Like many people who are in therapy or considering it, you may wonder what kind of psychological change is possible. Some of us think therapy can be like the treatment in the movie Eternal Sunshine of the Spotless Mind, in which “bad” thoughts, feelings, and behaviors are erased. But is that possible? Can things really be erased from the human mind, rendering it “spotless”?
We hear reports from people who have been in therapy: “I was depressed, and now I’m not.” Was the depression “cleaned out” of the mind? Were the neural pathways of the brain that created the thoughts, feelings, and behaviors of depression wiped away? If so, is this change permanent?
Certainly, change occurs in psychotherapy—about 50% of people who seek therapy get better (e.g., Lambert, 2013). However, we may wonder if those changes are permanent, like the extinction of the dinosaurs. Let’s explore some ideas about what types of change are possible in therapy, as well as this idea of change as a result of erasing something “bad” from the mind.
There’s No Such Thing as Extinction
Sure, we no longer see dinosaurs roaming the earth. Thank goodness. But their bones still emerge from the earth from time to time. We pump their liquefied remnants into our cars and homes. This fact seems to support the first law of thermodynamics—that energy cannot be created or destroyed, it can only be changed from one form to another. Is the same true of mental energy? Do our emotional difficulties “go away”? Do they transform and go underground? We can gain some insights from behavior therapy.
In behavior therapy, the concept “extinction” describes the process by which a behavior disappears because it is adequately punished and/or no longer rewarded. When I studied behavior therapy in graduate school, I came to understand behavior extinction in a simplistic way: if you don’t reward the behavior or if you punish it enough, it will go away. It will be extinct like the dinosaurs. I was impressed by the purported power of this approach and heartened by the idea that therapy can “kill off” unwanted inhabitants of the mind in what sounded like a permanent way. The idea supported my Eternal Sunshine-driven fantasies.
Recently, my sometimes-grand notions about what therapy can do were again humbled by a passage about extinction theory that I came across. The authors referred to extinction as a “misnomer” and suggested we never truly “unlearn” anything (Antony and Roemer, 2011, pp. 22-25). They summarized research that shows that behaviors that appear “extinct” can be reactivated by certain triggering experiences, or even reemerge as a result of the passage of time after treatment. These findings support the idea that no matter how much we learn and grow in life and in therapy, under the right (or wrong) conditions we can return to the “self-at-worst” (Fosha, 2000) behaviors that brought us to therapy.
These findings may spell the end of our fantasies of a “spotless mind,” which is, at least for me, a bummer. But they also beg a new question: If there’s no such thing as extinction, and if therapy can’t promise a spotless mind, what can therapy realistically help with?
Learning Not to Fear
All effective therapies have an “exposure” dimension, in which the person in therapy faces something feared and avoided in the past. Exposure is a potent aspect of therapy. By facing what we usually fear and avoid with a supportive person, we can learn we don’t need to be afraid, and thus we can feel less anxious and avoidant next time. The learning-not-to-fear that can come from exposure is a realistic goal of good therapy.
Our anxious and avoidant response can still come back given the right triggers, at the right intensity, in the right context.
In some therapies, the exposure is to a phobic object such as a snake. In others, it is to feared social situations. And in still others, the exposure aims to help a person face complex emotions or conflictual interpersonal situations. Exposure can be targeted and graded to meet the unique needs of the person in therapy, and can be delivered through a variety of therapy styles. When we face what we previously feared and avoided with a therapist, we can learn it’s not as bad as we thought. As a result of this learning, we may be less anxious. We can then respond differently the next time we face the snake, dinner party, or emotions we feared. We learn we can stop expecting the bad or scary outcome, and that our fear-driven avoidance behaviors, which are often self-defeating, are less necessary.
Were our fears erased thanks to exposure? Scrubbed out of our minds? Research on extinction cited by Antony and Roemer (2011, pp. 22-25) suggests they were not. Our anxious and avoidant response can still come back given the right triggers, at the right intensity, in the right context. What exposure provides is an increase in our tolerance for experiences, sometimes referred to as affect tolerance or anxiety tolerance. Exposure to higher and higher levels of that which we once feared helps us learn we can survive and even calmly face more and more of the experiences we once avoided. When we can face what we used to fear and avoid, we can also calmly choose our behavioral responses rather than suffer through whatever automatic non-choices our anxiety would force us to make.
Learning New Responses
Another realistic merit of therapy is the opportunity to learn and practice new, more helpful responses to the things we used to avoid. Different therapists will help us differently in this step: some will teach us new responses, while others will support us as we figure out new responses for ourselves.
Did our old responses go away? Are they extinct? Say it with me now: no! If we get anxious enough and we are no longer calm and in control of how we respond, we may revert to the automatic, unconscious avoidance behaviors that brought us to therapy. We will always have a maximum threshold of anxiety tolerance, a level of stress and emotion at which we shift into autopilot and do whatever it takes to avoid the anxiety. Sadly, that can mean a relapse, a regression, or a return to behaviors we’d rather leave behind.
Over time, though, through exposure learning, our anxiety tolerance threshold increases so we can bear and calmly face more and more of our life experiences. Though this is something to be realistically hopeful about in therapy, we must accept that our old avoidance behaviors will never be truly extinct, and exposure can never perfectly inoculate us against our old fears. As our range of calm responses to formerly scary situations broadens and deepens in therapy, we will still be human beings with brains that never completely forget our fears.
When Our Dinosaurs Return
Despite what I now understand about extinction, I still think it would be great if we could erase certain things from our minds. We have all had bad experiences we did not ask for, that hurt us and changed us in ways we did not want. Don’t we deserve the right to a “spotless” mind, without all that traumatic learning that taught us to fear? This is why avoidance is so attractive—“out of sight, out of mind” can almost feel like the things that make us anxious are “extinct.”
How do we handle the fact we will always be somewhat vulnerable to our old fears and our old ways of coping?
But we know there is no such thing as extinction. The dinosaurs have not come roaring back, but their mark upon the earth remains. We have grown and matured thanks to therapy and life, so the dinosaurs of our problematic behaviors may be quiet right now. But we know that on any day, given the right triggers, our personal dinosaurs can return.
That unearths a handful of T-Rex-sized questions: What do we do about that? How do we handle the fact we will always be somewhat vulnerable to our old fears and our old ways of coping? How do we treat ourselves when we are triggered and our dinosaurs return uninvited? Can we accept that therapy can never eliminate the possibility of relapse because our ability to tolerate anxiety and emotions can never be 100% perfect? Can we accept that, though we can make tremendous progress, vulnerability to our old fears and old avoidance behaviors is a permanent part of our humanity? Can we accept our vulnerable selves, prone to regression and relapse, no matter how old, wise, and anxiety-tolerant we become?
The bad news: there’s no such thing as extinction. The good news: now you know. What now?
- Antony, M.M., & Roemer, L. (2011). Behavior therapy. Washington DC: American Psychological Association.
- Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York, NY: Basic Books.
- Lambert, M.J. (2013). The efficacy and effectiveness of psychotherapy. In M.J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (169-208). Hoboken, NJ: Wiley.
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