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Rethinking our memories

New trial aims to mitigate pain and suffering

Human beings crave love. We want to feel like we are a part of a caring and supportive relationship. At a time when we desperately need to know that our significant other is there for us, if the support we expect from them is missing, we risk developing an ‘attachment injury.’ In 2001, based on observations of impasses in couples therapy, Sue Johnson, a psychologist and researcher specializing in Emotion Focused Couples Therapy at the University of Ottawa, defined attachment injury as an event involving a betrayal of trust or emotional abandonment by a romantic partner. This can take the form of infidelity, actual abandonment, or emotional abandonment during a time of need. Johnson draws a parallel between attachment injuries and trauma, suggesting that relationship betrayals can be traumatic for the injured partner, in that they shatter once held positive assumptions about the self, the partner, and the future. We can all imagine how such an event can leave emotional scars.

“Generally, emotional memories are advantageous, as they allow us to remember the most significant parts of life. However, for certain people exposed to emotional trauma, the memories can become pathological, and lead to symptoms of posttraumatic stress disorder (PTSD) or other psychiatric disorders,” said Michelle Lonergan, a PhD student in the department of psychiatry at McGill University, who is currently working on a project examining new treatment for relationship trauma, in an interview with Sereena Pigeon.

When an individual experiences an attachment injury, they may develop symptoms that resemble those of PTSD such as anxiety, feelings of depression or hopelessness, insomnia, nightmares, inability to function, increased substance use, flashbacks, and intrusive memories, among others. Clinical experts in Emotion Focused Couples Therapy observed that the presence of infidelity or other types of injuries to the romantic bond in a couple presenting for counseling is an important barrier to recovery.

New trial underway studying emotional attachment

Lonergan is conducting a study to test the effectiveness of an exposure based treatment which involves the medication propranolol in helping individuals suffering from the aftermath of betrayal. The day that someone finds out their partner was unfaithful, or stole from them, or called them names, or emotionally abandoned them during a time of need can be very traumatizing, and memories of the event can be haunting. Exposing oneself to the memories can be difficult, but if done in a safe and therapeutic environment, it can be greatly beneficial. Adding the medication propranolol should, at least in theory, enhance the therapeutic effects of exposure.

Lonergan is conducting a study to test the effectiveness of an exposure-based treatment that involves the medication propranolol to help individuals suffering from the aftermath of betrayal

Propranolol is a medication typically used to treat hypertension and migraines: it blocks the release of certain neurochemicals that are involved in the stressful or unpleasant feelings we experience when we remember a traumatic memory. The act of remembering, or “memory reactivation”, destabilizes long-term memories and triggers a process called memory reconsolidation, allowing us to incorporate new information into an old memory. If propranolol is taken during that time, it blocks neurotransmitters such as epinephrine and norepinephrine and therefore reduces the psychological distress which accompanies the traumatic memory.

That being said, propranolol must be taken in conjunction with memory reactivation in order for it to be effective. To reactivate the memory, participants either write or read out loud the story of the event in as much detail as possible. Lonergan states “propranolol given by itself will have no therapeutic effects, aside from maybe making you a feel a bit calmer and tired.” However, the pairing of memory reactivation and propranolol together reduces the distressing symptoms. This treatment has demonstrated success among individuals with PTSD, specific phobias, and substance addiction.

What will this trial involve?

With regards to her current study, Lonergan hypothesizes that individuals will show improvement in symptoms related to anxiety, depression and trauma – such as persistent crying and sadness, nightmares and insomnia, flashbacks and intrusive thoughts, avoidance of reminders, or emotional numbness – after six weeks of the treatment, and that this improvement should endure at a 3-month follow-up. The trial therefore involves six sessions and two follow-ups (at one week and then three months after the clinical trial). The trials take place about an hour after the consumption of propranolol. The first session involves writing about the betrayal in detail and the other five sessions involve reading about it aloud.

Lonergan states “propranolol given by itself will have no therapeutic effects, aside from maybe making you a feel a bit calmer and tired.” However, the pairing of memory reactivation and propranolol together reduces the distressing symptoms.

What are the risks?

The trial poses very few risks and is expected to have long-term benefits for participants. Side effects associated with propranolol are minimal and typically involve some fatigue on treatment days. Of course, reading and writing about a traumatic event can be difficult; participants may be surprised by the feelings that the exposure exercise brings up. But this reaction is temporary and not much different from what would be observed in a regular individual or couples psychotherapy session.
Lonergan states that “the research, from our lab and that of others, demonstrates that people still remember what happened to them, and how they felt when it happened.” She explains that propranolol only dims the emotions associated with the memory, not the memory itself. “The difference is that they do not have the same debilitating emotional response toward memory,” she asserts. Participants are able to function again in their day to day life; they can sleep better, eat better, and generally feel better. They may no longer break down every time they hear or see something that reminds them of what happened, or avoiding people or situations that are reminders; they can finally have peace.