We applaud Lane et al.'s modern, neurobiologically informed integration of research on memory, emotion, and behavior change in psychotherapy. Indeed, we have applied a similar “multiple trace theory” to enhance cognitive behavioral therapy (CBT) for adolescents who are prodromal for paranoid delusional psychosis, with promising preliminary results (Landa Reference Landa2012; Landa et al. Reference Landa, Mueser, Wyka, Shreck, Jespersen, Jacobs, Griffin, van der Gaag, Reyna, Beck, Silbersweig and Walkup2015). The theory is called “Fuzzy Trace Theory” (e.g., Reyna Reference Reyna2008) and it distinguishes gist memory (representations of bottom-line meaning) from verbatim memory (representations of exact details). Verbatim memory is subject to interference (e.g., from strong emotions), and it fades rapidly; in contrast, gist memory is more stable and generalizable. Thus, fostering reliance on gist in CBT is predicted to produce greater and more enduring behavior change.

Adolescence is an important transitional period in which decision processes shift to greater reliance on gist. Onset of psychosis also typically occurs during adolescence and can have profound adverse impacts on social and cognitive development. The onset of psychosis is preceded by attenuated psychotic symptoms and decline in psychosocial and cognitive functioning. Preventative interventions during this phase can improve the course of illness, facilitate recovery from an at-risk mental state, and prevent future illness.

However, CBT has not kept pace sufficiently with new developments in cognitive theory, a crucial gap that the proposed framework addresses (see also Brainerd & Reyna Reference Brainerd and Reyna2005). Hence, to the degree that Fuzzy Trace Theory and the proposed framework overlap, the large literature on memory, decision making, and behavior change supporting our theory also supports the approach taken in the target article (Reyna et al. Reference Reyna, Nelson, Han and Pignone2015; in press). Applying such new developments in cognitive theory is critical to enhancing the efficacy of CBT.

The mechanisms we have applied to CBT, such as inculcating new gist representations of experience, are loosely analogous to changing “semantic structures” in the target article. Also somewhat analogous, in Fuzzy Trace Theory, we emphasize re-interpreting episodic memories of the gist of past experience. Each type of memory representation in our theory supports alternative modes of processing: a “verbatim-based” analytical mode (processing precise literal details of experience) and a gist-based intuitive mode. The gist-based intuitive mode operates on simple, bottom-line representations of the meaning of experience, a target for CBT (Reyna Reference Reyna2012).

The third major component of the Lane et al. model (emotional responses) is also present in Fuzzy Trace Theory. Rivers et al. (Reference Rivers, Reyna and Mills2008) describe how emotion interacts with these different modes of thinking, reviewing research on emotion as valence (positive–negative), arousal (excited–calm), feeling states (moods), and discrete emotions (e.g., anger vs. sadness). The literature on valence, for example, supports its interpretation in terms of gist representations, including evidence for long-term retention in memory, a hallmark of gist. Rivers et al. also review research on mood congruency, affect-as-information, memory and emotion, and the relation between arousal and inhibition. Thus, emotions conceived as valence, arousal, feeling states, or discrete emotions color information processing.

Contrary to aspects of the proposed framework, emotional arousal can foment false memories for the gist of experience (although negative valence does so even more than arousal), and intense emotion can interfere with the ability to recognize the gist of when a threat is present (or not). Different emotions also shape gist interpretations of experiences and pre-load responses to risk (e.g., anger encouraging risk-taking and fear discouraging it) regardless of memory for verbatim facts (Lerner & Keltner Reference Lerner and Keltner2001). Unlike the proposed framework, verbatim and gist memories have been shown to be dissociated, rather than growing out of one another or interacting. Thus, the familiar characterization of memory as “constructive” in line with results for the “War of the Ghosts” (Bartlett Reference Bartlett1932; but see Bergman & Roediger Reference Bergman and Roediger1999) has been disproven, although some features of schema theory and constructivism are preserved in Fuzzy Trace Theory through the notion of gist representations.

Lane et al.'s thesis about different points of entry is broadly consistent with the dissevering of insightful gist-based intuition from rote (verbatim) behavioral memorization or conditioning, but, according to Fuzzy Trace Theory, these modes of behavior change are distinct. An individual can observe that specific behaviors do not “pay off,” and change those behaviors (win: stay; lose: shift) without insight or transfer to superficially different – but essentially similar– situations. This lack of insight contributes to the often-observed fadeout effect of interventions, as opposed to the enhanced transfer and long-term retention of gist (Reyna & Mills Reference Reyna and Mills2014). More generally, the paradoxes of implicit versus explicit memory (including neuroscience research) can be accounted for more easily by assuming that distinct verbatim and gist memories underlie judgments of recollection (true and phantom recollection) versus familiarity (Brainerd et al. Reference Brainerd, Reyna and Zember2011).

In sum, like Lane et al.'s proposed framework, Fuzzy Trace Theory draws on research about memory, emotion, semantic structures, and the brain (Reyna & Huettel Reference Reyna, Huettel, Reyna and Zayas2014). Therefore, the evidence base for much of the proposed framework is broader and deeper than indicated in the target article. Moreover, Fuzzy Trace Theory has been successfully applied not only to prevention and behavior change in adolescents (evaluated using randomized experimental designs; Reyna & Mills Reference Reyna and Mills2014), but to behavior change in nonsymptomatic adults (e.g., Wolfe et al. 2015 and to adult patients (e.g., Fraenkel et al. Reference Fraenkel, Peters, Charpentier, Olsen, Errante, Schoen and Reyna2012, increasing value-concordant medication decisions from 35% to 64%). This track record of successful application of Fuzzy Trace Theory augurs well for the proposed model and its implications for psychotherapy, especially for CBT. Specific details regarding information processing differ between Fuzzy Trace Theory and the proposed framework, however, which should motivate future research testing alternative frameworks.