Prevention of recurrent affective episodes using extinction training in the reconsolidation window: A testable psychotherapeutic strategy.
Stressors may initially precipitate affective episodes, but with sufficient numbers of recurrences, episodes can occur more autonomously. It is postulated the memory engram for these recurrent depressions moves from the conscious representational memory system to the unconscious habit memory system encoded in the striatum. If this were the case, cognitive behavior therapy targeted toward extinction of habit memories could be an effective maneuver for helping reverse the automaticity of affective episode recurrence. Extinction training in the reconsolidation window (which opens about 5min to 1h after active memory recall) can revise, reverse, or eliminate the long term memories associated with PTSD and other anxiety disorders and with drug abuse craving. We hypothesize that similar cognitive behavioral work in the reconsolidation window could inhibit stress-induced and spontaneous affective episodes. Some initial formulations of possible therapeutic strategies are presented and discussed, as well as caveats. It is hoped that preliminary exposition of this theoretical approach to recurrences in the affective disorders based on principles dependent on work in the reconsolidation window will lead to more detailed elaboration of the therapeutic maneuvers most likely to be successful and ones that can be specifically tested for their clinical efficacy.
George Washington University, School of Medicine, Bipolar Collaborative Network, 5415 W. Cedar Lane Suite 201-B, Bethesda, MD 20814, USA. Electronic address: robert.post@speakeasy.net.
Robert M
RM
Post
Harvard University, Graduate School of Education, 205 Longfellow Hall, Appian Way, Cambridge, MA 02138, USA.
Robert
R
Kegan
D000818:Animals; D005108:Extinction, Psychological / Q000502:physiology; D005239:Fear / Q000523:psychology; D006801:Humans; D008568:Memory / Q000187:drug effects; D000069077:Memory Consolidation / Q000502:physiology; D019964:Mood Disorders / Q000517:prevention & control* / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods*; D012008:Recurrence
Amygdala; Brain imaging; Cognitive behavior therapy; Epigenetics; Extinction training; Habit memory representational memory; Memory; Reconsolidation window; Recurrent mood disorders; Stress; Striatum