How do we heal?
This post is an overview of independent research that I’m doing as part of my career break.
our current predicament
A lot of people are suffering, including people who are living lives of (relative) comfort and abundance. Much of this suffering is within our power as individuals to change, and alleviating this suffering will have enormous positive impact, not just on individuals but on civilization as a whole. I’m inspired by my friend Amanda’s writing on the prevalence of little-t trauma:
When I say ‘everyone is quietly struggling with trauma’, I don’t mean Capital T Trauma – the kind that stems from really terrible events like abuse or sexual assault. I mean little t trauma – events that “exceed our capacity to cope and cause a disruption in emotional functioning”. It’s being told off by a teacher when you were 6, and learning to live within the lines to avoid being yelled at. It’s thinking that your parents’ love is conditional on you achieving, and learning to contort yourself to get love.
Everyone is walking around with a heavy quilt of beliefs they accumulated throughout their lives that is holding them back from living in a fulfilled, resonant way.
Why are we like this? There are many ways to answer to this question, but they can be broken down into two rough causes1: our cultural circumstances, and our psychology.
On the cultural front, there’s an excessive atomization of the individual, a lack of overarching narratives of meaning, and an overload of choices (where to live, who to befriend, what to read, who to date). Each person is a singular floating node, untethered to any durable sense of community, place, or family. People who lack financial stability are stuck, and people who do have financial stability have to choose from a dizzying array of life paths. The absence of strong values and a support system leaves us feeling overwhelmed and lost.
On the psychological front, we’re stuck with a brain that evolved under circumstances of far greater danger and scarcity than most of us deal with today. Our brain is prone to feedback loops of anxiety, rumination, and depression; subtle reminders of past traumas condition our nervous system to chronic alertness. Our ability to think gives us enormous power to imagine new possibilities and plan for the future, but it also ensnares us in endless loops of misery about the past or worry about hypotheticals.
There are a smorgasbord of reinforcing pieces to this puzzle, each of which requires its own lifetime to study and address. You have to start somewhere: pick a single angle of attack on the broader problem of human suffering. The one that I’m choosing is the psychological.
how does therapy work?
I want to understand how we can overcome toxic mental patterns—how we can be happier, more wise, more compassionate, and more resilient—by doing work on our own psychology, especially through therapy and coaching. I want to understand how therapy works and why it works and what that reveals about the brain, and what a better understanding of the brain can tell us about how to do better therapy.
Some more specific questions:
Does therapy work? How often, on a population level, do people report that therapy significantly helped them? Do we have any other measures than subjective self-report?
Which therapy modalities are most effective? Is the main determinant of therapeutic outcome the common factors shared by all modalities or is it the specific technique used?
Is memory reconsolidation the mechanism that underlies successful therapeutic outcomes? If so, how can we use our understanding of this mechanism to make therapy more targeted and more effective? If not, is there some other psychological or neural mechanism at play?
Ultimately I want to synthesize insights from psychology, psychotherapy, neuroscience, and Buddhism-inspired contemplative practices to come to a coherent and robust understanding of how the mind works. I’m driven by the parallel motivations of finding knowledge for its own sake and helping people flourish.
In the appendix to this piece, I share some rough notes on my learnings and questions on memory reconsolidation so far.
personal angle & long-term goals
My background: I have fairly extensive meditation experience, two degrees in computer science and a minor in math. I’ve also spent time learning and thinking about basic neuroscience, philosophy, and psychology. I’m also decently good at writing, which will be useful for communicating my work.
But more importantly: I have been obsessed with this stuff for a long time and that obsession has not worn away. If anything, the more I read, the more fascinated I become. And my fair share of mental health struggles and experiences with therapy helps give me a more experiential perspective to accompany the analytical.
My expectation (hope) is that in the course of doing this work I will find some way to sustain myself financially before I burn through all my savings from my tech job. That may look like (a combination of): doing this research within a university; becoming a licensed therapist; funding myself through writing/software engineering/other endeavors; or some other creative means.
I expect that in the course of spending the next ~fifty years of my life working on this problem, I will make a meaningful contribution to it. There’s also a possibility that I’ll get bored after a few years and work on something else, but I actually doubt that. This feels like the kind of work I was placed on this earth to do.
would you like to help?
There are many ways you could help me. First, it would be great to find more collaborators and mentors working in the field or adjacent to it. In the next few weeks I’ll be reaching out to professors and researchers who might be interested in an informal mentorship relationship. If you know of anyone who might be interested, I’d love the connection!
Aside from that, the best thing you can do is support my writing – whether it’s reading, sharing with others, or making a pledge. The more support I get, the easier it will be for me to keep working on this problem. Much of the newsletter already engages with the themes I’m exploring in this research, so the content won’t change much – I’ll continue to intersperse personal essays with research notes and technical essays.
Your support means the world. Thank you for being here!
appendix A: notes and questions on memory reconsolidation
What follows is a snapshot of what I’ve learned far about memory reconsolidation; I’m going to write more polished essays about this in the future, but I wanted to give a preview to start.
Most of the things that we experience, we forget. You remember what you had for dinner last night and perhaps the night before, but you don’t remember your dinner from three Tuesdays ago. Past events meld into this undifferentiated mass of experiences, and almost everything is lost: except for a small number of memories that remain distinct. We say that these memories—unlike all the ones we forget over the course of a few days—are consolidated into our long-term memory.
Once consolidated, memories are hard to forget. Emotionally intense experiences in particular—the day you got into your dream school, or the day you got into a painful accident—form an imprint in our minds that lasts for decades, if not our entire life. We see this not just in humans but in lab animals too: if you teach a rat to associate a colored lamp and a foot shock, that association will be very hard to erase.
Our brain is filled with such associations—things like, “romantic rejection stings”, or “public speaking will lead to humiliation”, or “hard decisions are painful”, and so on—that subconsciously guide our behavior (”avoid asking people out”, “don’t speak in large groups”, “avoid big decisions”). These models serve to protect us from further emotional or physical pain, but they can also become debilitating.
The usual process by which we “forget” traumatic memories, and undo the associations that result from them, is traditionally called memory extinction. Think: getting over a fear of spiders by incremental exposure. First you get comfortable with a drawing of a spider; then a picture of one; then a real spider from afar, and so on. In lab studies, rats who learned to associate a lamp with a foot shock, once they’re given enough instances of the lamp unpaired with the foot shock, will stop having a fear response to the lamp.
The trouble is that extinction is a fickle process. Once a given emotional model has formed in the brain—e.g. ”lamp = foot shock”, or “don’t go to that intersection because bad things happen there”—it’s never fully erased. Relapse is common. Even after the rat has unlearned the association between shock and lamp, if you give it just one reinforcement, it will suddenly revert back to a fear response.
Here’s what we think is happening in memory extinction: the original memory is suppressed by new information, but not fully erased. The memory is still sitting there deep in our subcortical brain structures, while its hold over us is tenuously regulated by higher-level regions of the brain. The actual memory, and its potential to dictate our behavior, is “indelible”. This was the predominant view in the 1990’s: that sufficiently distressing experiences cause an imprint that last for the individual’s lifetime.
In the late 1990’s and early 2000’s however, scientists uncovered what seems to be a separate process by which the actual, original memory is updated or even erased, rather than merely suppressed. This results in an enduring change in behavior, without the need for ongoing maintenance, without the prospect of elapse. This is the process of reconsolidating the memory.
To understand what reconsolidation is, we should first note that every memory is composed of several parts: there’s the autobiographical component (your memory of what transpired), but also the emotional associations (e.g. feelings of fear, anger, or joy that the memory evokes). The idea is that when a memory is reconsolidated, part of it remains unchanged (the autobiographical component – you still remember the facts of the event), but part of it is updated – your emotional response to it changes.2 The fear associated with a traumatic event loses all potency. Once the emotional component of the memory is rewired, new behaviors flow effortlessly: you’re no longer constantly avoiding the thing that your emotions were trying to prevent.
This begs the question: how do we reconsolidate a memory? The idea, at least according to Bruce Ecker et al, is that it occurs in a few steps: first we have to reactivate the memory and the emotional associations that accompany it. This brings the memory into an unstable state. Then we need to identify another experience that fundamentally conflicts with the model of the world that the original memory supports. This is called a “mismatch experience”. For this to work, both the reactivation of the memory and the conflicting experience have to be very clear and vivid, activated in a safe and supportive context. With sufficient attention on the conflict, it’s believed that the emotional component of the memory is updated. This process can be aided by drugs like propranolol (see this and this).
There is still much research to be done on the details of memory reconsolidation, and not everyone agrees on its significance (see commentary at the end of this article). But as it stands, memory reconsolidation holds tremendous potential as an explanatory model for how therapy works, across a number of modalities and a number of mental health problems, and could help significantly improve the efficacy and efficiency of therapy. Imagine being able to resolve thorny issues of anxiety, bouts of depression, PTSD, phobias, shame, or low-self worth in the course of a few sessions of therapy: enduring change with little to no need for ongoing regulatory efforts.
Some of the things I’m trying to figure out now:
What neural evidence is there that extinction and reconsolidation are fundamentally different processes? Where are the boundaries between the two?
How enduring are the results of memory reconsolidation in more severe cases of depression, anxiety, etc?
Is mere reactivation sufficient to destabilize a memory, or do we need what Ecker et al call “a mismatch experience” to actually trigger reconsolidation?
What are the specific arguments that strong emotional memories are “indelible”, in both humans and non-human animals, and that behavioral extinction is really suppression of an enduring memory?
How does the idea that “reactivating a memory destabilizes it” accord with the common-sense intuition that our memories are fairly durable? Yes, memories do change upon repeated retrievals and are not perfectly reliable, but we also don’t run around constantly confused about what happened in the past.
Where do most psychopathologies come from? George Ainslie, for example, argues that the most common cause is not trauma per se, but “intertemporal bargaining”, citing this paper and this book.
How does memory actually work? I’m specifically curious about the relationship between autobiographical and semantic memory, e.g. Barsalou’s claim that semantic memory is “embedded within a network of autobiographical memories”.
appendix B: readings
Here are some of the papers, books, etc that I’ve been reading so far:
books:
papers:
There are also structural problems, like economic and social inequities, war, pandemics, climate change, decaying infrastructure, and all the other things that generally suck about life like disease and death. At the same time, things are pretty good compared to the past which makes addressing our psychology even more urgent: there’s not much point in trying to make the world better if we can’t enjoy any of it.
Technically the inverse can also happen: you can reconsolidate the autobiographical component and not the emotional component (see Unlocking the emotional brain, chapter 2), though there’s no therapeutic benefit to this.
Have you read Healing Back Pain by Dr. Sarno? Just started it today and only one chapter in. Although it's about healing physical pain, the claim that he makes is that it's deeply tied to our mind, psychology, and emotions.
Interesting. Although I'm fairly new to psychotherapy and it's specifics, I recently read "the untethered soul" by Michael A singer. The explanation and method shared in the book are almost exact similar to the one you laid down here.