Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components – autobiographical (event) memories, semantic structures, and emotional responses – supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: (1) reactivating old memories; (2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and (3) reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed.

The role of emotional trauma in psychopathology is limited. One additional mechanism is predictable from hyperbolic discounting: When a person uses willpower to control urges each success or failure takes on extra significance through recursive self-prediction, potentially motivating several constricting defense mechanisms. The need for eliciting emotion in psychotherapy is as the authors say it is, but their hypothesis about reconsolidation of memories adds no explanatory power.

As cultural anthropologists, we noticed an unexpected and interesting convergence of the therapeutic practices suggested in the target article and the rites of passage occurring across multiple societies, as individuals make the transition from one significant age or status to another.

I suggest it is premature to assume memory reconsolidation provides a unifying model of psychotherapeutic change given our current state of knowledge, and that other basic memory mechanisms, also supported by neuroscience, have a stronger claim at present. In particular, I propose that retrieval competition provides a more plausible alternative to memory reconsolidation.

The Integrative Memory Model offers a strong foundation upon which to build successful strategies for clinical intervention. The next challenge is to figure out which cognitive strategies are more likely to bring about successful and beneficial modifications of reactivated memories during therapy. In this commentary we suggest that exercising emotional regulation during episodic counterfactual thinking is likely to be a successful therapeutic strategy to bring about beneficial memory modifications.

Like Lane et al., we believe that change in psychotherapy comes about by updating dysfunctional memories with new adaptive experiences. We suggest that sleep is essential to (re-)consolidate such corrective experiences. Sleep is well-known to strengthen and integrate new memories into pre-existing networks. Targeted sleep interventions might be promising tools to boost this process and thereby increase therapy effectiveness.

That memory reconsolidation is the process underlying decisive, lasting therapeutic change has long been our proposal, and the recognition of its critical role by Lane et al. is a welcome development. However, in our view their account has significant errors due to neglect of research findings and neglect of previous work on the clinical application of those findings.

Lane et al.'s proposal that psychotherapeutic change comes about through memory reconsolidation is compelling; however, the model would be strengthened by the inclusion of predictions regarding additional factors that might influence treatment response, predictions for improving outcomes for non-responsive patients, and a discussion of how the proposed model might explain individual differences in vulnerability for mental health problems.

The relations between the semantic and episodic-autobiographical memory systems are more complex than described in the target article. We argue that understanding the noetic/autonoetic distinction provides critical insights into the foundation of the delineation between the two memory systems. Clarity with respect to the criteria for classification of these two systems, and the evolving conceptualization of episodic memory, can further neuroscientifically informed therapeutic approaches.

Lane et al. emphasize the role of emotional arousal as a precipitating factor for successful psychotherapy. However, as therapy ensues, the arousal diminishes. How can the unfolding therapeutic process generate long-term memories for reconsolidated emotional material without the benefit of arousal? Studies investigating memory for emotionally regulated material provide some clues regarding the neural pathways that may underlie therapy-based memory reconsolidation.

Hypothesizing that an effective common feature in divergent forms of psychotherapy is a process of memory reconsolidation integrating new emotional experiences, Lane et al. usefully shift the focus away from established and/or specialized techniques to deeper questions about the underlying principles of psychotherapeutic change. More research attention to cultural factors influencing the definition and treatment of psychopathology is also needed.

Lane et al. propose a heuristic model in which distinct, and seemingly irreconcilable, therapies can coexist. Authors postulate that memory reconsolidation is a key common neurobiological process mediating the therapeutic effects. This conceptualization raises a set of important questions regarding neuroscience and translational aspects of fear memory reconsolidation. We discuss the implications of the target article's memory reconsolidation model in the development of more effective interventions, and in the identification of less effective, or potentially harmful approaches, as well as concepts of contextualization, optimal arousal, and combined therapy

The target article argues memory reconsolidation demonstrates how therapeutic change occurs, grounding psychotherapy in brain science. However, consolidation has become an ambiguous term, a disadvantage applying also to its derivative – reconsolidation. The concept of re-association (involving active association between memories during rapid eye movement [REM] dreams followed by indexation and network junction instantiation during non-rapid eye movement [NREM] periods) brings greater specificity and explanatory power to the possible brain correlates of therapeutic change.

The states called “psychopathology” are very diverse, but Lane et al.'s single-process explanation does little to account for this diversity. Moreover, some other crucial phenomena of psychopathology do not fit this theory: the role of negative evaluations of conscious emotions, and the role of emotions without physiological correlates. And it does not consider the processes maintaining disorders.

Recent findings in social psychology show how implicit affective responses can be changed, leading to strong, fast, and durable updating. This work demonstrates that new information viewed as diagnostic or which prompts reinterpretations of previous learning produces fast revision, suggesting two factors that might be leveraged in clinical settings. Reconsolidation provides a plausible route for making such reasoning possible.

Lane et al. are right: Troublesome memories can be therapeutically recontextualized. Reconsolidation of negative/traumatic memories within the context of positive/prosocial affects can facilitate diverse psychotherapies. Although neural mechanisms remain poorly understood, we discuss how nonlinear dynamics of various positive affects, heavily controlled by primal subcortical networks, may be critical for optimal benefits.

Lane et al. propose an integrative model for the reconsolidation of traces in their timely and impressive article. This commentary draws attention to trade-offs between accuracy and self-narrative integrity in the model. The trade-offs concern the sense of agency in memory and its role in both implicit and explicit memory reconsolidation, rather than balances concerning degrees of emotional arousal.

A model that suggests reconsolidation of traumatic memories as a mechanism of change in therapy is important, but problematic to generalize to disorders other than post-traumatic and acute-stress disorder. We suggest that a more plausible mechanism of change in psychotherapy is acquisition of adaptive emotion regulation strategies.

The seemingly puzzling datum that behavior decreases after punishing stimulation while individuals are still able to remember traumatic episodes is discussed in relation to dopaminergic and noradrenergic neuromodulation. The described mechanisms may contribute to an understanding of how occurrences of learning reconsolidation yield different outcomes across intra- and extra-therapeutic settings.

We question memory reconsolidation and emotional arousal as sufficient determinants of therapeutic change. Generating new feelings and meanings must be contrasted with activating and stabilizing the evolving memories that reflect those novel experiences. Some therapeutic changes are not attributable to a memory model alone. “Emotional processing” is also needed and is often an undeclared form of complex executive problem solving.