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MEMORY THEORY AND RELAPSE PREVENTION

 “PTSD may represent the best human illustration of the ability of ‘significance’ to facilitate ‘remembrance.”  Indeed, PTSD may represent an unhappy human confirmation of the proposition that ‘emotional memory may be forever’” (Pitman, 1997).

Implications for PTSD of the “new theory of disuse” in memory (Lang et al., 1999):

·         Memory representations are characterized by two facets:

o        Storage Strength: how strongly a memory is stored.  Storage capacity is probably unlimited and, once stored, an emotional memory may be “forever”

o        Retrieval Strength.  Recall is primarily a function of retrieval strength.  Retrieval processes are described as “erratic, highly fallibly, and heavily cue-dependent” (Bjork & Bjork, 1992 cited in Lang et al., 1999). 

§          when information “A” is retrieved, that information gains retrieval strength; when other information that shares retrieval cues with “A” is retrieved, “A” loses strength. (Example: a person associates travel in the car with commuting and boredom.  After an accident, they associate car travel with danger and may repeatedly think about car travel and feel afraid, making that association stronger and more accessible than the old association of commuting and boredom.)

·         Storage strength, once established, is not lost.  However, retrieval strength may be affected by competitive processes or associations

o        Possible implications: once a traumatic memory is stored it is likely to be resilient.  However, by practicing exposure to the memory in a safe environment new learning takes place: one can remember without being in danger.  This new learning competes with and (if therapy is successful) becomes more accessible than the traumatic memory.

·         Massed practice vs. Spaced practice:

o        Partial forgetting between sessions allows, in effect, additional opportunities for effortful learning since some of what was learned during the prior session is forgotten.  This approach increases storage strength of the new learning taking place in therapy. 

o        Massed practice does not increase storage strength.  Although a client may have good short term results, the benefits of therapy will not “stick” and there will be a high relapse rate. 

§         Therefore, need to space sessions so that client has to make effortful retrievals of non-fearful responses and be challenged to “relearn” over several therapy sessions that s/he is safe

o        Practice spaced at 1-2 sessions/week maximizes benefits of spaced practice while also making sure that client practices frequently and does not completely lose benefits of learning from the prior session

·         Retrieval strength increases when learned information is paired with more retrieval cues

o        Imaginal exposure in therapy is good, but it is also important that the person continue to expose her or himself to a variety of “real life” cues or situations that contradict fears they learned due to the trauma.  Generally, this process implies not avoiding “objectively safe” situations when one is anxious, and instead approaching and mastering them

·         With lack of use, the retrieval strength of new learning decreases over time.  During disuse, the retrieval strength of new memories will decrease faster than the retrieval strength of old memories.  The reason posited for this difference is that older memories have greater storage strength

o        Even after therapy ends, the client should continue to make a point of approaching cues she or he had been afraid of after the trauma, especially if s/he starts to feel anxious about them again

o        Otherwise, there is a risk that the older memory of trauma will gain strength compared to the newer memory of mastery and safety learned in therapy

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The information posted on this site reflects our understanding of peer-reviewed research and generally accepted principles in psychology.  It is not intended to be used for self-treatment or as a substitute for individualized assessment and treatment by a licensed professional, and should not be construed as professional advice.

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