interventions,
comparable with present-day most strongly endorsed
holistic approaches to human suffering (Kleiman &
Seeman, 2000).
The consistency-theoretical model suggests that
mental activity is hierarchically organised and gov-
erned by goals and motivational schemas which are
formed over the course of mental development. Thus,
Grawe defines motivational schemas as “the means
the individual develops in the course of his or her life
in order to satisfy his or her needs and protect them
from violation” (p. 170). In the case of growing up in
the environment that is oriented to the fulfilment of
needs, the individual develops approach motivational
schemas and behavioural repertoires intended for the
realisation of goals under various conditions. By con-
trast, if basic needs are repeatedly violated, avoidance
motivational schemas are formed, primarily for pro-
tection purposes.
A continuous stream of perceptions is produced
during the individual’s interaction with the environ-
ment, corresponding with situational experience and
behaviour and lies at the lowest level of the model
(Grawe, 2007) (see Figure 1 below).
These perceptions form feedback signals on how
motivational goals are being achieved. They are
termed incongruence signals, for which Grawe draws
upon Power’s control theory (1973). If avoidance
dominates over approach, the incongruence signals in
regards to unfulfilled approach signals emerge, which
creates approach incongruence. In case of inability to
avoid feared experiences avoidance incongruence aris-
es. In addition, approach and avoidance tendencies
can be activated simultaneously and mutually inhibit
each other, which give rise to motivational conflicts or
motivational discordance. Motivational conflicts can
subsequently lead to incongruence or “mismatch be-
tween actual experiences and activated motivational
goals” (Grawe, 2007, p. 172). Therefore, discordance
and incongruence are considered by Grawe as most
important versions of inconsistency in human men-
tal functioning. The continuously repeated failure to
fulfil approach and avoidance goals can lead to an el-
evated incongruence level or, in other words, a highly
complex stress state, accompanied with chronically el-
evated level of negative emotions.
Volume 3 Issue 1 (2015)
 Figure 1. Consistency-theoretical model of mental functioning (Grawe, 2007) First, Rossouw outlines the
basic human needs that ought
to be addressed when working
System(Level( with clients. The need for safety
Feedback&on&consistency& Striving&for&consistency& is regarded as a primary need
that plays the major role in
Basic&Needs& the facilitation of motivational
schemata. This idea stems from
Pleasure/& the key neural principle - the
Orienta3on/& Self=&
Pain& A9achment& principle of survival (the brain
Control& enhancement&
avoidance& changes to enhance survival),
where safety “holds the key”
(Rossouw, 2014, p. 55) to the
Striving&for&need&sa3sfac3on& Feedback&on&need&sa3sfac3on&
facilitation of neural prolifera-
Mo#va#onal(Schemata( tion and approach motivational
Approach& Avoidance& schemas, while compromised
safety leads to neural protec-
tion and avoidance. Therefore,
Feedback&on&goal=& Bo9om&up&ac3va3on&
of&mo3va3onal&schemata&&
the facilitation of safety in the
achievement&
Experience(and(Behaviour( process of neuropsychotherapy
(Grawe,&2007)&
helps clients experience con-
trollable incongruence as well
psychological needs are viewed to be present among as master approach motiva-
all humans and their violation or enduring nonful- tional schemas.
fillment is seen as the most important cause of im-
pairments in mental health and well-being of clients The basic need for safety is activated through the
(Grawe, 2007). Among basic needs Grawe differenti- need for control, the need for distress and pain avoid-
ates: the need for attachment, the need for orientation ance and pleasure maximisation, as well as the need
and control, the need for self-esteem enhancement and for attachment. Unlike Grawe’s conceptualisations, in
self-esteem protection, and the need for pleasure maxi- the integrated model the concept of self (and self-es-
misation and distress avoidance. teem) represents a higher order construct that results
from neural patterns related to the primary needs and
can be identified only in regards to the development
An integrated theoretical model of of basic needs and their exposure to enriched or com-
promised environments. Thus, in the integrated neu-
neuropsychotherapy
ropsychotherapeutic framework, self is a higher order
A more refined model which incorporates contem- construct that results in the culmination of the basic
porary thinking in neuropsychotherapy as a unique needs.
meta-theoretical framework for understanding the
In a nutshell, the integrated theory of
human condition has been recently proposed by
neuropsychotherapy incorporates genetic influences
Dr Pieter Rossouw (Rossouw, 2014). He states that
to which a person is exposed to in the environment
neuropsychotherapy represents a holistic model that
- impacts, which result in varied genetic expressions.
integrates neuromolecular and environmental data for
Either safe (enriched) environments or challenging
the main purpose of facilitating change in clients and
(compromised) environments lead to the activation of
shifting their patterns of pathology towards healthy
incongruence as the basis of change, life, survival, and
change that increases quality of life. The author un-
thriving. The experience of controllable incongruence
derlines the grey area between “nature” (genetics) and
results in addressing all three basic needs through pat-
“nurture” (external impact), primarily on the basis of
terns of approach. This, in turn, down-regulates the
neural plasticity and epigenetics - notions that see the
stress response and its activation as well as facilitates
brain as a complex network and that neural activation
neural proliferation, pre-frontal cortical activity and
is susceptible to environmental factors.
shifts in cortical blood flow to frontal regions. In cases
Based on Grawe’s ideas outlined above, Rossouw of compromised safety, the stress response system is
has introduced several new features in his integrated activated, eventually resulting in increased produc-
model of neuropsychotherapy (see Figure 2). tion of stress hormones and impaired activation of
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 74
 Figure 2. Integrated model of Neuropsychotherapy (Rossouw, 2014)
frontal lobes. In such cases, the neural activation of
survival initiates the onset of patterns of avoidance.
This short-term enhancement of survival can compro-
mise thriving in the long-term, leading to the onset of
psychopathology. Rossouw (2014) postulates that fear
based neural activation when it become the default ac-
tivation pattern leads to psychopathology developing
from the bottom to the top.
Rossouw (2014) describes particular principles of
bottom up neuropsychotherapy derived from the out-
lined theoretical framework, which are also support-
ed by a number of case studies presented in the book.
The major trajectory of neuropsychotherapeutic work
implies the priority of facilitating safety experiences
(on physical and emotional levels) for clients, through
down-regulation of their stress responses by means of
the Rogerian principles (Rodgers, 1961) and thereby
addressing basic human needs. Here the robust ther-
apeutic alliance ensures “integrative relationships”
75 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
between neuropsychotherapist and cli-
ents, “in which differences are respect-
ed and compassionate connections are
cultivated” (Rossouw, 2014, p. 62).
It is only after appropriately pac-
ing treatment and the establishment
of a safe environment for clients, a
neuropsychotherapist can proceed to
uncover the experiences of violation of
needs and facilitation of new narratives.
Rossouw underlines that one of the key
features of neuropsychotherapy is the
need to facilitate cortical capacity rath-
er than assuming it. This facilitation is
achieved by ongoing therapeutic sup-
port and continues activation of new
healthy neural networks, supported by
advanced mirror neural networks in-
volving the neural principles of Donald
Hebb and Michael Merzenich (Kandel,
2005).
Contemporary state of
neuropsychotherapy as a
research field
Present-day authors define
neuropsychotherapy as a field of ap-
plied research which tries to: identify
neural mediators and functional tar-
gets of psychotherapeutic effects, to de-
termine new therapeutic routes using
neurotechnology, and to design psycho-
therapeutic interventions on the basis of
neuroscientific knowledge (author’s emphasis) (Walter
et al., 2009). The main trajectory of the field is seen in
its potential to provide investigators with “reliable sur-
rogate markers” (Walter et al., 2009, p. S180) or clini-
cal indicators of causal factors for the development of
mental disorders, useful for diagnosis, prognosis and
prediction of psychotherapeutic changes. This course
becomes possible with the integration of neuroscience
into psychotherapeutic education, research and prac-
tice.
With regard to identification of the neural mediators
and functional targets of psychotherapeutic effects, the
most clearly marked examples refer to the research on
the neural substrate underlying dysfunctional emo-
tional regulation (Beauregard et al., 2001; Davidson et
al., 2000; Grawe, 2007; Ochsner et al., 2004; Rossouw,
2012; Walter et al., 2009). Even though anxiety and de-
pression are functionally different (Grawe, 2007), the
Volume 3 Issue 1 (2015)
targets of possible psychotherapeutic work with these
mental conditions in some or other way involve sim-
ilar brain structures. Generally speaking, these struc-
tures might include the amygdala, the ventromedial
and dorsolateral prefrontal cortices (PFC), related to
avoidance mechanisms and negative emotions; and
the anterior cingulate cortex (ACC), responsible for
transformation of emotions into defined feelings as
well as for attention and action. Most importantly, re-
searchers argue that this area of neuropsychotherapy
underlines the importance of neuroimaging for trac-
ing mechanisms which would not be apparent while
using behavioural methods, for example, the sus-
tained regulatory effect on amygdala activation (Wal-
ter et al., 2009). Here the advance of neuroimaging
methodologically associates brain processes with the
mediators of psychotherapeutic effects. Further, it is
recognised that the understanding of mind and brain
interrelations can be beneficial for clients themselves,
building their motivation to change, as well as gaining
deeper understanding of their conditions (Walter et
al., 2009).
The second area of contemporary
neuropsychotherapy is concerned with determination
of new therapeutic routes with the usage of neurotechol-
ogy, which researchers find most remarkable in at least
two domains. The first refers to the neurobiological ap-
plications of the psychotropic drugs as well as natural
neurotransmitters that can impact psychotherapeutic
interventions (Grawe, 2007). For example, several re-
searchers have focussed on the function of oxytocin
in psychotherapy as it serves as a neuropeptide which
proves to have a calming effect on the separation-anx-
iety system (Rossouw, 2011). Oxytocin was shown
to increase trust and mentalising competency of the
individuals (Domes et al., 2007), while playing a ma-
jor role in attachment, which is so important for “the
developmental path of a well individual” (Rossouw,
2011, p. 5). Another example comes from the use of
drugs that can influence receptors important for the
processes of learning and extinction, which in com-
bination with cognitive-behavioural therapy proves
to be effective, especially for social anxiety disorder
(Hofmann et al., 2006).
Another domain for determination of possible
therapeutic routes becomes possible with the help
of functional neuroimaging procedures and the us-
age of neuro-feedback as the process whereby clients
can learn to self-regulate their brain activity (Lin-
den, 2006; Masterpasqua & Healey, 2003). Thus, for
example, transcranial magnetic stimulation (TMS),
functional magnetic resonance imaging (fMRI) and
neuro-feedback prove to be beneficial for wide range
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
of issues: symptoms of obsessive-compulsive disor-
der (OCD), drug-resistant hallucinations, disrupted
perception of pain, attention deficit/hyperactivity dis-
order (ADHD), as well as schizophrenia and depres-
sion (DeCharms, 2008; Masterpasqua & Healey, 2003;
Schonfeldt-Lecuona et al., 2003).
The third area of the contemporary neuropsycho-
therapeutic application is seen in designing psychother-
apeutic techniques on the basis of the neuroscientific
knowledge. Here the author points out such innovative
therapeutic processes as eye movement desensitisa-
tion and reprocessing (EMDR) and re-consolidation
of memory traces, particularly for clients experiencing
post-traumatic stress disorder (PTSD) (Jeffries & Da-
vis, 2012; Nader & Hardt, 2009; Shapiro, 1996). In this
vein, the evidence in favour of eye movement bilater-
al stimulation as an essential component of EMDR,
suggests that it firstly increases the access to episodic
memories and then it acts upon components of work-
ing memory (Jeffries & Davis, 2012). This progression
helps psychotherapists find the best way to awake and
re-integrate traumatic memories, which makes client
focus on the traumatic memories less unpleasant and,
therefore, allows easier access to these memories.
The outlined contemporary neuropsychotherapy
frequently views major mental disturbances as “net-
work disorders” (Walter et al., 2009, p. S176), which
suggests a pathologic functional connectivity or a
“neurofunctional mode” (i.e., “a dysfunction of a
distinct neural network”), as the underlying process
for any given mental condition. For example, corti-
co-limbic dysregulation is seen to account for depres-
sive symptoms, rather that previously supported in-
teraction of increased bottom-up emotional reactivity
and decreased top-down PFC regulation of emotion
(Brooks et al., 2009). Additionally, the changes in PFC
activation through psychotherapy and pharmacolog-
ical treatment are currently linked to the differentia-
tion of tonic or resting-state activation and event-re-
lated responses, not merely decreases of bottom-up
and increases of top-down regulation (Walter et al.,
2009).
Russian psychology
Introduction
The Russian troika
Modern-day Russian psychology has its roots in
the 1920s when the remarkable group of Soviet re-
searchers, “the Russian troika” (Rossouw & Kostyan-
aya, 2014) - lead by Lev Vygotsky, started a thorough
Volume 3 Issue 1 (2015) 76
examination of broad psychological phenomena. The the external activity of a person and can be internal-
general line of their research inquiry was manifest- ised further during the lifespan of a person. Another
ed by the ambitious desire of young Alexander Luria important principle is that consciousness is charac-
to take part in “the creation of an objective approach terised by systemic structure and all higher mental
to behaviour that concentrated on real-life events” functions are related to each other. Therefore, in order
(Luria, 1979, p. 25). to understand a singular function one should analyse
Both due to the peculiar state of global psychology the system as a whole (Luria, 1973; Vygotsky, 1978).
as a scientific discipline of that time and to socio-his- Importantly, the “progressive” significance of Vy-
torical context of the ‘motherland’, Vygotsky and his gotsky’s postulates recognised by his disciples is seen
colleagues seemed to have a clear view on what should in the “dynamic” vision of human mental processes:
be studied. According to Luria and Alexei Leontiev, the functions themselves occur in the process of child
at that time they aimed to establish the materialistic mental development and change their interconnect-
study of human mental activity (Homskaya, 2001). edness due to their transition to more complex forms
For better understanding, it is important to men- of mental activity (Homskaya, 2010).
tion that these researchers tried to define themselves The study of the concept of “meaning” was among
somewhere in between the “idealistic” and “natural- the latest collaborative research attempts of the troi-
istic” approaches to human processes with particular ka (Homskaya, 2010). Soviet investigators were par-
attention to the main postulates of the philosophy of ticularly interested in its origins and development in
Marxism. Several core research themes can be identi- cultural, social and psychological contexts (Gredler
fied in the mutual works of the troika, while particular & Shields, 2008). Researchers stated that “mean-
interests of each of the researchers are presented in the ing” finds its representation in a word and mediates
following paragraphs. the process of immediate sensuous reflection of the
Soviet psychologists were primarily concerned world (Homskaya, 2010). The word here is seen as
with the problem of consciousness or, in other worlds, being inseparable form the meaning and vice versa.
with understanding what constitutes the psychology In order to examine the psychological meaning one
of human beings and how they are different from oth- should examine the word in its function of generalisa-
er species (Homskaya, 2010). Thus, the Russian troi- tion process, which was reflected in troika’s studies of
ka devoted its primary attention to the cultural and the formation of notions (concepts) among children
historical development of higher mental functions via (Homskaya, 2010).
mediation processes of speech and mnemotechnics as While promoting and supporting the outlined
specific outcomes of the cultural development of so- general postulates of soviet psychological framework,
ciety. To explain mediation1 processes, Vygotsky put each of the researchers concentrated on a particular
forward the notion of “a sign”, emphasising that hu- aspect of the framework, and in accordance with their
man mental processes are mediated by the tools which individual interests: Luria (1973) was generally con-
have “meanings” and not just cognitive meanings, cerned with cerebral organisation of mental functions,
but also psychological (Vygotsky, 1999). The second Vygotsky (1978) was primarily focused of socio-cul-
major idea of soviet psychological framework is that tural aspects of human functioning and Leontiev
the activity of a person in altering his or her environ- (1979a) further introduced his own theory of activity.
ment plays a crucial role in the process of mediation
of higher mental functions and mastering specific hu-
man behaviour (Homskaya, 2010). As a result, con- Alexander Romanovich Luria
sciousness is referred to as a specific human form of Alexander Luria was the founder of Russian neuro-
reflection, which is created by external conditions and psychology who based his studies on the above-men-
complex social forms of practical activity. tioned general psychological framework of the Russian
Further, the research group devoted its inquiry to troika and came up with the unique considerations in
the main principles of the development of the human the area of brain and mind interaction (Kostyanaya
mind or the study of the systemic and dynamic struc- & Rossouw, 2013; Rossouw & Kostyanaya, 2014). In
ture of mind/consciousness (Homskaya, 2010). The Russian domain of neuropsychology is seen as a field
core principle of the study suggested that the structure that emerged in between psychology, medicine and
of specific human mental processes is formed through physiology, where the central theme was represented
1 According to Vygotsky, all higher mental functions are by the study of cerebral organisation (localisation) of
mediated by psychological tools such as language, signs, and mental functions (Homskaya, 2010).
symbols (Karpov & Haywood, 1998)

77 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

 Homskaya (2010) notes that the three following
questions were of particular interest for Luria and de-
termined his investigation into human mind and brain
interaction: 1) What constitutes a mental function as
a psychological phenomenon? 2) What constitutes the
brain as the substrate for mental functions or what are
the main principles of its organisation? 3) How can
mental functions be associated with brain structures?
As a result of combining Luria’s queries with those
of Vygotsky and Leontiev, the highest human mental
function in Soviet psychology was recognised as a
complicated form (configuration) of mental activi-
ty, comprising; driving motives, goals (programme),
executional elements (actions and operations), and
control mechanisms (Homskaya, 2010). Also, the
researchers underlined that higher mental functions
take up the supreme position as they arise during
one’s lifetime, are mediated by psychological tools and
voluntarily controlled.
It is worth noting that it was Luria who in the ear-
ly 1920s began his thorough investigation in the ar-
eas of philosophy, psychology and medicine at Kazan
University, which later allowed him to attract Vygotsy
and Leontiev in Moscow and set up the Russian troi-
ka (Kostyanaya & Rossouw, 2013). Those years were
the time of a totalitarian regime in Soviet Russia as
well as political repression, lack of freedom, isolation
from the world scientific communities and propogan-
disingand politisation of the social sciences (Gindis,
1991; Sokolova, 2005). The historical turmoil of these
times disrupted research in many ways, preventing
investigators studying diverse areas of their interests
because of thorough scrutiny and political censor-
ship. Therefore, Luria himself as well as his colleagues
and disciples mention that his scientific progression
was “somewhat incoherent” (Kostyanaya & Rossouw,
2013, p. 48), however, several core themes can be
identified throughout his career .
Interestingly enough, some historical accounts
of Soviet psychology question whether the scientif-
ic achievements which emerged should be initially
credited to Marxist-Leninist methodology, or rather
if they emerged in spite of this ideological pressure
(Gindis, 1991; Lomov, 1984). Thus, the beginning of
the 1920s in the Soviet Union was marked by the troi-
ka’s research in the area of “pedology” or “the inte-
grative science of a child as a whole entity” (as cited
in Gindis, 1991, p. 169). The researchers were driven
by the ideas of the plasticity of human nature, the pow-
er of social conditioning and the capability of scientific
methods. These ideas as well as the troika’s empha-
sis of qualitative methods and individual differenc-
es in children, were criticised by the authorities and
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
recognised as harmful for the “social state” (Gindis,
1991, p. 170). However, as Gindis states, “a science has
its own logic of development and intellectual activity
cannot be reduced simply to reaction to political en-
vironment” (p. 170). In this vein, the initial postulates
about human capacities and the plasticity of human
nature were further incorporated by Luria in his re-
search on analysis and restoration of human mental
functions (Luria, 1963, 1966, 1973, 1976, 1979).
Before meeting Vygotsky at the Second Psycho-
neurological Congress in Leningrad, Luria had al-
ready began his well-known collaborative work with
Leontiev on the combined motor method, which led
to the development of the first lie detector in the So-
viet criminal justice system (Kostyanaya & Rossouw,
2013). This first investigation in complex human
behaviour through the analysis of the influence of af-
fective reactions on motor reactions was followed by
Luria’s research on the planning and regulating role
of speech as well as on aphasia and abnormal onto-
genetic development in children (Glozman, 2007).
In the years of troika’s collaborative work Luria both
managed to contribute to the development of the cul-
tural-historical approach to psychology and pursue his
own interests (Kostyanaya & Rossouw, 2013). He en-
gaged in numerous studies on the role of heredity and
external factors in mental processes (Luria, 1979), on
the localisation and restoration of cerebral impair-
ments and related functions, which was eventually de-
scribed in one of his major works, The Working Brain:
An Introduction to Neuropsychology (Luria, 1973).
Among the most significant of Luria’s concepts that
he introduced during the post-war period is that of
the three principal functional units of the brain re-
sponsible for human mental processes and conscious
activity (1973): the unit for regulating tone and waking;
the unit for obtaining, processing, and storing informa-
tion, and the unit for programming, regulation and ver-
ifying of mental activity. He claimed that those units
possess hierarchical structure comprising three cor-
tical zones: the primary (projection) area; the second-
ary (projection-association) area, and the tertiary areas
(zones of overlapping). In his neuroscientific analysis
Luria underlined that human mental processes repre-
sent complex functional systems that involved groups
of brain areas working in collaboration (Kostyanaya &
Rossouw, 2013).
During the last years of Luria’s career and life he
concentrated on a new approach to the structure of
memory processes, new areas of neuropsychology
(i.e., neurolinguistics) and the study of the interre-
lationship between brain hemispheres (Kuzovleva &
Volume 3 Issue 1 (2015) 78
Das, 1999). His theoretical ideas found their practical ies in psychology of abnormal children, which later
application in Luria’s unique clinical approach to the became the Experimental Institute of Defectology
development, application and interpretation of neu- (Vygotskaya, 1999). At that time various professionals
rospsychological assessment (Ardila, 1992; Lewis et from related fields as well as parents and relatives of
al., 1993). suffering children would attend Vygotsky’s case pre-
sentations and his consultations.
Vygotsky is well-known for his major account of
Lev Semyonovich Vygotsky the cultural-historical theory of mental development,
Lev Vygotsky is one of the most recognised Russian which has been scattered across his numerous works
psychologists, who’s works have been translated into and implemented in diverse domains, primarily in the
many languages, have been applied in diverse cultur- studies on child normal and abnormal development
al settings and have significantly influenced develop- (Gallagher, 1999; Gredler & Shields, 2008). Being
mental psychology around the world (Gallagher, 1999; driven by Marxist theory as well as by an objective ap-
Gredler & Shields, 2008; Homskaya, 2010; Karpov & proach to psychology, Vygotsky saw the main subject
Haywood, 1998; Kostyanaya & Rossouw, 2013; Louis, of psychological science in the study of consciousness
2009). He managed to leave behind about two hun- (Homskaya, 2010). His robust theoretical consider-
dred and seventy scientific works, when in 1934 at the ations nevertheless allowed Vygotsky highly develop
age of thirty-seven he died of tuberculosis, which not his theory which was applied both in educational and
easily curable at that time in Russia (Gallagher, 1999). clinical areas of practice (Gredler & Shields, 2008;
Among the most obvious factors, which influenced Homskaya, 2010).
Vygotsky’s trajectory of work and, in particular, his
When analysing human development as well as
development of cultural-historical theory, Gredler &
the development of any given individual, Vygotsky
Shields (2008) found that the socio-historical context
came to the major conclusion that human ontogene-
of the Soviet Socialist Republic, influenced his talents
sis is determined by both natural (organic maturation)
and methods of scientific analysis.
and cultural developmental plans (Homskaya, 2010).
Vygotsky’s early childhood interests in history, art, According to Vygotsky, it is exactly in the process of
literature, and theatre were among the precursors of the historical development of social human beings that
his future scientific advances, the first of which was his changes the means of mastering their behaviour and
thesis on Shakespeare’s tragedy of Hamlet, recognised develops human beings unique, higher and cultural
by many leading scholars in the field and followed by forms (Homskaya, 2010). In case of applying the the-
his studies in the psychology of art (Bayanova, 2013). ory to the development of a child, Vygotsy postulat-
After his glorious presentation in 1924 on “Methods ed that social interaction takes the major role in con-
of Reflexological and Psychological Investigation” at tinuous changes in children’s thoughts and patterns
the Second All-Union Psychoneurological Congress of behaviour, which can be quite complex in diverse
held in Leningrad, Vygotsky joined Luria and Leon- cultures (Gallagher, 1999). Vygotsky proposes that de-
tiev at the Moscow Institute of Experimental Psychol- velopmental processes rely on the cultural tools which
ogy. This time is recognised by his colleagues as “the can be passed from individual to individual in three
turning points” in their careers (Luria, 1979), as it was main ways: through imitative learning, instructed
the start of many fruitful research pathways for Rus- learning, and collaborative learning (Gallagher, 1999).
sian psychological science. The psychological tools Vygotsky defined as “intellec-
In the following years of continuous battles with tual mechanisms or operations which we use to exam-
tuberculosis, Vygotsky managed to defend his disser- ine our environment and interact with others” (Louis,
tation on “The Psychology of Art”, write an outstand- 2009, p. 20). Among the most profound cultural tools
ing methodological essay on the “Historical Meaning he proposed were, symbols, written and oral language,
of Crisis in Psychology” as well as his major works in maps, and the scientific method (Gredler & Shields,
the fields of education, abnormal psychology and cul- 2004).
tural-historical approach to psychology: “Pedagogical Gallagher (1999) outlines several major principles
Psychology”, “Thought and Speech”, “History of the of Vygotsky’s theory of child cognitive development
Development of Higher Psychological Functions”, and which also relates to the broader framework he ap-
“Problems of Mental Retardation” (Vygotsky’s theory, plied to the psychology of human mental functions.
2010). In 1926, after finishing his degree in medical Firstly, private speech is used by children for planning
training, Vygotsky established the laboratory for stud- and guiding their own behaviour. Most frequently

79 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

children use private speech when the tasks they are
performing become too difficult for them to accom-
plish without appropriate assistance. As a result, the
second principle refers to Vygotsky’s concept of the
zone of proximal development (ZPD) or the difference
between the actual development level as determined
by individual problem solving and the level of poten-
tial development as determined while problem solv-
ing under adult guidance or in collaboration with
more knowledgeable peers (Louis, 2009).
Therefore, the success of learning and cognitive
development depends on the ability to perform tasks
within the individual’s ZPD. Additionally, the learn-
ing process that leads development should possess
two main features: subjectivity and scaffolding (Galla-
gher, 1999; Louis, 2009). Subjectivity takes place when
during the learning process two individuals begin the
task with different understanding and eventually end
up with a shared understanding. Scaffolding refers to
the change in the assistance of a more knowledgable
person from intensive to reduced, while the skills of
the learner improve. In addition, Vygotsky claimed
that every mental function in the child’s cultural de-
velopment appear twice: firstly, while in communica-
tion with others (interpsychologically) and afterwards
inside the child (intrapsychologically), where the ac-
quisition of language plays the most influential role
(Vygotsky’s theory, 2010). Generally speaking, the
theme of most of Vygotsky’s works refer investigators
to the emphasis on the social learning, cultural expe-
riences and inner strengths of a person in develop-
mental processes.
Alexei Nikolaevich Leontiev
Alexei Leontiev is the eminent Russian researcher,
who in the 1930s formed the Kharkov school of psy-
chology that focused on the activity approach to psy-
chology, which to the present day remains the main
psychological doctrine in Russia (Sokolova, 2005).
Several investigators have tried to analyse what im-
pacted the polarisation of Vygotsky’s and Leontiev’s
views as well as whether it actually took place upon
foundation of the Kharkov school of psychology (Ko-
zulin, 1996; Leontiev, 2005; Sokolova, 2005). The ma-
jor conceptual contention between the two Russian
investigators was described in Leontiev’s “Study of
the Environment in the Pedological Works of L.S. Vy-
gotsky” published only in 1998 (Sokolova, 2005). In
this work Leontiev for the first time emphasises that
the source of psychological development lies in the ac-
tivity of a subject in the environment, but not solely in
the environment.
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
It is important to mention, that Leontiev also
shared the most fundamental postulates of the cultur-
al-historical theory initiated by Vygotsky (Sokolova,
2005). In particular, he endorsed Vygotsky’s dialecti-
cal removal of the dichotomy between environment
and heredity in Western experimental psychology.
Leontiev emphasised the necessity to explore “the
unity of the subject and his environment” (as cited
in Sokolova, 2005, p. 4), however, he also stated that
Vygotsky’s concept of experience cannot explain the
importance of the relationship “that personality enters
the reality that surrounds it”. Instead, he offers the cat-
egory of “meaning”, which within the context of activi-
ty transforms any socio-historical fact of a subject into
a psychological one (Sokolova, 2005).
When analysing and comparing the most prom-
inent Soviet psychological developments, some au-
thors tend to reflect on the socio-political impact of
the times when both Vygotsky’s and Leontiev’s theo-
ries happened to emerge (Kozulin, 1996). Thus, when
acknowledging the mutual sociocultural framework
of research of both Vygotsky and Leontiev, Kozulin
(1996, p. 328) states that Leontiev was more restricted
by “internal censorship” and “outright opportunism”
of Marxism, masking his “true thoughts and inten-
sions”. Kozulin (1996, p. 329) writes that the major
focus of Leontiev’s works was made on the develop-
ment of a coherent and robust psychological model
where “labor as a paradigmatic human activity be-
comes a source of psychological development of the
individual”. The author concludes that Leontiev’s late
focus on the meaning and the motives of human ac-
tivity was “poorly articulated”, which was indeed lat-
er acknowledged by Leontiev’s followers and which
has now been thoroughly examined by Russian and
foreign psychologists around the world (Baumeister
& Vohs, 2002; King & Hicks, 2012; Leontiev, 2005b;
2012; 2013; Reker & Wong, 2012; Schnell, 2009).
As a result, Leontiev proposed the psychologi-
cal examination of human mental processes from
the perspective of three different levels of analysis
(Rossouw & Kostyanaya, 2014). The highest and most
generic level refers to motives that drive human activ-
ity. The intermediate level is characterised by actions
and their associated goals, and the lowest level is the
analysis of operations which can serve as means for
achievement of the higher-order goals. In addition,
Leontiev was particularly concerned with the activi-
ties which can eventually lead to the internalisation of
external human actions in the form of inner mental
processes (Kozulin, 1996).
Together with other members of the Soviet psy-
Volume 3 Issue 1 (2015) 80
chological school, Leontiev was involved in diverse
experimental studies (Sokolova, 2008), which in turn
prompted his unique conceptualisations of funda-
mental psychological ideas through the lenses of his
theory of activity. Thus, with reference to Vygotsky’s
analysis of mediation processes, Leontiev studies the
formation of memory and attention as higher human
mental functions (Leontiev, 1979b). When adminis-
tering his method of double-stimulation, Leontiev
proved Vygotsky’s hypothesis on the development of
higher mental functions via the internalisation pro-
cess of signs/stimuli (Sokolova, 2008). As a result of
his studies, Leontiev described the development of
memory and attention processes from pre-associative
to associative and mediated. It was endorsed by Le-
ontiev that speech plays one of the major roles in the
mediation of higher mental functions, while recom-
mendations for future research were made in favour
of the analysis of human needs and affects.
It is worth to mentioning that among his most
prominent concepts was the idea of the “subject-ob-
ject continuum” or, in other words, understanding the
person within the world (Leontiev, 2000) as well as the
related conceptualisation of personality “as a type of
junction connecting the development of the society
and the individual (“subjective development”) (Le-
ontiev, 2005a, p. 46). Leontiev strongly believed that
the new psychological dimension should constitute
the study of people’s place and position within the sys-
tem of social connections and communications or the
study of what is “innate” in people together with what
they “acquire” (Leontiev, 1983).
The practical application of Leontiev’s activity the-
ory has been primarily established in the domain of
human-computer interaction, in particular, in the in-
teraction design, promoted by the proponents by the
computer-supported collaborative work communities
in different countries (Kaptelinin & Nardi, 2006).
Comparing and contrasting the
two paradigms
In the previous two parts of this paper the de-
velopments of Soviet psychological school and the
foundations of a neuropsychotherapeutic framework
were discussed. The final part of this paper presents a
critical reflection on what is similar between the two
paradigms and what allows their theoretical compari-
son, how they differ, and what are the future perspec-
tives in terms of their mutual impact. It is worthy to
note that the comparison of these particular areas of
81 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
knowledge is not found in any of the relevant litera-
ture and thus constitutes the novelty and the signifi-
cance of this analysis.
Core similarities and differences between
the paradigms
When taking into account the levels of methodol-
ogy of scientific knowledge offered by contemporary
Russian personality psychologist Asmolov (1990),
several core points of similarity between the two para-
digms become evident.
At the highest level of methodology or, in other
words, when comparing the philosophy or the world
view of the investigators of both paradigms, it is clear
that the major goal of past and present investigators
was to understand the “human condition” (Rossouw,
2014) via creation of robust explanatory models. For
Luria and his colleagues (Luria, 1979) the Soviet re-
gime was the time to fulfil the “primary ambitions” of
becoming psychologists and taking part in the “cre-
ation of an objective approach to behaviour that con-
centrated on real-life events” (as cited in Kostyanaya
& Rossouw, 2013). In addition, it was precisely the
problem of consciousness and the following interac-
tion between the mind and brain which were of the
most importance for Soviet psychologists (Homskaya,
2010). By the same token, the major goal of one of the
founders of neuropsychotherapy - Klaus Grawe - was
in the formulation of a “grand theory of psychopathol-
ogy and psychotherapy” (Grawe, 2007, p. xxi), which
takes “patients’ experience seriously on all levels”.
Here, Grawe (2007) also emphasises that his major in-
terest is in the neuroscientific explanations for an “in-
tegrative” or “generic” psychotherapeutic framework
based on his consistency-theoretical model of mental
functioning.
However, the principle difference between the two
paradigms emerge around the highest level of meth-
odology. In line with Western experimental psychol-
ogy of the 19th and 20th centuries, Soviet investigators
were mostly concerned with explaining general psy-
chological principles of mental functioning (Fancher,
2006; James, 1981; Luria, 1932; Titchener, 1902; Vy-
gotsky, 1978, 1987). Moreover, as mentioned in pre-
vious sections, the main attention of their work was
given to the impact of society and culture in general
on the development of higher mental functions which
were claimed to differentiate human beings from other
species (Vygotsky, 1978). It was predominantly during
the World War II and its aftermath with the treatment
and rehabilitation of veterans, when the Soviet school
Volume 3 Issue 1 (2015)
of psychology shifted from pure theory to its practical
applications (Homskaya, 2010; Luria, 1979). Addi-
tionally, during the last years of the Soviet era, Russian
psychologists started to became more and more inter-
ested in the problem of personality, therefore, referring
to the role of context and internalisation of meaning in
human functioning; and started to see the future of
psychology in the thorough analysis of idiosyncratic
psychological phenomena rather than of generic phe-
nomena (Homskaya, 2010; Leontiev, 2000).
By contrast, the proponents of a neuropsychothera-
peutic framework emphasise that neuropsychotherapy
refers to a “neuroscientific perspective on the prob-
lems of psychotherapy” (Grawe, 2007, p. 14) as well
as to the “practical implications that emerge from
this perspective”. According to Rossouw (2014, p.
3), neuropsychotherapy aims to “understand the
pathogenesis of wellness as well as the pathogenesis
of psychopathology”, to allow practitioners to better
understand how they can restructure the brain to-
wards “higher levels of functioning and well-being”
(Rossouw, 2011). Therefore, despite being initiated
by the very similar goal of creating a generic explan-
atory model of human functioning, the Soviet school
of psychology can be characterised as predominantly
theoretical and meeting the requirements of classi-
cal scientific psychology, while neuropsychotherapy
is a specifically applied area of knowledge (Rossouw,
2014; Walter et al., 2009).
When, referring to the next two levels of meth-
odology (Asmolov, 1990), the general and concrete
principles/methods of scientific inquiry, one can also
find various corresponding concepts introduced in
both paradigms of concern. Interestingly enough, the
unique ideas of each of the members of the Russian
troika (Kostyanaya & Rossouw, 2014) can be directly or
indirectly traced in the consistency-theoretical model
of mental functioning and its therapeutic implications
suggested by Grawe (2007). For instance, Leontiev’s
(2000) argument on the premiere role of activity, and
related motives, goals, and actions as well as general
active stance of a person in changing environments
which contributes to the understanding of human de-
mential functioning,corresponds remarkably with the
notion of approach and avoidance motivational sche-
mas in Grawe’s model (2007). Thus, in parallel to Le-
ontiev’s (1979) emphasis on human motivation as the
driving force of activity, Grawe (2007, p. 348) states
that “congruence and consistency refer to the motivat-
ed aspects of mental functioning” and that in order
for therapy to be effective, the neuropsychotherapist
should question “the factors that move a person, both
positively and negatively” (2007, p. 164).
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
The fundamental assumption of the neuropsycho-
therapeutic framework is that the therapeutic out-
come depends on “the extent to which the therapy
manages to achieve consistency improvements in the
patient’s mental functioning” (Grawe, 2007, p. 353).
It is also recognised that the improvement of consis-
tency can be achieved: via disorder-oriented treatment,
experiences in the therapy process and the treatment of
individual sources of incongruence (Grawe, 2007, p.
353)). The onset of psychopathology as well as the fre-
quently presenting “anxious brain” in clients is seen to
emerge as a result of compromised or violated basic
needs and following “protective action” of avoidance
motivational schemas (Rossouw, 2014, p. 16). Clients
in these psychopathological conditions need “an ex-
pert outside perspective”, while “getting outside help”
also refers to “influencing one’s neural structures via
someone with other neural structures” (Grawe, 2007,
p. 355). Here the author indirectly mentions not only
the significance of mirror neurones as possible me-
diators of the neuropsychotherapeutic interventions
(Rossouw, 2010), but also refers to “challenging incon-
gruence situations” as a mean for clients’ mastery of
behaviour and experiences (Grawe, 2007, p. 222). In
other words, “the motor of metal development” and
following enhancement of clients’ well-being is seen
in controllable incongruence, which can be reached
when the individuals are confronted with situations
that can be potentially achieved; when one devel-
ops “potentials beyond the currently attained level”
(Grawe, 2007, p. 222).
Those fundamental neuropsychotherapeutic con-
ditions that aim to enhance clients’ well-being can be
compared with the conditions for the development
of the higher mental functions and cognitive devel-
opment of human beings in general, postulated more
than half a century ago by Vygotsky (Louis, 2009). Ac-
cording to Vygotsky, effective learning and cognitive
development can only occur when a learner is con-
fronted with a task that seats within his or her zone of
proximal development (see Russian psychology part).
The effectiveness of a person’s cognitive development
also depends on the possibility of scaffolding, where
the assistance of a more knowledgeable person de-
creases according to the continuous mastery of the
learner’s skills. In that sense, neuropsychotherapy can
be metaphorically related to the formation of new
higher mental functions of the client that are deter-
mined by their needs and baseline capabilities. Both
paradigms pay particular attention to the strengths of
clients, which neuropsychotherapy and cognitive de-
velopment (in the case of Vygotsky) are built upon
(Grawe, 2007; Homskaya, 2010).
Volume 3 Issue 1 (2015) 82
 The unique ideas of Luria in regards to mind and genetics that underlines the role of environment
brain interactions have most similarity to the neuro- for brain functioning allow changes in clients at the
psychotherapeutic views on the importance of neuro- “neuro-structural, neurochemical and neural net-
science for psychotherapeutic practice. Thus, Kostyan- work levels” (Rossouw 2004, p. 7). The Soviet school
aya & Rossouw (2013) state that Luria’s description of of psychology was primarily concerned with another
the bottom-up development of the brain (Luria, 1973) level of analysis of human functioning, pertaining to
is very similar to neural research implemented by Paul general psychological principles and with the empha-
MacLean (1990) and his conceptualisation of the tri- sis on the role of social interaction (Homskaya, 2010).
une brain. The understanding of fundamental neuro- Therefore, when looking at the two paradigms from
scientific processes is essential for practitioners when the perspective of biopsychosocial-spiritual approach
implementing theory in practice, which has been to human functioning (Greenberg, 2007), each of the
reiterated by major investigators in the field (see, for paradigms have their main focus of inquiry, as aiming
example Grawe, 2007; Kandel, 1998; Rossouw, 2014). to be all-encompassing.
Rossouw (2014, p. 8) underlines that the emerging The two analysed paradigms significantly differ on
paradigm of mental health care focuses on linking the last level of methodology, i.e., the level of methods
the bottom-up and top-down approaches, where “the and techniques of inquiry (Asmolov, 1990). The neu-
key feature of neuropsychotherapy - the need to fa- ropsychotherapeutic framework allows the therapist
cilitate cortical capacity rather than assuming cor- to use techniques of whichever therapeutic stance, as
tical capacity”. By the same token, Luria developed long as she addressees clients’ needs and the outlined
a specific series of tests and tasks for restoration and above therapeutic strategies (Grawe, 2007). Grawe
correction of compromised mental functions in his also offered and successfully tested a particular ques-
patients, primarily based on his conceptualisation of tionnaire, the Inventory of Approach and Avoidance
the three principle functional units of the brain (Luria, Motivation, which can help a neuropsychotherapist
1973; Purisch & Sbordone, 1986). Similar to most of to identify clients’ motivational goals, “particularly
the proponents of neuropsychotherapy (Rossouw, pertinent in the context of psychotherapy” (Grawe,
2014), Luria believed in the flexibility of the substrate 2007, p. 259). With regard to the Soviet school, the
and the ability of compensative mechanisms to take most pronounced series of specific psychological
place when appropriate neuropsychological assistance techniques was offered by Luria (Purisch & Sbordone,
is available for those suffering psychological incapaci- 1986). The distinctive feature of the Luria-Nebraska
ty (Luria, 1973). neuropsychological test is that it is useful for a wide
The main difference on the level of concrete prin- range of issues that addresses diverse psychological
ciples and methods between Soviet psychological de- conditions and has proven to be effective in different
velopments and those of neuropsychotherapy comes cultures (Purisch & Sbordone, 1986). However, here
from the present-day availability of such technologi- again the main focus is on the most fundamental psy-
cal tools as neuroimaging (Walter et al., 2009). While chological processes and their distortions, relating to
foreshadowing the “beginning of a new intellectual the domain of neuropsychology.
framework”, (Kandel, 1998, p. 457), psychiatrists have
envisioned gaining knowledge in different ways, but
those of the troika were “fully comparable to that of Future considerations
a well-trained neurologist” (p. 466). Research shows The above comparative analysis of the neuropsy-
that neuroscientific knowledge is indeed incorporated chotherapeutic framework and Soviet elaborations in
into current treatment practice [see for example eye psychology allows us to mark how the two paradigms
movement desensitisation and reprocessing in ther- could mutually contribute to each other’s trajectories
apy for post-traumatic stress disorder (Raboni et al., of future development and enhancement. Two major
2006)]. directions for future consideration become apparent
Rossouw (2014, p. 7) argues that neuropsychotherapy at this stage of the analysis, each of which has also
focuses on “the neural basis for understanding the hu- been acknowledged by some researchers in the re-
man condition” and that allied neuroscientific fields lated fields in their individual works (Gindis, 1991;
contribute to psychotherapeutic theory and practice Rossouw, 2014).
in multiple ways. For instance, the latest knowledge Thus, Rossouw (2014) argues that contemporary
on gene expression, on fundamental neural princi- neuropsychotherapy focuses both on neurobiology
ples (see, for example research by Donald Hebb and and interpersonal interactions which are the essential
Michael Merzenich), as well as developments in epi-
83 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
markers of pathology and wellness and which cre-
ates the neuroscience of the “interconnectedness of
us”. Here the focus is given to the role of the society
in shaping human functioning, which also was men-
tioned by Grawe (2007) when underlining the neces-
sity of the analysis of clients’s needs in their contexts
and specific environments. This trajectory for future
neuroscientific consideration could draw upon more
thorough analysis of the fundamental Soviet psycho-
logical principles of the formation of human men-
tal functions. The concept of mediation (Karpov &
Haywood, 1998) and the principles of the creation of
personal meaning (Leontiev, 2012; 2013), dependant
on cultural and individual contexts, could better in-
form professionals about inner worlds of their clients.
Also, certain concepts (yet to be thoroughly analysed)
could shed more light on the psychological process-
es of mental conditions. For example, the concept of
shifting motives onto goals introduced by Leontiev
(2006) could be used as an explanatory concept for
the understanding of the mechanisms of addictive
behaviours. Therefore, Soviet psychology could serve
as the additional theoretical source for a neuropsy-
chotherapeutic framework, if further more thorough
analysis of the known and not so well known concepts
is undertaken.
By contrast, starting from Leontiev’s proposition
of the necessity to analyse personality and its features
(Homskaya, 2010), it has been further noted that So-
viet and later Russian psychological schools need to
divert attention from purely theoretical to more prac-
tical problems in order to make psychology more ap-
plicable to the needs of the society (Gindis, 1991). In
1989 it was noted that in the USSR there were about
5000 psychologists, 12 universities and two peda-
gogical institutes where psychologists could achieve
highly recognised academic degrees (Gindis, 1991).
By 2005 there were already 400 universities across the
country, with 5000 psychology graduates each year
(Sokolova, 2005). It was the time of “perestroika” (or
rearrangement, structural adjustment), when the first
private practices in psychology started to emerge with
less stigma for clients asking for psychological support
and help (Sokolova, 2005). However, as it was noted in
the past by Gindis (1991) and can be confirmed by
the experience of the author of this paper, most of
the psychology graduates in Russia are still trained
predominantly as academic researchers, rather than
practitioners. Also, in line with previous claims about
the lack of availability of foreign psychological liter-
ature and corresponding scientific communication
in Russia (Tulviste, 1988), it can be stated that there
are still a lot of hindrances for Russian psychological
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
schools to duly perform on a global scale. Therefore,
the above comparative analysis of the two paradigms
suggests that while having very similar theoretical as-
sumptions with the Soviet school, a neuropsychother-
apeutic framework could be further modified and in-
corporated into Russian psychological practice, where
robust psychotherapeutic approaches are in extremely
high demand (Gindis, 1991). Additionally, current
conceptualisations of psychotherapeutic processes
(explained with reference to mirror neural networks
and epigenetics) could serve as robust theoretical
ground, the development of which has always been in
best interests of the Russian school of psychology.
Conclusion
According to a famous Russian proverb, “Every-
thing new is well-forgotten old” or translated into En-
glish “There is nothing new under the sun” . There-
fore, in the current time of the “dawn of the mental
health renaissance” (Rossouw, 2011, p. 3), this paper
aimed to build a bridge between uncovered Soviet de-
velopments in psychology and present neuropsycho-
therapeutic considerations.
Both paradigms have been discussed with a partic-
ular focus on their origins and corresponding scientif-
ic and societal demands. The first part of the paper fo-
cused on the consistency-theoretical model of mental
functioning offered by Klaus Grawe (2007) and most
recent conceptualisations of neuropsychotherapy as
a research field (Walter et al., 2009). The second part
outlined the main psychological developments of the
Russian troika (Rossouw & Kostyanaya, 2014), and
in particular the major contributions of Alexander
Luria, Lev Vygotsky, and Alexei Leontiev to the field
of psychology in the Soviet Union and later Russia.
In the third part of this paper the major similarities
and differences between the two approaches were an-
alysed in accordance with the four levels of scientific
methodology suggested by Asmolov (1990). Future
considerations in relation to how the two approaches
could further contribute to each others’ development
have also been discussed.
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discussion

the development of memory:

implications for learning and education

Pieter Rossouw

School of Psychology, School of Nursing, Midwifery and Social Work

The University of Queensland
p.rossouw@uq.edu.au

Crisis in Western Education end Australian indicated a problem in technique, with

an education expert pointing toward a narrative ap-
On 25 October 2014, the China Daily ran an
proach to learning, and the second article pointed to a
in-depth article “Homework seen as damaging to pu-
lack of cultural sensitivity and showed how this com-
pils in early years” (“Homework Seen”, 2014) in which
promises learning. All three articles addressed some
researchers discussed why teachers should avoid giv-
important issues that may be unrelated—or are they
ing homework to students until the last years of pri-
the proverbial tip of the iceberg?
mary school. One of my focuses in this discussion is
on how relationships between children and parents These articles should also be linked to the 5th
are compromised as a result of the change in roles Programme for International Student Assessment re-
when parents become co-teachers, as well as the lack port (PISA 2012) by the Organisation for Econom-
of effective socializing. ic Co-operation and Development (OECD) and key
findings (OECD, 2014). The report is based on results
On 29 November 2014, the popular Australian
from 510,000 students in 65 countries, aged between
newspaper, The Weekend Australian, ran a series of
15.3 and 16.2 years, representing 28 million 15-year-
in-depth articles on education, leading with the front
olds globally and 80% of the world economy. Demo-
page article “Writing’s on the wall: Kids failing basic
graphic information was collected via questionnaires
literacy” (Ferrari, 2014) followed by “National curric-
to students and their school principals regarding the
ulum railroaded by utilitarian bias” (Donnelly, 2014).
student’s background, the school, the learning envi-
The front-page article had a focus on the drop in liter-
ronment, and school systems. The results are not good
acy rates and the mechanics of grammar and writing,
news for most western countries (like Australia and
while the second focused more on the need for con-
the USA, for example), where students are found to be
textual learning.
slipping further behind in global rankings (Rossouw,
On face value these three articles have little in 2014). Some of the findings are:
common except an indication that something is not
• Shanghai-China had the highest scores in
well in the domain of schooling—that learning is suf-
mathematics, with a mean score of 613 points.
fering. The article in the China Daily suggested that
That is 119 points, or the equivalent of nearly
learning should be the domain of teachers, and that
three years of schooling, above the OECD av-
learning is compromised when it is enforced outside
erage. Singapore, Hong Kong-China, Chinese
of the school domain, where it becomes too much too
Taipei, Korea, Macao-China, Japan, Liechten-
young. This is a very interesting concept with signifi-
stein, Switzerland, and the Netherlands, in de-
cant implications. The front-page article in The Week-
scending order of their scores, rounded out the
89 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
 top 10 performers in mathematics.
• Of the 64 countries and economies with trend
data between 2003 and 2012, twenty-five had
improved in mathematics performance.
• On average across OECD countries, 13% of
students are top performers in mathematics
(Level 5 or 6). At these levels, students can de-
velop and work with models for complex sit-
uations, and they can work strategically using
broad, well developed thinking and reasoning
skills. The partner economy Shanghai-China
has the largest proportion of students perform-
ing at Level 5 or 6 (55%), followed by Singa-
pore (40%), Chinese Taipei (37%), and Hong
Kong (34%). At the same time, 23% of students
in OECD countries and 32% of students in all
participating countries and economies did not
reach the baseline Level 2 in the PISA math-
ematics assessment. At this level, students
should be able to extract relevant information
from a single source and use basic algorithms,
formulae, procedures, and conventions to solve
problems involving whole numbers.
• Between 2003 and 2012, Italy, Poland, and Por-
tugal increased their share of top performers
and simultaneously reduced their share of low
performers in mathematics.
• Boys performed better than girls in mathemat-
ics in 38 of the 65 countries and economies that
participated in PISA 2012, and girls outper-
formed boys in five countries.
• Shanghai-China, Hong Kong-China, Singa-
pore, Japan, and Korea were the five high-
est-performing countries and economies in
reading in PISA 2012.
• Of the 64 countries and economies with com-
parable data throughout their participation in
PISA, 32 improved their reading performance.
• On average across OECD countries, 8% of
students are top performers in reading (Level
5 or 6). These students can handle texts that
are unfamiliar in either form or content and
can conduct fine-grained analyses of texts.
Shanghai-China has the largest proportion of
top performers (25%) among all participating
countries and economies. More than 15% of
students in Hong Kong, Japan, and Singapore
are top performers in reading, as are more than
10% of students in Australia, Belgium, Canada,
Finland, France, Ireland, Korea, Liechtenstein,
New Zealand, Norway, Poland, and Chinese
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
Taipei.
• Between the 2000 and 2012 PISA assessments,
Albania, Israel, and Poland increased their
share of top performers and simultaneously re-
duced their share of low performers in reading.
• Between 2000 and 2012 the gender gap in read-
ing performance (favouring girls) widened in
11 countries.
• Shanghai-China, Hong Kong-China, Singa-
pore, Japan, and Finland were the top five per-
formers in science in PISA 2012.
• Between 2006 and 2012, Italy, Poland, and Qa-
tar, and between 2009 and 2012, Estonia, Isra-
el, and Singapore increased their share of top
performers and simultaneously reduced their
share of low performers in science.
• Across OECD countries, 8% of students were
top performers in science (Level 5 or 6). These
students can identify, explain, and apply scien-
tific knowledge, and knowledge about science,
in a variety of complex life situations. (OECD,
2014; Rossouw, 2014).
Reaction and Solutions
The reaction to the report and solutions of-
fered are also of interest. Notably, all western coun-
tries responded with a similar outcry—that the drop
in performance was due to funding cuts, and there-
fore more funds were needed, both to get more effec-
tive and highly trained teachers in the early education
system and to have more high quality facilities avail-
able to more students. Almost no focus was placed
on understanding the neuroscience of development,
memory, and learning—that neural development pro-
vides a fundamental basis of education, not just for
more effective learning (doing it better) but for doing
it right.
Memory and Learning
To understand education at its core is to un-
derstand the neuroscience of memory. Since Eric
Kandel demonstrated the neuromolecular pathways
of memory (Kandel, 1998, 2005; Kandel, Schwartz,
Jessell, Siegelbaum, & Hudspeth, 2013) it has become
clear that memory formation is not a mere process of
repetition and/or conditioning. In its essence, memo-
ry is synaptic connection: When synapses are formed,
memory is established; when synaptic connections
change, memory changes. As Joseph LeDoux showed,
Volume 3 Issue 1 (2015) 90
we are our synapses (LeDoux, 2005). Who we are and
what defines us are the multitude of neural connec-
tions and the intricate interactions between these con-
nections. The complexity of these connections (where
increasing complexity equates to cognitive reserve)
points toward high levels of capacity, and lesser con-
nectivity points toward lower levels of capacity. And
there is more: Neural activation is also reliant on ef-
fective neural highways and effective neural pruning.
Ineffective neural pruning leads to chaotic (albeit
complex) communication—a typical example is the
autistic brain where neural communication is com-
plex but due to ineffective neural pruning is not well
structured.
However, there is more to add before we can
consider aspects of the solution for more effective ed-
ucation. This is an aspect mostly forgotten when edu-
cation is discussed.
Education and Neural Development
The concepts of development and education
are closely aligned in modern education theory—the
developmental stages of giants like Jean Piaget appear
in almost every text on childhood development and
education. And yet, while the development of the
brain is well described in every neuroscience textbook
on paediatrics and developmental neuroscience, what
is of interest is how little attention is paid to the devel-
opment of the brain—or the significant implications
of neural development for memory formation—in
discussions about effective education.
Some of the key aspects that need to be inves-
tigated to maximize learning from a brain-based per-
spective are
• an overview of brain development with specific
links to memory formation and learning;
• the function of primitive survival memories
and learning (fear-based learning);
• emotional wellbeing and basic needs and im-
plications to memory formation;
• the development of higher order memory sys-
tems that define the development of self;
• memories of self in relation to others—the neu-
roscience of relationships; and
• education and learning as needs-based activity.
91 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
A Brave New Education System
To maximise learning through the develop-
ment of strong, healthy neural networks, well aligned
on social levels, is one of the cornerstones of a well
developing society. Neuroscience should play a pivotal
role in this endeavour.
References
Donnelly, J. (2014, November 29). National curricu-
lum railroaded by utilitarian bias. The W e e k -
end Australian. Retrieved from
http://www.theaustralian.com.au/national-affairs/
opinion/national-curriculum-railroaded-by-utili-
tarian-bias/story-e6frgd0x-1227138823814
Ferrari, J. (2014, November 29). Writing’s on the wall:
Kids failing basic literacy. The Weekend Aus-
tralian. Retrieved from
http://www.theaustralian.com.au/national-affairs/
education/writings-on-the-wall-kids-failing-basic-
literacy/story-fn59nlz9-1227138940282
Homework seen as damaging to pupils in early
years (2014, October 25). China Daily. R e -
trieved from http://www.chinadaily.com.cn/hkedi-
tion/2015-02/26/hk.html Kandel, E. R. (1998). A
new intellectual framework for psychiatry. Ameri-
can Journal of Psychiatry, 155, 457–469.
Kandel, E. R. (2005). Psychiatry, psychoanalysis and the
new biology of mind. Washington, DC: American
Psychiatric Publishing.
Kandel, E. R., Schwartz, J. H., Jessell, T. M., Siegel-
baum, S. A., & Hudspeth, A. J. (Eds.) (2013).
Principles of neural science (5th ed.). New York, NY:
McGraw-Hill.
LeDoux, J. (2005). Synaptic self: How our brains be-
come who we are. New York, NY: Penguin.
Organisation for Economic Co-operation and Devel-
opment (2014). PISA 2012 Results in focus.
What 15-year-olds know and what they can do with
what they know. Retrieved from http://www.oecd.
org/pisa/keyfindings/pisa-2012-results-overview.
pdf
Rossouw, P. J. (2014, January/February). The social
brain and education. Neuropsychotherapy in
Australia, 25, 4–11. Retrieved from
h t t p : / / w w w. m e d i r o s . c o m . a u / w p - c o n t e n t /
uploads/2014/03/e-Journal-Neuropsychotherapy-
in-Australia-Edition-25.pdf
Volume 3 Issue 1 (2015)
theory

social deficit hyperactivity disorder (sdhd):

a sibling of adhd?

Sandy Laurens & Pieter Rossouw

The University of Queensland

Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders,
affecting approximately 7% of the population, the exact cause of which is unknown. It is widely recog-
nized as a non-curable neurobiological behavior disorder, characterized by inattention, hyper¬activ-
ity, and impulsivity, and is routinely treated using stimulant medication and behavior modifica¬tion
techniques.
New research indicates a positive correlation between ADHD symptoms and physiological changes
associated with the increased release of the stress hormones norepinephrine, epinephrine, and corti-
sol, and a corresponding reduction in neurotransmitter levels of dopamine and serotonin. It is sug-
gested that these physi-ological changes in children may be directly attributed to prolonged exposure
to stress in early childhood, both in care facilities and the compulsory school system.
Ongoing research has linked bullying with similarly fluctuating neurotransmitter levels. Bullying
is a complex and subjective behavior pattern, destructive by nature, pervading every aspect of society,
and thought to affect 20% of the population. Given that bully behavior is characterized by morbid so¬-
cial behavior, hyperactivity and/or hyper-reality, and impulsivity, and predominates in the compulsory
school system, the parallel with ADHD is observed, making the choice of the label, social deficit hy-
perac-tivity disorder (SDHD), appropriate.
The authors believe that the impact bullying has on learning and working environments cannot be
quantified until SDHD is first recognized and accepted as a neurobiological behavioral disorder with
determinate criteria. Classification of SDHD would facilitate research into the hypothesis that ADHD
and SDHD are comorbid conditions and give the condition the attention it deserves.

Cite as: Laurens, S. D., & Rossouw, P. J. (2015). Social deficit hyperactivity disorder (SDHD): A sibling of
ADHD? International Journal of Neuropsychotherapy, 3(1), 92–100. doi: 10.12744/ijnpt.2015.0092-0100

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 92

 Attention deficit hyperactivity disorder (ADHD) is
a neurobiological behavioral disorder (Rief, 2005) that
is also referred to as a brain-based biological disorder
(“ADHD: A Biological Disorder,” n.d.), a behavioral
disorder (Hutchison, 2013), a neurobehavioral devel-
opmental disorder (Raposa & Perlman, 2012), a di-
mensional disorder of human behavior, and a chronic
physiological disorder (Rief, 2005). ADHD is evaluat-
ed and diagnosed by professional clinicians including
paediatricians, psychiatrists, clinical psychologists,
neurologists, clinical social workers, and family prac-
titioners (Rief, 2005) and is based on observable be-
havior characterized by inattention, hyperactivity, and
impulsivity (The Royal Australasian College of Physi-
cians, 2009).
Genetic predisposition is thought to be the most
likely and most common cause of ADHD (Nation-
al Institute for Mental Health, 2014), accounting for
about 80% of children with ADHD according to lead-
ing researchers (Rief, 2005). ADHD is one of the most
common childhood disorders; it usually appears be-
tween the ages of 3 and 6 and is typically diagnosed in
children before they reach the age of 7 years. ADHD
affects approximately 7% of the population and is 4
times more likely to affect boys than girls. ADHD can
be a lifetime affliction: It is not curable and is habitu-
ally treated with stimulant medication and/or behav-
ior modification techniques to control the symptoms
(National Institute for Mental Health, 2014).
The central nervous system stimulant medications
approved for use in children diagnosed with ADHD
Table 1. Stages of Psychosocial Development
Stage Maslow Erikson
1 Physiological Trust
2A Safety
2B Autonomy
3 Belonging / love Initiation
4 Self-esteem Industry
5 Self-actualization Identity
93 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY
have the same chemical structure as some potent ille-
gal drugs: Adderall is an amphetamine (street name:
speed); Dexedrine and Dextrostat are dextroamphet-
amines (street name: uppers); Desoxyn is a meth-
amphetamine (street names: ice, crystal meth); and
Ritalin, Concerta, Metadate, and Methylin are meth-
ylphenidates (street names: kiddy-cocaine, poor man’s
cocaine). These medications are available in short-act-
ing, long-acting, or extended-release varieties and
are approved for use in children age 6 and older; two
have an approved age of 3 years. Commonly report-
ed side effects of stimulant medications are decreased
appetite, sleep problems, anxiety, irritability, stomach
aches, and headaches (National Institute for Mental
Health, 2014). These side effects serve to compound
the problem behavior already associated with ADHD.
Behavior is a response by an individual in the con-
text of stimuli from the environment (Odendaal &
Meintjes, 2003) and can be viewed as being a nonver-
bal communication tool used to ensure the individu-
al’s needs are met. Behavior gives clues as to how an
individual is handling a situation with the onus on the
observer/facilitator to correctly interpret the behavior
to assist, where appropriate, an outcome where the
needs of the individual are met. Observable behavior
that suggests inattention, hyperactivity, and impulsivi-
ty in the ADHD diagnosis can be interpreted as a nor-
mal response to a stress stimulus where a flight or fight
reaction can be expected.
The fundamental need of an individual to be in a
state of physical and emotional safety is of primary
Rossouw Roberts
Safety Free from physical
restraint
Control
Attachment Choice
Pain avoidance/ Join-up (trust)
pleasure maximiza-
tion
Self (self-esteem) Follow-up (inter-
relationships)
Volume 3 Issue 1 (2015)
importance in each individual’s physical, emotional, promises the body’s innate ability to restore itself to
social, and cognitive development. Four theories that equilibrium (homeostasis), leaving it vulnerable to
support this assertion are: long-term nerve cell damage. Chronic stress may ul-
• Abraham Maslow’s hierarchy of needs timately lead to a depletion of norepinephrine, epi-
(Odendaal, 2002); nephrine, cortisol, serotonin, and dopamine (Selye,
1950). Symptoms associated with some of these phys-
• Erik Erikson’s stages of psychosocial develop- iological changes, as outlined in Jade (2014), Gloom
ment (Cherry, 2015); (2014), TheDEA.org (n.d.), and Schultz (2011), are set
• Pieter Rossouw’s neurobiological perspective out in Table 2.
(Rossouw, 2012, 2013a, 2014); and A comparison of the symptoms resulting from
• Monty Roberts’s philosophy of join-up (Rob- fluctuation in neurotransmitter levels and the diag-
erts, 2000). nostic criteria for hyperkinetic disorders could lead
one to conclude a correlation between chronic stress
The relevant stages of psychosocial development
and ADHD may exist. (See Table 3.)
according to these four models are summarized in Ta-
ble 1. Given that the onset of ADHD symptoms usu-
ally appear in children between the ages of 3 and 6,
Whilst each of these theories varies enormously in
and ADHD is usually diagnosed by the age of 7, it is
their approach, common threads are evident:
appropriate to consider what elements of stress have
1. The fundamental basis is safety. Pathology presented in these children during that time. As the
emerges when this need is violated or compro- compulsory age for school attendance is usually 6
mised (Rossouw, 2013b, 2014). years and is often preceded by a couple of preschool
2. There is a basic need for attachment with the preparation years, it is appropriate to suggest a signifi-
primary caregiver and the need to establish cant contributory source of fear and distress—and, ul-
trust. timately, chronic stress—may indeed be derived from
a child’s participation in early childhood care facilities
3. The ability of an individual to maintain control and the compulsory school system.
over their physical and emotional needs is de-
termined by the available choices and is depen- These facilities require children to leave their
dent on the foundational needs having been home environment—essentially a place of physical
met. and emotional safety—and the nurturing influence of
their trusted primary caregivers. Children are then ex-
4. Relationship stability is initiated by an indi- posed to a foreign environment, which, by virtue of its
vidual’s need for a sense of belonging and can unfamiliarity, in most cases invokes fear and distress
only be initiated successfully from a position of resulting in behavior appropriate for the situation,
self-control. instinctive survival behavior. This behavior is unfor-
5. A well-established self-esteem is wholly depen- tunately deemed inappropriate for the school envi-
dent on relationship permanence. ronment. The opportunity to regain a sense of equi-
librium at home is then thwarted by the requirement
6. A successful assimilation of self-worth paves
for children to comply with homework demands. As a
the way for a joyful realization of an individu-
result, the basic needs of safety, trust, and attachment
al’s true identity and potential.
are eventually eroded, the element of choice and con-
Optimal brain development occurs in an environ- trol is deprived, the prospect of self-determination is
ment where an individual’s primary needs are met, jeopardized, significant learning difficulties are expe-
where the needs are not compromised or violated. rienced, and lasting damage to the individual’s cog-
Such an environment is conducive to the release of nitive function is imposed (Rossouw, 2013a). Monty
neurotransmitters essential for the activation of open Roberts (2000), in his work with horses, shows that if
neural pathways. Violation of an individual’s basic fear is removed from the environment, both learning
needs triggers a stress response with corresponding and innovation can develop freely. The same can be
physiological changes, including an increased release said of children, as illustrated by the countless lives
of the stress hormones norepinephrine, epinephrine Robert’s has influenced through his equine facilitated
(adrenaline), and cortisol, and a decreased release interventions.
of the neurotransmitters serotonin and dopamine
The impact of the school environment on chil-
(Rossouw, 2012). Prolonged exposure to stress com-
dren’s behavior should also be considered in the con-
INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 94
 Table 2. Symptoms Resulting From Fluctuations in Norepinephrine, Serotonin, and Dopamine

Norepinephrine Norepinephrine Serotonin reduced Dopamine reduced levels

increased levels reduced levels levels
Alertness Fatigue Insomnia Fatigue
Energy Low energy Low energy
Concentration Lacks concentra- Impatience/impulsivity Distractible
tion
Focused Lacks focus Irritability Restless
Responsive General apathy Indifference Lacks motivation
Chronic boredom
Anxiety Lacks ability to feel pleasure and reward
Mood swings Inappropriate emotional responses
Sadness Lacks sense of attachment/feeling of
being loved
Aggressive behavior Lack of remorse about actions
OCD behavior includ- Addictive behavior
ing thoughts

Cravings (carbohy- Cravings (coffee, chocolate, carbohy-

drates, sugar) drates, sugar)
Appetite loss
Cognitive impairment Diminished academic achievement
Organizational diffi- Working memory (short term memory)
culties impairment

text of other causes implicated by reduced serotonin Notwithstanding the significance of a possible
and dopamine levels. Lack of sufficient sleep, lack of ADHD gene and nicotine involvement, the learned
physical activity, insufficient exposure to sunlight, and
behavior option is of particular interest in the context
nutritional deficiencies are all considered contributing
of this article. Just as a child learns to speak English in
factors in ADHD behavior. an English-speaking family, so too does a child learn
Another factor, genetic predisposition to ADHD, anxiety-reducing methods by imitating the same
suggests: methods used by the family members. Suffice to say,
if a child is not exposed to chronic stress prematurely,
An individual was born with presumed ADHD there should be no need for their survival instinct to
genes, thereby predisposing that individual to ADHD manifest—thereby eliminating or reducing a child’s
through genetic transference. need to experiment with or implement learned stress
An individual was exposed as a foetus to nico- management techniques.
tine, thereby predisposing the individual to ADHD The possible causes of ADHD and links to reduced
through environmental factors (National Institute for neurotransmitter levels are outlined in Table 4.
Mental Health, 2014)
Whilst ADHD is considered a neurobiological
An individual was born into a family where at least behavioral disorder, there is an equivalent social dis-
one parent/primary caregiver is diagnosed as having order that deserves recognition and consideration.
ADHD, thereby predisposing the individual to ADHD Social deficit hyperactivity disorder (SDHD) is the
through learned behavior. name we have given to what is commonly referred to

95 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

 Table 3. Elaborate Interpretation of the Diagnostic Criteria for Hyperkinetic Disorders Extracted From
DSM-IV and ICD-10 Tables
Diagnostic criteria for hyperkinetic dis- Suggested symptom Suggested neu- Suggested Suggested learn-
orders (The Royal Australasian College of of fluctuation in neu- rotransmitter communica- ing style prefer-
Physicians, 2009) rotransmitter levels involvement tion preference ence

Inattention Reduced levels Reduced levels

1. Is often easily distracted by exter- Distracted Dopamine Nonverbal Visual

nal stimuli
2. Often does not seem to listen Lacks focus Norepinephrine Nonverbal Not auditory
when spoken to directly
3. Often fails to give close attention Lacks concentration Norepinephrine Nonverbal Not visual
to detail
4. Often has difficulty sustaining Lacks concentration Norepinephrine Nonverbal Not tactile
attention in tasks or play activities
5. Often makes careless mistakes in Indifference/impatience Serotonin Nonverbal Not visual
school work or other activities
6. Often avoids or strongly dislikes Lacks motivation Dopamine Nonverbal Not visual
tasks that require sustained mental
effort
7. Fails to follow through on instruc- Lacks motivation Dopamine Nonverbal Not auditory
tions
8. Fails to finish schoolwork or Lacks motivation Dopamine Nonverbal Not tactile
chores
9. Is often impaired in organizing Organizational difficul- Dopamine Nonverbal
tasks and activities ties
10. Often loses things necessary for Memory impairment Dopamine Nonverbal
certain tasks or activities
11. Is often forgetful in the course of Memory impairment Dopamine Nonverbal
daily activities

Hyperactivity Increased levels Increased levels

12. Often leaves seat in situations Energy Norepinephrine Nonverbal Kinetic

when remaining seated is expected
13. Often runs about or climbs in situ- Energy Norepinephrine Nonverbal Kinetic
ations where it is inappropriate
14. Is often “on the go” Energy Norepinephrine Nonverbal Kinetic
15. Often acts as if “driven by a mo- Energy Norepinephrine Nonverbal Kinetic
tor”
16. Often squirms in seat Energy Norepinephrine Nonverbal Kinetic
17. Often fidgets with or taps hands Energy Norepinephrine Nonverbal Tactile
18. Often has difficulty playing or en- Energy Norepinephrine Verbal Auditory
gaging in leisure activities quietly
19. Is often unduly noisy in playing Energy Norepinephrine Verbal Auditory
20. Often talks excessively Energy Norepinephrine Verbal Auditory

Impulsivity Reduced levels Reduced levels

22. Often intrudes on others (e.g., Impatient/ impulsive Serotonin Nonverbal Kinetic
butts into games)
23. Often has difficulty waiting in line Impatient/ impulsive Serotonin Nonverbal Kinetic
or awaiting a turn in games or
group situations
24. Often interrupts others (e.g., butts Impatient/ impulsive Serotonin Verbal Auditory
into conversation)
25. Often blurts out answers before Impatient/ impulsive Serotonin Verbal Auditory
questions have been completed

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 96

 Table 4: Possible Causes of ADHD and Reduced Neurotransmitter Levels
Possible causes of Causes of reduced serotonin Causes of reduced dopa-
Factor ADHD (Martin, 2014) levels mine levels
Genetic Genetic predisposition Genetic predisposition Genetic predisposition

Physiological Not managing stress levels Chronic stress

Lack of exercise/physical activity Lack of exercise/physical

activity
Lack of sufficient sleep

Food additives Consistent dopamine stim-

ulation
Nutritional deficiencies Nutritional deficiencies

Brain injuries Medical conditions

Environmental Foetal exposure to Insufficient exposure to sunlight

nicotine
as bullying, the complex behavior commonly found
in the compulsory school system. SDHD shows some
remarkable similarities to the same neurotransmit-
ter level distortions found in ADHD patients and
inasmuch can be considered in the same light—as a
neurobiological behavioral disorder. SDHD is charac-
terized by morbid social behavior, hyperactivity and/
or hyperreality, and impulsivity. (See Table 5.)
It is widely believed that bullying is perpetrated by
an individual from a position of power or perceived
power. This simply means the individual is in control
of a situation, indicating a position of dominance or
leadership. The fact that bullying is often conducted
as a group reinforces the pack concept: In a group, an
individual’s chances of survival are much greater, and
the need for an individual to want to take control of a
situation suggests that the individual may very well be
operating from a position of fear themselves. Unfor-
tunately (and with the utmost respect for professional
educators), fingers once again point to the compulsory
school system. Fundamentally, the school system is an
institution where control of an individual, or the re-
moval of choice from an individual, is paramount to
the success of its intended outcomes, even when the
intended outcomes are noble. The element of control
essential for the efficacy of the compulsory school sys-
tem may in fact be the source of fear to which an in-
dividual who engages in bullying activities is respond-
ing. Bullying, therefore, can essentially be viewed as
social survival; an individual taking control of their
life at the expense of someone else.
The physical and psychological welfare of SDHD
on a targeted person is not within the scope of this
article. However, suffice to say that the social, emo-
tional, and cognitive implications are extremely sig-
nificant given the high rate of anxiety, depression,
suicide, self-harm and substance abuse that occurs
amongst those affected.
When control is wrested from children, the myri-
ad of behavior exhibited through ADHD and SDHD
may perhaps be regarded as a nonverbal communica-
tion tool children use to tell us something is horribly
wrong with the situation they find themselves in. If
indeed bullying or SDHD can be described as social
survival, is it appropriate to consider whether ADHD
may be a child’s effort to ensure cognitive survival? Is
a child who is diagnosed with ADHD predisposed to
developing SDHD? Is ADHD a precursor to SDHD?
Are individuals who do not participate in the com-
pulsory school system (i.e., home educated) equally
predisposed to ADHD and SDHD? Does the same
gender ratio (i.e., 4 males to 1 female) observed with
ADHD also extend to SDHD? Or does the gender ra-
tio perhaps reverse (e.g., 4 females to 1 male)? Is there
a link between Asperger’s syndrome and SDHD?
As ADHD and bullying (SDHD) continue to cre-
ate mayhem in society, these are but a few of the ques-
tions that merit an answer while children continue to
be the target of research involving stimulant medi-

97 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)

cation and behavior modification techniques. Whilst
experimentation on animals is hideous but arguably
necessary, experimentation on our children is heinous
and quite intolerable. Serious consideration should be
given to viable alternatives to prescription stimulant
medication and behavior modification techniques.
For example, alternatives that recognize that the satis-
faction of the needs of a child is integral to their phys-
ical, cognitive, emotional, social, and moral develop-
ment; alternatives where the child’s need for control
is respected, their emerging self-esteem celebrated,
and their desire to strive for self-actualization encour-
aged; and alternatives in which the environment is joy
based and provides sufficient pleasurable experiences
to ensure neurotransmitter levels are naturally main-
tained at a healthy level.
Until SDHD is recognized and accepted as a
neurobiological behavioral disorder with determinate
criteria, the economic impact on learning and work-
ing environments cannot be quantified and the pro-
portion of the population affected by the condition
cannot becounted. It is conservatively estimated that
20% of the population are victims of individuals with
SDHD (i.e., are victims of bullying), but this figure
is in all probability much higher given the subjective
nature of bullying. There is no doubt SDHD is an ex-
tremely destructive condition, pervading every aspect
of our society and deserving urgent attention.

Table 5:
Elaborate Interpretation of Suggested Diagnostic Criteria for the Evaluation of Social Deficit Hyperactivity
Disorder (SDHD)

Note. The information in Table 5 was compiled from the following sources: REACHOUT.com, Australia’s leading online youth
mental health service; beyondblue (2014); State Government of Victoria Department of Education & Training (2014); McGrath and
Noble (2006); and Porter (2007); and Robinson (n.d.).

Neurotransmitter Communication
Suggested Diagnostic Criteria for the evaluation of Social Symptom of reduced
Deficit Hyperactivity Disorders (SDHD) neurotransmitter levels involvement preference

Morbid Social Behavior Reduced levels

1. Repeatedly engages in behavior intended to be hurtful or Inability to feel pleasure Dopamine Nonverbal
cause distress to another person
2. Often abuses position of power (or perceived power) to Inability to feel pleasure Dopamine Nonverbal
exert control over another person
3. Often uses extortion to obtain money, food, possessions, Inability to feel pleasure Dopamine Nonverbal
or sexual gratification from another person
4. Often uses extortion to force a person to commit antiso- Inability to feel pleasure Dopamine Nonverbal
cial or illegal acts, including theft, vandalism, sexual acts
5. Often uses threats to expose shared confidences Inability to feel pleasure Dopamine Nonverbal

6. Often uses threat of exposed shared confidences to ob- Inability to feel pleasure Dopamine Nonverbal
tain favors, including sexual favors
7. Often discriminates against a person based on ethnic or Inability to feel pleasure Dopamine Nonverbal
gender bias, subjecting that person to repeated harass-
ment
8. Often discriminates against a person with a physical Inability to feel pleasure Dopamine Nonverbal
handicap, cognitive impairment, emotional vulnerability,
or who is socially disadvantaged, subjecting that person
to repeated harassment
9. Often uses exclusion tactics to socially isolate a person, Inability to feel pleasure Dopamine Nonverbal
including conditional or restrictive tactics
10. Often uses public exclusion tactics to socially isolate a Inability to feel pleasure Dopamine Nonverbal
person, including huddles, loud gangs, or hiding away
11. Often leaves anonymous notes or phone messages for Inability to feel pleasure Dopamine Nonverbal
another person

INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015) 98

12. Often uses inappropriate facial expressions intended to Inability to feel pleasure Dopamine Nonverbal
embarrass, humiliate, or intimidate another person
13. Often uses inappropriate hand gestures intended to em- Inability to feel pleasure Dopamine Nonverbal
barrass, humiliate, or intimidate another person
14. Often uses social network channels to isolate, misrepre- Inability to feel pleasure Dopamine Nonverbal
sent, embarrass, humiliate, or intimidate another person
15. Fails to show empathy for their victim Lacks sense of attach- Dopamine Nonverbal
ment
16. Fails to show regret for antisocial behavior Lack of remorse Dopamine Nonverbal

17. Fails to acknowledge that antisocial behavior is inappro- Lack of remorse Dopamine Nonverbal
priate

Hyperactivity/Hyperreality

18. Often involved in aggressive physical behavior with in- Aggressive Serotonin Nonverbal
tent to oppress another person, including pushing, shov-
ing, punching, hitting, bashing, kicking, tripping, hair
pulling, and clothing pulling, with or without a weapon
19. Often uses loud, aggressive language with intent to em- Aggressive Serotonin Verbal
barrass, humiliate, threaten, or oppress another person,
including screaming and swearing
20. Often involved in destructive behavior with intent to Aggressive Serotonin Nonverbal
steal or destroy another person’s property
21. Often makes unsolicited sexual advances toward another Aggressive Serotonin Nonverbal
person, including kissing and touching
22. Repeatedly and intentionally stalks another person OCD behavior Serotonin Nonverbal

23. Often uses technology to sabotage another person’s iden- OCD behavior Serotonin Nonverbal
tity and wellbeing
24. Often uses stares, disparaging looks or rolling eyes to Inability to feel pleasure Dopamine Nonverbal
embarrass or intimidate another person
25. Often calls another person derogatory names Inability to feel pleasure Dopamine Verbal

26. Often gossips or spreads malicious rumors about another Inability to feel pleasure Dopamine Verbal
person
27. Often tells lies about another person Inability to feel pleasure Dopamine Verbal

28. Often verbally insults or ridicules another person, in- Inability to feel pleasure Dopamine Verbal
cluding the use of taunts or sarcasm
29. Often engages in negative verbal teasing of another per- Inability to feel pleasure Dopamine Verbal
son including telling jokes about that person
30. Often engages in negative physical teasing of another Inability to feel pleasure Dopamine Nonverbal
person, including playfully pulling hair or clothing,
intentionally bumping or crowding
31. Often uses code names for a person or whispers about Inability to feel pleasure Dopamine Verbal
another person behind their back

Impulsivity

32. Often intrudes on others (butts into games or activities) Impatience/impulsivity Serotonin Nonverbal

33. Often actively attempts to spoil a game or activity of Impatience/impulsivity Serotonin Nonverbal
another person
34. Often interrupts another person (butts into a conversa- Impatience/Impulsivity Serotonin Verbal
tion)
35. Often taunts or provokes another person already in- Impatience/Impulsivity Serotonin Verbal
volved in a conversation
99 INTERNATIONAL JOURNAL OF NEUROPSYCHOTHERAPY Volume 3 Issue 1 (2015)
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