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Erasing trauma memories

  • Emily A. Holmes (a1), Anders Sandberg (a2) and Lalitha Iyadurai (a3)
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Abstract
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References
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1 Kindt, M, Soeter, M, Vervliet, B. Beyond extinction: erasing human fear responses and preventing the return of fear. Nat Neurosci 2008; 12: 256–8.
2 Schiller, D, Monfils, M, Raio, C, Johnson, DC, LeDoux, JE, Phelps, EA. Preventing the return of fear in humans using reconsolidation update mechanisms. Nature 2009; 463: 4953.
3 Liao, SM, Sandberg, A. The normativity of memory modification. Neuroethics 2008; 1: 8599.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Erasing trauma memories

  • Emily A. Holmes (a1), Anders Sandberg (a2) and Lalitha Iyadurai (a3)
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eLetters

Why we should treat but not erase trauma memories

Lalitha Iyadurai, Clinical Psychologist
26 January 2011

We read with interest Menzies’ response to our letter on the topic of erasing trauma memories [1]. We were curious about his first sentence, which seems to interpret the aims of our letter in a slightly divergent way from our intentions. He writes that we “identify potential drawbacks in treating traumatic memories”. To the contrary!

As stated in our initial letter [2], our concerns are not with “treating traumatic memories”, but on the wider issue of advocating memory erasure as a key target of treatment (whether pharmacological or psychological). In fact we had asserted that reducing or even erasing the pain of traumatic memories is an important clinical and ethical goal. Our concern is that the increasing coverage of this issue, such as in last month’s New Scientist [3], often phrases this as erasing the informational content of memories themselves. This suggests memory might be like a file on a computer that could simply be deleted – which is misleading. Such an analogy misinforms both the public and clinicians hopeful of new treatments. This is no benign form of misinformation; avoidance is a key maintaining symptom of post-traumatic stress disorder (PTSD) so raising false hopes of memory erasure could even contribute to clinical distress by reinforcing avoidant behaviour.

Treating the fear and distress of traumatic memories is one of the goals of effective treatments for PTSD, such as trauma-focused CBT [4]. However, we still need new innovations. As yet, we lack evidence-based treatments for the immediate aftermath of a trauma, such as a bombing.

Menzies provides some excellent clinical examples of the importance and possibilities of alleviating trauma-related suffering. The case of the date rape victim, who was distressed despite no memory of the assault, is a good example of why erasing memory content can still leave emotional pain. Thus this case supports rather than refutes our claim. Similarly the second example of the policeman further supports our point; treatment helped him to reduce his anxiety, enabling him to stand up in court, but did not affect the information in his memory. In summary, it is the emotion, not the memory content per se, that is the critical target for effective treatment.

We welcome the publication of Menzies’ ongoing study, a decade after initial reports of the successful use of propanolol in alleviating post-traumatic symptoms [5]. Given the surprising lack of progress towards a positive result in a randomised control trial over this period, we look forward to new developments in this treatment. We also welcome data on the claim that this type of treatment markedly reduces the integrity of specific memories and that this is actually beneficial to patients. Mental health has moved beyond the anecdotal case example and needs to substantiate claims such as this with empirical evidence.

Promoting wellbeing after trauma is a key aim for clinicians, and we applaud and seek the appropriate treatment of trauma memories. This means treating emotional distress, not erasing these memories from the mind.

1. Menzies R P. Treating traumatic memories. Br J Psychiatry [Online] 8 December 2010. Availabe at: http://bjp.rcpsych.org/cgi/eletters/197/5/414-b.

2. Holmes E A, Sandberg A, Iyadurai L. Erasing trauma memories: Is this what the science suggests or even what we want to do? Br J Psychiatry 2010; 197: 414-415. doi: 10.1192/bjp.197.5.414b

3. Thomson H. To erase a bad memory, first become a child. New Scientist December 2010; Issue 2790. Also available at: http://www.newscientist.com/article/mg20827903.400-to-erase-a-bad-memory-first-become-a-child.html

4. National Institute for Health and Clinical Excellence. Post-traumatic stress disorder (PTSD): the management of PTSD in adults and children in primary and secondary care. London:National Institute for Health and Clinical Excellence, 2005.

5. Pitman R K, Sanders K M, et al. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry 2002; 51(2): 189-192.

Authors:

Lalitha Iyadurai, Clinical Psychologist, Amersham Hospital, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK.

*Emily A Holmes, Senior Research Fellow, Department of Psychiatry, University of Oxford, Oxford, UK, emily.holmes@psych.ox.ac.uk, tel + 44 (0)1865 223912, fax +44 (0)1865 793101 (corresponding author).

Anders Sandberg, James Martin Research Fellow, Future of Humanity Institute, University of Oxford, Oxford, UK.
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Conflict of interest: None Declared

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Treating traumatic memories

Robin P Menzies, Psychiatrist
08 December 2010

In their letter, Holmes et al1 identify potential drawbacks in treating traumatic memories. I have been treating traumatic memories of psychiatric patients,

most of whom have posttraumatic stress disorder, for over two years with a

single treatment of one or two doses of propranolol. The handful of cases already reported2 has now grown and the full series of 36 patients will be

submitted for publication shortly.

Holmes et al1 are right that current research does not talk about “erasure” of memory, although I have found that the integrity of the memory in those patients who responded to treatment is markedly reduced. This change is seen as beneficial by the patients, and is accompanied by both reduced re-experiencing of the traumatic event and associated emotional distress.

Instances where incomplete memory of the traumatic experience may lead to problems are stated in their letter1. One of my cases was given the date rape drug, and could only recall events leading up to and following the sexual assault. It was not what she could not remember that was traumatic; it was

the fact that she knew she had been raped. She responded to treatment, and

now can go out socially without being paralyzed with fear about it happening again. The other example cited is the potential for any future court testimony being affected. I treated a police officer before he gave evidence in a trial involving the homicide of two police officers. The patient responded to treatment and gave good evidence in court, in part, because he was not overwhelmed by anxiety. The accused was convicted of two counts of first-degree murder and given a life sentence.

None of my patients saw themselves as a reflection of some traumatic experience that was not of their making and they could not change. They only wished that they could move on with their lives rather than relive an experience that happened years ago and still haunted them. They certainly did not see this as contributing to their sense of self or well-being. Thelucky ones among us are able to move on and the memory of a traumatic event becomes a normal memory, which decays over time.

Colleagues and I are undertaking a study comparing the effects of propranolol and placebo in the treatment of traumatic memories and associated emotional distress. The results of this study will help determine whether the clear benefits evident in clinical cases will be confirmed in a randomized clinical trial.

1Holmes E A, Sandberg A, & Iyadurai L. Erasing trauma memories. Br J Psychiatry 2010; 197: 414-415. doi: 10.1192/bjp.197.5.414b

2Menzies R P. Propranolol treatment of traumatic memories (letter). Adv Psychiatr Treat 2009; 15 (2): 159-160.
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Conflict of interest: None Declared

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