Fighting against fear Novel approaches to understanding, modifying, and manipulating maladaptive memories

An increasingly mechanistic understanding of memory formation, storage, and change, opens up novel avenues for the treatment of mental health problems. Given that many disorders, such as PTSD, specific phobias, and addiction, can be conceptualized as disorders of emotional memory, might we be able to harness insights into the neurobiology of memory to combat them? If we have the power to manipulate ‘emotional memories’, should we champion it, or be concerned? Finally, how do we know what processes underpin such effects, and how can they be understood in relation to existing treatments? Each chapter of this dissertation deals in some way with these issues. I argue that such treatments are by no means simple: The translation of experiments on memory modification into legitimate clinical interventions still faces many challenges (Chapters 2, 4, and 7). If we can harness these approaches, then we should champion them, while carefully considering the boundaries between proper use, misuse, and abuse (Chapter 3). We should also seek to elucidate the mechanisms underpinning such effects (Chapter 5). I propose that many novel developments in the treatment of trauma-related and anxiety disorders – whether pharmacological, behavioral, or cognitive – may broadly be understood within a framework emphasizing competition between adaptive and maladaptive representations (‘memories’) of the feared stimuli. In treatment, we seek to enhance existing and generate new adaptive representations. Simultaneously, we hope to reduce the retrievability and motivational power of maladaptive ones (see Chapters 6 and 7).