Affective psychotherapy in post-traumatic reactions guided by affective neuroscience: memory reconsolidation and play

Abstract

Göran Högberg1,2, Davide Nardo3, Tore Hällström4,5, Marco Pagani6,71Department of Women's and Children's Health, Child and Adolescent Psychiatric Unit, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden; 2BUP Huddinge Child and Adolescent Psychiatry, Stockholm, Sweden; 3Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy; 4Department of Clinical Neuroscience, Section for Psychiatry/Huddinge, Karolinska Institutet, Stockholm, Sweden; 5Department of Neuroscience, Section of Psychiatry and Neurochemistry, Unit for Neuropsychiatric Epidemiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 6Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden; 7Institute of Cognitive Sciences and Technologies, CNR, Rome, ItalyAbstract: This paper reviews the affective neuroscience dealing with the effects of traumatic events. We give an overview of the normal fear reactions, the pathological fear reaction, and the character of emotional episodic memories. We find that both emotions and emotional memories are a tripartite unit of sensory information, autonomic reaction, and motor impulse (the PRM complex). We propose that emotions and movements are part and parcel of the same complex. This is our main finding from the review of affective neuroscience, and from here we focus on psychotherapy with post-trauma reactions. The finding of the process of memory reconsolidation opens up a new treatment approach: affective psychotherapy focused on reconsolidation. The meaning of reconsolidation is that an emotional memory, when retrieved and being active, will rest in a labile form, amenable to change, for a brief period of time, until it reconsolidates in the memory. This leads us to the conclusion that emotions, affects, must be evoked during the treatment session and that positive emotion must come first, because safety must be part of the new memories. In the proposed protocol of affective psychotherapy based on reconsolidation the emotional episodic memory is relived in a safe and positive setting, focused in turn on the sensory experience, the autonomic reaction, and the motor impulse. Then it is followed by a fantasy of a different positive version of the same event. All in all treatment should provide a series of new memories without fear related to the original event. With the focus on the motor program, and the actions, there is a natural link to art therapy and to the mode of play, which can rehearse and fantasize new positive actions.Keywords: post-traumatic, PTSD, affective neuroscience, memory reconsolidation, psychotherapy, play