Lane et al. suggest that a core element in therapeutic change (the reduction in clinical symptoms after psychotherapy) is reconsolidation of traumatic memories. This supposedly occurs through the activation of autobiographical memories, associated emotional responses, and semantic structures. Lane et al. suggest that this mechanism underlies the therapeutic change in a variety of treatments, including behavioral therapy, cognitive behavioral therapy (CBT), emotion-focused therapy, and psychodynamic therapy. We agree that this account may be plausible for post-traumatic stress disorder and acute stress disorder, which result from specific stressful events. Hence, in these disorders, activation and reconsolidation of traumatic memories may constitute a core psychotherapeutic change mechanism. However, Lane et al. have made a far broader suggestion for psychotherapy in general, in which “change occurs by activating old memories and their associated emotions, and introducing new emotional experiences in therapy enabling new emotional elements to be incorporated into that memory trace via reconsolidation” (sect. 1, para. 7). This suggestion consists of an underlying assumption that the etiology of psychiatric disorders in general relates to identifiable traumatic events that can undergo reconsolidation. This assumption is unsupported. Examine, for example, specific phobia, which can be considered a prototype of fear conditioning. Most patients do not recall any memories of direct, vicarious, or informational learning (Ollendick et al. Reference Ollendick, King and Muris2002). Thus, autobiographical memories of the onset of specific phobia are the exception rather than the rule.

One of the principles of CBT, which is considered a first-line treatment for various disorders (Hofmann et al. Reference Hofmann, Asnaani, Vonk, Sawyer and Fang2012; Tolin Reference Tolin2010; Vocks et al. Reference Vocks, Tuschen-Caffier, Pietrowsky, Rustenbach, Kersting and Herpertz2010), is focusing on the present. Moreover, effective emotion regulation strategies such as labeling (an integral part of self-monitoring) and reappraisal (often termed cognitive restructuring) constitute main ingredients of CBT treatment (Arch & Craske Reference Arch and Craske2009). Lane et al. suggest that change during CBT occurs through exploring recent events and their outcomes and “to the extent that these experiences share common characteristics with the original memories, they will also be subject to reconsolidation” (sect. 9.2, para. 3). However, reconsolidation necessitates a highly specific reminder stimulus activating the memory of the original fear response (Quirk & Milad Reference Quirk and Milad2010; Schiller et al. Reference Schiller, Monfils, Raio, Johnson, LeDoux and Phelps2009). Nevertheless, if such a memory does not exist or is inaccessible, the suggestion is problematic that a core element in therapeutic change is reconsolidation and modification of memories. It is well established that schemas (or semantic structures), through which an individual understands and interprets the world, evolve as a result of life experiences (Kellogg & Young Reference Kellogg and Young2006). However, this does not necessarily indicate that the therapeutic change occurs through activation and reconsolidation of autobiographic memories that formed the basis for the development of these schemas. Although we agree that activation of emotional arousal is essential for effective treatment, we disagree with the proposition that this should occur through the activation and modification of traumatic memories.

We suggest that acquisition of adaptive emotion regulation strategies, rather than memory reconsolidation, may be a transdiagnostic core process underlying all approaches described in Lane et al.'s paper. Emotion regulation is defined as “the processes by which individuals influence which emotions they have, when they have them and how they experience and express them” (Gross Reference Gross1998b). Various psychopathologies are strongly associated with deficits in emotion regulation, including depression, anxiety disorders, bipolar disorder, borderline personality disorder, substance abuse, and eating disorders (Aldao et al. Reference Aldao, Nolen-Hoeksema and Schweizer2010; Amstadter Reference Amstadter2008; Carpenter & Trull Reference Carpenter and Trull2013; Kring & Werner Reference Kring, Werner, Philippot and Feldman2004).

Evidence in recent years suggests that emotion regulation has an important role in the process of change and outcomes in therapy in various disorders and psychotherapy modalities (Azizi et al. Reference Azizi, Borjali and Golzari2010; Baer Reference Baer2003; Berking et al. Reference Berking, Wupperman, Reichardt, Pejic, Dippel and Znoj2008; Geller & Srikameswaran Reference Geller and Srikameswaran2014; Mennin Reference Mennin2004; Whelton Reference Whelton2004). Understanding the role of emotion regulation in psychopathology and psychotherapy led to the suggestion that treatment in emotional disorders should include three fundamental factors: training in reappraisal, prevention of emotional avoidance, and changing action tendencies that are related to the maladaptive emotional reactions (Barlow et al. Reference Barlow, Allen and Choate2004). This suggestion is in line with the transdiagnostic treatment approach, which highlights the common factor in emotional disorders and uses unified protocols instead of developing different treatment protocols for each emotional disorder (Ellard et al. Reference Ellard, Fairholme, Boisseau, Farchione and Barlow2010). The transdiagnostic treatment includes emotion regulation components, such as cognitive reappraisal and emotion awareness training (Wilamowska et al. Reference Wilamowska, Thompson-Hollands, Fairholme, Ellard, Farchione and Barlow2010). The unified protocol has demonstrated high effectiveness in various disorders including generalized anxiety, panic and agoraphobia, social anxiety and major depressive disorders (Ellard et al. Reference Ellard, Fairholme, Boisseau, Farchione and Barlow2010). Moreover, different psychotherapeutic approaches aim (either explicitly or implicitly) at enabling learning of emotion regulation skills (Whelton Reference Whelton2004). For example, there are various interventions that include mindfulness – an emotion regulation skill that enhances the awareness and experience of emotions (Chambers et al. Reference Chambers, Gullone and Allen2009). Examples of two approaches that use mindfulness as a core component are dialectical-behavior therapy (DBT) and acceptance and commitment therapy (ACT). These approaches further emphasize other forms of emotion regulation. In DBT, learning emotion regulation skills (including mindfulness) is considered to be a main mechanism of change during therapy, and patients learn how to be aware of their emotions and regulate them adaptively through individual, as well as group skills sessions (Lynch et al. Reference Lynch, Chapman, Rosenthal, Kuo and Linehan2006). ACT encourages patients to accept their emotional experiences instead of avoiding them as a means of regulating emotional intensity (Blackledge & Hayes Reference Blackledge and Hayes2001).

Taken together, the studies mentioned above demonstrate that learning to regulate emotions and to modify negative emotional experience can be construed as an alternative common mechanism of change during therapy. However, reconsolidation of memories may also be a complementary process to emotion regulation. In recent years, there has been growing evidence regarding successful outcomes in reducing clinical symptoms using imagery rescripting, which includes changing the meaning of traumatic events using imagery (e.g., Arntz et al. Reference Arntz, Tiesema and Kindt2007; Cooper Reference Cooper2011; Frets et al. Reference Frets, Kevenaar and van der Heiden2014). Imagery rescripting involves modification of traumatic memories, and also incorporates emotion regulation skills (e.g., mindfulness, training in positive interpretation bias; Holmes et al. Reference Holmes, Arntz and Smucker2007). Hence, memory reconsolidation may serve as a potential complementary process to enhancement of emotion regulation skills when traumatic memories are available.