Of Mice and Memories

Last October, my family had some unexpected tenants move into our home. While I’m all for practicing the virtue of hospitality, these particular guests were a bunch of pests - mice, to be precise! To my chagrin, I permanently evicted quite a few of these guests (ew), but when they kept inviting more friends (honestly! They weren’t even paying rent!), I called in a professional. It turns out, finding the tiny entrance the mice were using (a hole near the A/C unit) and sealing it up with steel wool was way more effective in the long run. I can’t quite tell you how relieved I was to not have to check the snap traps behind the oven every morning!

Most of us would rather fix the root cause of a problem than just treat the symptoms, right? So, why do we often focus on managing symptoms in therapy? The “snap traps” of the psychotherapy field (psychoeducation, relaxation skills, mindfulness, cognitive restructuring) are helpful for addressing individual problems (especially when there is immediate harm or risk involved), but wouldn’t it be better to take care of the issue once and for all, rather than constantly playing symptom-whack-a-mole…er, mouse?

Let’s take a quick detour to talk a bit about the brain…

Dr. Dan Siegel has helpfully labeled humans’ two different memory systems as the "upstairs/downstairs brain." Explicit memory, "upstairs," is consciously accessed and verbalized, such as remembering a phone number or a meaningful birthday gift you received. Implicit memory, "downstairs," is unconscious, automatic, and not easy to put into words, such as riding a bike, an emotional flashback, or the feeling you get when you smell something that reminds you of “home”.

Explicit/implicit memory theory proposes that many - if not most - mental health symptoms are generated by emotional learnings acquired through life experiences. Like mice in the kitchen that create symptoms upstairs (explicit awareness), the actual cause is downstairs (implicit memory). Just as sealing their entry point is more effective than catching mice one by one, addressing the root cause in implicit memory can lead to permanent change without needing to manage ongoing symptoms.

Most therapies work in one of two ways, and both kinds are important!

Some therapies (like cognitive behavioral therapy, DBT, ACT, and solution-focused therapy) create gradual improvements through managing symptoms. Counteractive therapies like these use our conscious awareness to add something new (a coping skill, a new set of beliefs or affirmations, a preferred positive emotional state) in order to reduce the impact or intensity of symptoms (like setting up traps to catch mice when they climb up the back of the stove). However these new thoughts and behaviors don’t erase old ones, they simply exist alongside them and require regular reinforcement to maintain.

By contrast, noncounteractive therapies aim to accomplish permanent removal of symptoms by accessing our unconscious memory systems responsible for the symptoms and updating them through an amazing process in the human brain called memory reconsolidation (more on this in my next post). Author and therapist Bruce Ecker has a lot more to say about the distinctions between counteractive and noncounteractive therapies here, but the bottom line is this: when the hole downstairs is finally plugged up, the symptoms showing up in the kitchen wither away (and I won’t use our mouse analogy to be any more specific on this!).

Thankfully, there are a lot of different therapy styles that can create the kind of transformational, lasting change we are talking about; there is no “magic bullet” or “holy grail”. The key is to find a therapist who you feel you can trust to help you identify the cause of your symptoms in the form of an emotional learning or prediction about the world, and let them guide you through the process of unlearning this emotional learning so that you can accept up-to-date accurate information into your current life and experiences. As I’ll explain in my next post, the process is simpler (and maybe harder) than you might think. Stay tuned!