Humanistic Therapy and Other Treatments

Learning Objectives

  • Explain the basic characteristics of humanistic therapy
  • Explain the basic characteristics of mindfulness, treatment for addiction, and other emerging psychological treatments
  • Compare and evaluate various forms of psychotherapy
  • Explain and compare biomedical therapies

Psychotherapy: Humanistic Therapy

A therapist and patient sit across from each other in chairs in an office.

Figure 1. The quality of the relationship between therapist and patient is of great importance in person-centered therapy.

Humanistic psychology focuses on helping people achieve their potential. So it makes sense that the goal of humanistic therapy is to help people become more self-aware and accepting of themselves. In contrast to psychoanalysis, humanistic therapists focus on conscious rather than unconscious thoughts. They also emphasize the patient’s present and future, as opposed to exploring the patient’s past.

Psychologist Carl Rogers developed a therapeutic orientation known as Rogerian, or client-centered therapy (also sometimes called person-centered therapy or PCT). Note the change from patients to clients. Rogers (1951) felt that the term patient suggested the person seeking help was sick and looking for a cure. Since this is a form of nondirective therapy, a therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person to identify conflicts and understand feelings, Rogers (1951) emphasized the importance of the person taking control of his own life to overcome life’s challenges.

In client-centered therapy, the therapist uses the technique of active listening. In active listening, the therapist acknowledges, restates, and clarifies what the client expresses. Therapists also practice what Rogers called unconditional positive regard, which involves not judging clients and simply accepting them for who they are. Rogers (1951) also felt that therapists should demonstrate genuineness, empathy, and acceptance toward their clients because this helps people become more accepting of themselves, which results in personal growth.

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Psychotherapy: Mindfulness

One age-old practice that has seen a resurgence in popularity in recent years is mindfulness. Mindfulness is a process that tries to cultivate a nonjudgmental, yet attentive, mental state. It is a therapy that focuses on one’s awareness of bodily sensations, thoughts, and the outside environment. Whereas other therapies work to modify or eliminate these sensations and thoughts, mindfulness focuses on non-judgmentally accepting them (Kabat-Zinn, 2003; Baer, 2003). For example, whereas CBT may actively confront and work to change a maladaptive thought, mindfulness therapy works to acknowledge and accept the thought, understanding that the thought is spontaneous and not what the person truly believes. There are two important components of mindfulness: (1) self-regulation of attention, and (2) orientation toward the present moment (Bishop et al., 2004). Mindfulness is thought to improve mental health because it draws attention away from past and future stressors, encourages acceptance of troubling thoughts and feelings, and promotes physical relaxation.

Psychologists have adapted the practice of mindfulness as a form of psychotherapy, generally called mindfulness-based therapy (MBT). Several types of MBT have become popular in recent years, including mindfulness-based stress reduction (MBSR) (e.g., Kabat-Zinn, 1982) and mindfulness-based cognitive therapy (MBCT) (e.g., Segal, Williams, & Teasdale, 2002).

MBSR uses meditation, yoga, and attention to physical experiences to reduce stress. The hope is that reducing a person’s overall stress will allow that person to more objectively evaluate his or her thoughts. In MBCT, rather than reducing one’s general stress to address a specific problem, attention is focused on one’s thoughts and their associated emotions. For example, MBCT helps prevent relapses in depression by encouraging patients to evaluate their own thoughts objectively and without value judgment (Baer, 2003). Although cognitive behavioral therapy (CBT) may seem similar to this, it focuses on “pushing out” the maladaptive thought, whereas mindfulness-based cognitive therapy focuses on “not getting caught up” in it.

Treatment for Addiction

Addiction and substance abuse disorders are difficult to treat because chronic substance use can permanently alter the neural structure in the prefrontal cortex, an area of the brain associated with decision-making and judgment, thus driving a person to use drugs and/or alcohol (Muñoz-Cuevas, Athilingam, Piscopo, & Wilbrecht, 2013). This helps explain why relapse rates tend to be high. About 40%–60% of individuals relapse, which means they return to abusing drugs and/or alcohol after a period of improvement (National Institute on Drug Abuse [NIDA], 2008).

The goal of substance-related treatment is to help an addicted person stop compulsive drug-seeking behaviors (NIDA, 2012). This means an addicted person will need long-term treatment, similar to a person battling a chronic physical disease such as hypertension or diabetes. Treatment usually includes behavioral therapy and/or medication, depending on the individual (NIDA, 2012). Specialized therapies have also been developed for specific types of substance-related disorders, including alcohol, cocaine, and opioids (McGovern & Carroll, 2003). Substance-related treatment is considered much more cost-effective than incarceration or not treating those with addictions (NIDA, 2012).

A photograph shows a person injecting heroin intravenously with a hypodermic needle into her ankle.

Figure 2. Substance use and abuse costs the United States over $600 billion a year (NIDA, 2012). This addict is using heroin. (credit: “jellymc – urbansnaps”/Flickr)

Specific factors make substance-related treatment much more effective. One factor is duration of treatment. Generally, the addict needs to be in treatment for at least three months to achieve a positive outcome (Simpson, 1981; Simpson, Joe, & Bracy, 1982; NIDA, 2012). This is due to the psychological, physiological, behavioral, and social aspects of abuse (Simpson, 1981; Simpson et al., 1982; NIDA, 2012).While individual therapy is used in the treatment of substance-related disorders, group therapy is the most widespread treatment modality (Weiss, Jaffee, de Menil, & Cogley, 2004). The rationale behind using group therapy for addiction treatment is that addicts are much more likely to maintain sobriety in a group format. It has been suggested that this is due to the rewarding and therapeutic benefits of the group, such as support, affiliation, identification, and even confrontation (Center for Substance Abuse Treatment, 2005).Treatment also usually involves medications to detox the addict safely after an overdose, to prevent seizures and agitation that often occur in detox, to prevent reuse of the drug, and to manage withdrawal symptoms. Getting off drugs often involves the use of drugs—some of which can be just as addictive. Detox can be difficult and dangerous.Frequently, a person who is addicted to drugs and/or alcohol has comorbid disorders, meaning they may have additional diagnoses of other psychological disorders. In cases of comorbidity, the best treatment is thought to address both (or multiple) disorders simultaneously (NIDA, 2012). Behavior therapies are used to treat comorbid conditions, and in many cases, medications are used along with psychotherapy.

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Emerging Treatments

With growth in research and technology, psychologists have been able to develop new treatment strategies in recent years. Often, these approaches focus on enhancing existing treatments, such as cognitive-behavioral therapies, through the use of technological advances. For example, internet- and mobile-delivered therapies make psychological treatments more available, through smartphones and online access. Clinician-supervised online CBT modules allow patients to access treatment from home on their own schedule—an opportunity particularly important for patients with less geographic or socioeconomic access to traditional treatments. Furthermore, smartphones help extend therapy to patients’ daily lives, allowing for symptom tracking, homework reminders, and more frequent therapist contact.

Another benefit of technology is cognitive bias modification. Here, patients are given exercises, often through the use of video games, aimed at changing their problematic thought processes. For example, researchers might use a mobile app to train alcohol abusers to avoid stimuli related to alcohol. One version of this game flashes four pictures on the screen—three alcohol cues (e.g., a can of beer, the front of a bar) and one health-related image (e.g., someone drinking water). The goal is for the patient to tap the healthy picture as fast as s/he can. Games like these aim to target patients’ automatic, subconscious thoughts that may be difficult to direct through conscious effort. That is, by repeatedly tapping the healthy image, the patient learns to “ignore” the alcohol cues, so when those cues are encountered in the environment, they will be less likely to trigger the urge to drink. Approaches like these are promising because of their accessibility, however they require further research to establish their effectiveness.

Yet another emerging treatment employs CBT-enhancing pharmaceutical agents. These are drugs used to improve the effects of therapeutic interventions. Based on research from animal experiments, researchers have found that certain drugs influence the biological processes known to be involved in learning. Thus, if people take these drugs while going through psychotherapy, they are better able to “learn” the techniques for improvement. For example, the antibiotic d-cycloserine improves treatment for anxiety disorders by facilitating the learning processes that occur during exposure therapy. Ongoing research in this exciting area may prove to be quite fruitful.

Evaluating Various Forms of Psychotherapy

How can we assess the effectiveness of psychotherapy? Is one technique more effective than another? For anyone considering therapy, these are important questions. According to the American Psychological Association, three factors work together to produce successful treatment. The first is the use of evidence-based treatment that is deemed appropriate for your particular issue. The second important factor is the clinical expertise of the psychologist or therapist. The third factor is your own characteristics, values, preferences, and culture. Many people begin psychotherapy feeling like their problem will never be resolved; however, psychotherapy helps people see that they can do things to make their situation better. Psychotherapy can help reduce a person’s anxiety, depression, and maladaptive behaviors. Through psychotherapy, individuals can learn to engage in healthy behaviors designed to help them better express emotions, improve relationships, think more positively, and perform more effectively at work or school. In discussing therapeutic orientations, it is important to note that many clinicians incorporate techniques from multiple approaches, a practice known as integrative or eclectic psychotherapy.

Two people having a conversation in a library.

Figure 3. Therapy comes in many different forms and settings, but one critical factor in its success is the relationship between the therapist and client.

Consider the following advantages and disadvantages of some of the major forms of psychotherapy:

  • Psychoanalysis: Psychoanalysis was once the only type of psychotherapy available, but presently the number of therapists practicing this approach is decreasing around the world. Psychoanalysis is not appropriate for some types of patients, including those with severe psychopathology or mental retardation. Further, psychoanalysis is often expensive because treatment usually lasts many years. Still, some patients and therapists find the prolonged and detailed analysis very rewarding.
  • Cognitive-Behavioral Therapy: CBT interventions tend to be relatively brief, making them cost-effective for the average consumer. In addition, CBT is an intuitive treatment that makes logical sense to patients. It can also be adapted to suit the needs of many different populations. One disadvantage, however, is that CBT does involve significant effort on the patient’s part, because the patient is an active participant in treatment. Therapists often assign “homework” (e.g., worksheets for recording one’s thoughts and behaviors) between sessions to maintain the cognitive and behavioral habits the patient is working on. The greatest strength of CBT is the abundance of empirical support for its effectiveness.
  • Humanistic Therapy: One key advantage of person-centered therapy is that it is highly acceptable to patients. In other words, people tend to find the supportive, flexible environment of this approach very rewarding. Furthermore, some of the themes of PCT translate well to other therapeutic approaches. For example, most therapists of any orientation find that clients respond well to being treated with nonjudgmental empathy.

Many studies have explored the effectiveness of psychotherapy. For example, one large-scale study that examined 16 meta-analyses of CBT reported that it was equally effective or more effective than other therapies in treating PTSD, generalized anxiety disorder, depression, and social phobia (Butlera, Chapmanb, Formanc, & Becka, 2006). Another study found that CBT was as effective at treating depression (43% success rate) as prescription medication (50% success rate) compared to the placebo rate of 25% (DeRubeis et al., 2005). Another meta-analysis found that psychodynamic therapy was also as effective at treating these types of psychological issues as CBT (Shedler, 2010). However, no studies have found one psychotherapeutic approach more effective than another (Abbass, Kisely, & Kroenke, 2006; Chorpita et al., 2011), nor have they shown any relationship between a client’s treatment outcome and the level of the clinician’s training or experience (Wampold, 2007). Regardless of which type of psychotherapy an individual chooses, one critical factor that determines the success of treatment is the person’s relationship with the psychologist or therapist.

Watch It

Review each of the types of psychotherapy you’ve learned about in this lesson in the following CrashCourse video.

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Biomedical Therapies

Humans have a long, and sometimes disturbing history of biomedical treatment of disorders. In ancient and medieval times, the process of trepanation – a drilling or cracking of a hole in the skull to expose the brain – was sometimes used to free evil spirits or demons from within a person’s head.

Trepanation ultimately fell out of favor as a treatment for psychological disorders. However, in the 20th century another biomedical procedure, lobotomy, gained in use. Lobotomy is a form of psychosurgery in which parts of the frontal lobe of the brain are destroyed or their connections to other parts of the brain severed. The goal of lobotomy was usually to calm symptoms in people with serious psychological disorders, such as schizophrenia. Lobotomy was widely used during the twentieth century – indeed, it was so mainstream that Antonio Moniz won a Nobel Prize in physiology for his work on one lobotomy procedure. However, lobotomy was always highly controversial, and widely criticized as a tool of behavioral control of people who were engaged in behaviors that were not clinical in nature. By the 1960s and 1970s lobotomy fell out of favor in the United States.

One of the reasons lobotomy fell out of favor was the development in the 1950s and 1960s of new medications for the treatment of psychological disorders; these are now the most widely used forms of biological treatment. While these are often used in combination with psychotherapy, they also are taken by individuals not in therapy. This is known as biomedical therapy. Medications used to treat psychological disorders are called psychotropic medications and are prescribed by medical doctors, including psychiatrists. In Louisiana and New Mexico, psychologists are able to prescribe some types of these medications (American Psychological Association, 2014).

Different types and classes of medications are prescribed for different disorders. A depressed person might be given an antidepressant, a bipolar individual might be given a mood stabilizer, and a schizophrenic individual might be given an antipsychotic. These medications treat the symptoms of a psychological disorder. They can help people feel better so that they can function on a daily basis, but they do not cure the disorder. Some people may only need to take a psychotropic medication for a short period of time. Others with severe disorders like bipolar disorder or schizophrenia may need to take psychotropic medication for a long time. Table 1 shows the types of medication and how they are used.

Table 1. Commonly Prescribed Psychotropic Medications
Type of Medication Used to Treat Brand Names of Commonly Prescribed Medications How They Work Side Effects
Antipsychotics (developed in the 1950s) Schizophrenia and other types of severe thought disorders Haldol, Mellaril, Prolixin, Thorazine Treat positive psychotic symptoms such as auditory and visual hallucinations, delusions, and paranoia by blocking the neurotransmitter dopamine Long-term use can lead to tardive dyskinesia, involuntary movements of the arms, legs, tongue and facial muscles, resulting in Parkinson’s-like tremors
Atypical Antipsychotics (developed in the late 1980s) Schizophrenia and other types of severe thought disorders Abilify, Risperdal, Clozaril Treat the negative symptoms of schizophrenia, such as withdrawal and apathy, by targeting both dopamine and serotonin receptors; newer medications may treat both positive and negative symptoms Can increase the risk of obesity and diabetes as well as elevate cholesterol levels; constipation, dry mouth, blurred vision, drowsiness, and dizziness
Anti-depressants Depression and increasingly for anxiety Paxil, Prozac, Zoloft (selective serotonin reuptake inhibitors, [SSRIs]); Tofranil and Elavil (tricyclics) Alter levels of neurotransmitters such as serotonin and norepinephrine SSRIs: headache, nausea, weight gain, drowsiness, reduced sex drive
Tricyclics: dry mouth, constipation, blurred vision, drowsiness, reduced sex drive, increased risk of suicide
Anti-anxiety agents Anxiety and agitation that occur in OCD, PTSD, panic disorder, and social phobia Xanax, Valium, Ativan Depress central nervous system activity Drowsiness, dizziness, headache, fatigue, lightheadedness
Mood Stabilizers Bipolar disorder Lithium, Depakote, Lamictal, Tegretol Treat episodes of mania as well as depression Excessive thirst, irregular heartbeat, itching/rash, swelling (face, mouth, and extremities), nausea, loss of appetite
Stimulants ADHD Adderall, Ritalin Improve ability to focus on a task and maintain attention Decreased appetite, difficulty sleeping, stomachache, headache

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Link to Learning

Watch this CrashCourse video to learn more about research, biomedical therapy and drug treatments, as well as alternative biological treatments.

Another biologically based treatment that continues to be used, although infrequently, is electroconvulsive therapy (ECT) (formerly known by its unscientific name as electroshock therapy). It involves using an electrical current to induce seizures to help alleviate the effects of severe depression. The exact mechanism is unknown, although it does help alleviate symptoms for people with severe depression who have not responded to traditional drug therapy (Pagnin, de Queiroz, Pini, & Cassano, 2004). About 85% of people treated with ECT improve (Reti, n.d.). However, the memory loss associated with repeated administrations has led to it being implemented as a last resort (Donahue, 2000; Prudic, Peyser, & Sackeim, 2000). A more recent alternative is transcranial magnetic stimulation (TMS), a procedure approved by the FDA in 2008 that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms; it is used when other treatments have not worked (Mayo Clinic, 2012).

Dig Deeper: Evidence-based Practice

A buzzword in therapy today is evidence-based practice. However, it’s not a novel concept but one that has been used in medicine for at least two decades. Evidence-based practice is used to reduce errors in treatment selection by making clinical decisions based on research (Sackett & Rosenberg, 1995). In any case, evidence-based treatment is on the rise in the field of psychology. So what is it, and why does it matter? In an effort to determine which treatment methodologies are evidenced-based, professional organizations such as the American Psychological Association (APA) have recommended that specific psychological treatments be used to treat certain psychological disorders (Chambless & Ollendick, 2001). According to the APA (2005), “Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (p. 1).

The foundational idea behind evidence based treatment is that best practices are determined by research evidence that has been compiled by comparing various forms of treatment (Charman & Barkham, 2005). These treatments are then operationalized and placed in treatment manuals—trained therapists follow these manuals. The benefits are that evidence-based treatment can reduce variability between therapists to ensure that a specific approach is delivered with integrity (Charman & Barkham, 2005). Therefore, clients have a higher chance of receiving therapeutic interventions that are effective at treating their specific disorder. While EBPP is based on randomized control trials, critics of EBPP reject it stating that the results of trials cannot be applied to individuals and instead determinations regarding treatment should be based on a therapist’s judgment (Mullen & Streiner, 2004).

Glossary

biomedical therapy: treatment that involves medication and/or medical procedures to treat psychological disorders
cognitive bias modification: using exercises (e.g., computer games) to change problematic thinking habits
comorbid disorder: individual who has two or more diagnoses, which often includes a substance abuse diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia
eclectic psychotherapy: also called integrative psychotherapy, this term refers to approaches combining multiple orientations (e.g., CBT with psychoanalytic elements).
electroconvulsive therapy (ECT): type of biomedical therapy that involves using an electrical current to induce seizures in a person to help alleviate the effects of severe depression
humanistic therapy: therapeutic orientation aimed at helping people become more self-aware and accepting of themselves
lobotomy: a form of psychosurgery in which parts of the frontal lobe of the brain are destroyed or their connections to other parts of the brain severed
mindfulness: a process that tries to cultivate a nonjudgmental, yet attentive, mental state. It is a therapy that focuses on one’s awareness of bodily sensations, thoughts, and the outside environment
nondirective therapy: therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person identify conflicts and understand feelings
rational emotive therapy (RET): form of cognitive-behavioral therapy
relapse: repeated drug use and/or alcohol use after a period of improvement from substance abuse
Rogerian (client-centered therapy): non-directive form of humanistic psychotherapy developed by Carl Rogers that emphasizes unconditional positive regard and self-acceptance
unconditional positive regard: fundamental acceptance of a person regardless of what they say or do; term associated with humanistic psychology

Learning Objectives

  • Explain how conditioning aids in therapy techniques, particularly through memory reconsolidation

Problems with memory are at the core of many psychological disorders. For example, people suffering from both clinical-level depression and posttraumatic stress disorder (PTSD) often have difficulty remembering details of specific memories, especially for happy experiences. This is called overgeneralized autobiographical memory (OGM). A therapist might ask a depressed person showing OGM to recall a recent happy experience. The depressed person might answer, “When I was visiting my friends last weekend,” but then be unable to recall or describe any particular events or interactions during that visit that were enjoyable or rewarding. For another example, people suffering from obsessive-compulsive disorder (OCD) experience less confidence in the accuracy of memories they retrieve than people without the disorder. This uncertainty about memory can lead to obsessive thoughts about whether they turned off the stove or paid the electric bill when it was due. People with OCD also tend to show a bias to retrieve threatening memories. Nearly every major psychological disorder you will study in this course has some aspect of memory that is either a symptom or a process that maintains the disorder or more often both.

You may also have learned by now that remembering and thinking about past events—either recent or long ago—is the basis of most forms of psychotherapy. The psychodynamic therapy developed by Sigmund Freud is almost entirely based on remembering actual experiences or recent dreams. Even newer forms of therapy, like Cognitive-Behavioral Therapy (CBT), involve a great deal of memory work.

It may seem that research laboratories in universities and medical centers are a long way from psychotherapists’ offices, but professional therapists keep up with new developments in basic research and they often collaborate with researchers in bridging the gap between new theories and the application of those theories in the real world. A great example of the basic research-applied research connection is the development of therapies that can change the emotional impact of some memories without erasing or otherwise distorting them.

Memory Consolidation

Hand reaching for a book on a bookshelf.

Figure 1. Older theories on memory said that memories were stored like printed books, but new research suggests that they are not so set.

Until the early part of the 21st century, most people thought of memories—particularly memories of personal events, technically known as autobiographical memories—as mental representations that become relatively stable and unchangeable very quickly. We knew that memories do not stabilize immediately, however, because brain trauma (e.g., a concussion) or certain drugs could interfere with people’s ability to recall events immediately before the trauma or administration of the drug. The neural processes that occur between an experience and the stabilization of the memory for that experience is called consolidation. Consolidation is complex, with some consolidation processes taking minutes to hours and other consolidation processes taking weeks, months, or even years. For the rest of this reading, we will concern ourselves with the quick part of consolidation that occurs in the hours and days immediately after an experience.

The idea of consolidation does not rule out forgetting. Memories can fade—that is, lose details—or become impossible to retrieve. In the reading on memory, you also learned that misinformation that a person hears shortly after an event can be incorporated into the memory. But the idea is that the final version of the memory is fixed once it has consolidated within a few hours. This late-20th century theory says that memory is like a book. When it is first printed, the ink must dry (the consolidation process that takes up to a few hours), but when that has occurred, the contents of the book don’t change. The ink may fade over time or you may have trouble finding it in your library, but the contents of the book never change, no matter how often you pull it out to read it.

Reconsolidation

Around the beginning of the current century, our understanding of memory was shaken by new research, first in animal labs, but later with humans.[1] The study that initially caught the attention of memory scientists was a study using rats as subjects by Karim Nader, Glenn Schafe, and Joseph Le Doux of New York University in the year 2000. They taught their animals a fear memory by pairing a particular sound with a mild, but unpleasant shock using classical conditioning.[2] The researchers found that they could change a memory that had already been consolidated if they did just the right things at just the right time.

A man's hand at a computer screen with a popout box showing the file history. It says "Office Open XML presentation" that was created on October 5 2016, then modified and opened again on March 10, 2017.

Figure 2. Research on consolidation supports the idea that memory is saved somewhat like a computer file: the original file is there, but that file can be modified and re-saved.

What Nader and his colleagues found was that memories become open to changes for a brief period of time when they are retrieved. For a few hours, the changed memories can be disrupted (e.g., by trauma to the brain, by drugs, and by other means), but once they have reconsolidated, they become the new version of the memory. This newer theory of memory says that our memories are not really like books, which don’t change after the print has dried. Now memory is more like a computer file that is updated without saving the original. You originally create the memory (consolidation) and store it away. When you retrieve the memory, you can change some information in the file, but this new version now becomes the memory. Many researchers believe we don’t have a backup version of the original memory. All we have is the new, modified memory of the event.

Reconsolidation: In the Basic Research Lab

The theory of reconsolidation has changed the way we think about the stability and accuracy of memories, but a scientific theory must be more than interesting or novel: it must be supported by careful research. There is now an impressive body of research about reconsolidation. We have already mentioned experiments with rats by Karim Nader and his colleagues, but we will go into more detail on a study by Elizabeth Phelps, a highly respected psychologist who is one of the leaders on modern neuroscience of emotion and cognition. The study we will discuss is by Dr. Phelps, Daniella Schiller (now an associate professor of psychiatry at Mt. Sinai hospital in New York), and some of their colleagues.

You may remember learning about classical conditioning. Ivan Pavlov discovered how classical conditioning works when he trained dogs to salivate when they heard a bell (click HERE to review classical conditioning). Dr. Phelps and her colleagues classically conditioned volunteer research participants to fear a shock. They allowed this learning (i.e., the conditioned fear response) to consolidate, and then figured out the way to eliminate the fear response.

To start, we are going to look at what happened in one of the control conditions, which will give you an idea about what normally happens with this kind of fear learning.

DAY 1 – Control Group

On Day 1 for the control group, we create a memory for participants so that they come to “fear” a yellow box.

Day 1 is successful when classical conditioning of the fear response to the yellow box is complete. The participant now shows a fear response to the yellow box.

Note: we used emoticons in the exercise above, but the actual dependent variable in the study was a physiological measure of fear: skin conductance. When we are scared, our sweat glands respond by producing sweat, sometimes a lot, sometimes a little, but always some. This moisture on our skin changes the way that electricity moves across the skin, and these changes can be detected and measured, even if the changes are very subtle. This is the skin conductance response (called SCR). Detection of changes in skin conductance is simple, requiring only some detectors on your fingers, and it is painless.

DAY 2 – Control Group

For the control group, day involves extinction, which is the process of unlearning the fear response. Extinction is simple. You repeatedly show the person the yellow box, but there are no shocks. Over time, the person learns a new association: the yellow box means no shock. But this takes some time.

Day 2 has been successful. The person is no longer afraid of the yellow box. But, we’re still not quite done. We need to test for spontaneous recovery. Let’s go to day 3.

DAY 3 – Control Group

What is shown above is what typically happens. Despite the fact that the person learned on day that the yellow box does not signal a shock, if you wait a while (hours or, as in this case, 24 hours), the fear response has returned. This is called spontaneous recovery of the fear response.

Spontaneous recovery is one of the big problems with extinction training. You can get rid of a response for a while, but the response can return over and over again. According to the researchers—Dr. Phelps and Dr. Schiller—the problem may be that the person has two memories: one where the yellow box means a shock is coming, and another that means the yellow box equates to no shock. These two memories are both available, so when a yellow box happens to retrieve the first memory (yellow box = shock), the fear response returns.

So how can we change the first memory without creating a new memory? Here is a second condition in the experiment. We’re going to call this group the “10-Minute Group,” and we’ll explain why shortly.

The first step involves the same process as in the control group and involves conditioning the subject to “fear” a yellow box.

Day 1 – 10-Minute Group

Day 1 for this new group is exactly the same as day 1 in the Control Condition. We teach participants to “fear” the yellow box.

Now let’s go to day 2. Remember from the control group that day 2 involves extinction, which is the process of unlearning the fear response. But for this new group, we’re going to try something different to see if we can replace their original memory without creating a new memory.

Memory Reactivation

This time, before we begin the process of extinction, we are going to get the person to think about the shock experience—that is, we want them to retrieve the full fear memory—before they start extinction. Once the full memory is reactivated, there is a 10-minute delay, and then the subjects go through the same extinction trials that the Control Group subjects experienced on Day 2.

This reintroduction of the yellow box on day 2 is the one event that did not happen in the control condition you read about earlier. It turns out that this reactivation step is crucial to preventing spontaneous recovery.

Day 2 – 10-Minute Group

After the extinction process has been completed on day 2, the question is this: will the person show spontaneous recovery of the fear response on day 3? If they do show spontaneous recovery, then our new procedure (reinstatement of the memory on day 2) has failed to produce the change in memory that we hoped for.

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The last step is to again test for spontaneous recovery.

Day 3 – 10-Minute Group

The procedure on Day 3 for this group is exactly the same as it was for the Control Group. What is different is the subjects’ response. There is NO SPONTANEOUS RECOVERY for this group. The fear response is gone. The experimenters attribute this lack of a fear response to a changed memory, one that now associates the yellow box with no shock.

So far, the experimenters have shown that fear can be learned (day 1), extinguished (day 2), and then spontaneously recover (day 3) for the control condition. By contrast, the reactivation condition shows that, if the full memory is activated on day 2 just before extinction, then the fear response does not spontaneously recover.

However, our journey is not quite complete. The experimenters claim that a reactivated memory acts like a new memory: it is open to change for only a brief time and then it becomes stable again. So the day 2 extinction process should only work to change the original memory for a short while—at most, a few hours. If the memory is reactivated, but extinction is delayed for a few hours, then the memory should not be changed because it has had time to reconsolidate.

The final experiment tests this idea. The only difference between this new group and the last group is the time delay on the second day. Rather than waiting 10 minutes between reactivating the memory and extinction, the experimenters waited 6 hours. After 6 hours, the fear memory should no longer be active and extinction should not change the memory.

Day 1 – 6-Hour Group

Day 1 for this new group is exactly the same as day 1 for both of the previous groups. We teach participants to “fear” the yellow box.

Day 2 – 6 Hour Group

Day 2 is very similar to day 2 for the 10-Minute group. The only difference is that the delay has been increased to 6 hours.

clock with the words '6 hours' superimposed over it

This experiment is important because it serves as a control to help us determine if “rewriting a memory” is actually the correct interpretation of the results. In this experiment, the memory is reactivated (just like in the 10-minute group), but the memory is then allowed to deactivate over a 6-hour delay. If there is no spontaneous recovery in this condition, then rewriting memory is not a particularly convincing explanation for the results. If there is spontaneous recovery of fear, then the theory that we are actually rewriting a memory is more convincing.

So let’s see what happens.

Day 3 – 6-Hour Group

When we test the 6-Hour Group on day 3, we see that spontaneous recovery has occurred:

The procedure on day 3 is the same for all three groups, but the responses are different. Participants in the two control conditions (control group and 6-hour group) both act the same: they both show spontaneous recovery of the fear response. Those in the reconsolidation treatment condition (the 10-minute group), however, show no spontaneous recovery of the fear response.

Interpreting Results

Let’s take another look at the results of the study by Schiller, Phelps, and their colleagues. The Y-axis on the graph below shows the skin conductance response of the subjects. Higher values indicate higher levels of fear.[3] You will be adjusting the lines, so move them up to indicate more fear and down to indicate less fear. The X-axis shows the end of Day 1, after successful fear conditioning, and the first trial on Day 3, when spontaneous recovery is being measured.

We have placed the circles for day 1 in their correct positions. The fact that they sit high on the graph reflects the fact that all three groups of participants were successfully conditioned on day 1 to fear the yellow box. The differences among the three lines are not statistically significant.[4] Your task is to grab the circles on the right and move them to the appropriate positions for the results of the experiment. You can move them up or down or leave them where they are.  When you have entered your solution, you can look at the actual results.

Remember, spontaneous recovery means that the person returns to the fear level they had learned earlier, on day 1. No spontaneous recovery means that the fear response (high levels of skin conductance) had been eliminated. Lower fear is shown if the dots get closer to the X-axis.

Try It

Instructions: Click and drag the circles on the right (day 3) to where you think they should be to reflect the results of the experiment. When you’re done, click the link below to see the actual results.

Keep in mind that one experiment doesn’t convince anyone—certainly not experienced scientists. But, when many similar experiments are conducted and they generally give consistent results, then scientist become increasingly confident that the results are not just due to chance, but that they are seeing something real. Go online (for example, use Google Scholar) and search for “memory reinstatement” and you will find many studies that are related to the one you have just studied. Together, these experiments suggest that memories can be altered. In fact, every time we retrieve a memory, it is possible that we alter details or emotional elements of the memory. Our memories may change across our lifetimes in profound ways.

Watch It

This video shows the experimenters you have been reading about (Daniella Schiller and Elizabeth Phelps) discussing their work and you will even see a reenactment of part of the study. The video does not include many of the technical details you just went through, but it shows some of the procedures and the researchers give you some idea of the implications of their work.

What is the practical value of this research?

At the very end of the video, you heard Dr. Phelps (from an interview in 2009) explain the potential for turning this research into a useful procedure for therapists:

So, you know, at this point, how this works in the clinic is going to be all speculation. But what this data suggests might happen in the future is: if you come into the clinic with a fear-related disorder, like a phobia or PTSD, if we can understand how these memories are re-stored when they are retrieved, much as we did in this study, we then may be able to time our therapeutic interventions in such a way where we aren’t creating new learning that’s overriding those earlier memories but actually rewriting them, in a sense. If we can time that correctly so we can target these mechanisms, perhaps we’d have a more effective, long-lasting outcome.

One of the goals of this research, then, is to give therapists a way of working with memory disorders. Of course, rather than creating a fear as the researchers did, therapists work with people who experience debilitating fear-related memories that came from experiences, often traumatic ones, in their lives. The therapist’s job is to help the person overcome the disabling experiences of fear. In most cases, they would like to reduce the emotional impact of the experience, which is part of the memory itself, without actually changing the facts that are remembered.

This application of reconsolidation theory to therapy is already underway. Here are the basic steps in this therapy:

  • REINSTATEMENT: Have the person retrieve the memory. Be sure that the retrieval is emotionally powerful. If the person avoids fully reactivating the memory in its complete painful form, then reduction of the emotional impact will be impossible. The emotion may be fear or anxiety or some other strong negative response.
  • REDUCTION OF EMOTIONAL IMPACT: While the memory is active and painful, the therapist acts to reduce its impact. There are two approaches to this, using the example of a phobia (irrational fear) to illustrate the method:
    • EXTINCTION OF THE FEAR RESPONSE: In a therapy session, a person with a phobia (e.g., fear of spiders or dogs or heights) might (a) have the fear response reactivated (have them stand near a spider or dog or on a high perch) and then, (b) through continuous or repeated exposure to the source of fear with support from the therapist and experience of no bad consequences (not getting bitten or not falling), show a reduction of the fear response.
    • DRUGS THAT BLOCK FEAR MEMORY: In a therapy session, a person with a phobia (e.g., fear of spiders or dogs or heights) might (a) have the fear response reactivated (have them stand near a spider or dog or on a high perch) and then, (b) the person is given propranolol, a drug that inhibits the storage of emotional aspects of a memory.
  • REPETITION ACROSS DAY OR WEEKS: For a deep-seated problem, it is very unlikely that a single session will eliminate or even substantially reduce the automatic negative emotional response. The process of reinstatement followed by either extinction or drug intervention is necessary for effective treatment.

WAtch It

Here is a video about the work of Merel Kindt, a therapist and memory researcher. Dr. Kindt uses the drug propranolol, which interferes with the reconsolidation of the fear aspect of a memory, though it does not prevent the person from feeling fear during the training session nor does it interfere with the person’s memory for the events that occurred.

As you can see from the video, therapists can now use the new insights coming from research on reconsolidation of memory to help in their treatment of people with disorders that include memory dysfunctions. The video showed treatment of a phobia, but reconsolidation therapy has also been used with some success with people suffering from PTSD.

The reconsolidation research discussed is this exercise is just one example of the relationship between basic research taking place in scientific laboratories and practical application of discoveries about the mind and brain in the real world. Psychology in the 21st century owes a great deal to researchers in the 20th century, but old dogma is constantly being updated and even overthrown in favor of better ideas that come from deeper understanding of the causes of human behavior.

Glossary

consolidation: the neural processes that occur between an experience and the stabilization of the memory
reconsolidation: the process of replacing or disrupting a stored memory with a new version of the memory


  1. The basic idea of reconsolidation and some relevant research had been around for decades, but the idea did not grab hold and the supporting research was not sufficient until the last two decades.
  2. If you’ve forgotten what classical conditioning is, we will review it when we discuss a human version of Nader, Schafe, and Le Doux’s study.
  3. The actual dependent variable was a bit more complicated than the simple measure of skin conductance suggested in the figure. Consult the original study if you need to know the exact way that skin conductance was measured.
  4. In real research, we seldom find exactly the same averages for different conditions. There is always some natural variability. We use statistical tests to be sure that these typical differences are not greater than we would expect by chance.