Today's episode was inspired by an experience I had with a client in which we reframed triggers as cues for action or behavior. Even if the cue is to check in with herself and offer herself some love and care when she was having a hard time. When we framed trigger=avoidance. Cue=Curiosity, her body's energy and her orientation to what was happening shifted in a positive direction. In this podcast I take it one step further and explore the foundations of cue conditioning and how learning and neuroplasticity happen in the brain. I've dropped the links below to the articles and studies but I want to encourage you to think of this metaphorically and see how the brain easily learns from fear conditioning but we can also unlearn that fear conditioning.
https://changingminds.org/techniques/conditioning/cue.htm
https://med.stanford.edu/sbfnl/services/bm/lm/bml-fear.html
https://www.sciencedirect.com/topics/psychology/contextual-fear-conditioning
https://www.sciencedirect.com/topics/neuroscience/fear-conditioning
https://www.sciencedirect.com/science/article/abs/pii/S1074742710000845
https://www.sciencedirect.com/science/article/pii/S0165178116308770
[00:00:00] Welcome to the curiosity cure podcast. I'm your host, Deb Malkin, master certified life coach, body worker, hypnotist trained in pain reprocessing by the pain psychology center, queer elder, fat human on planet earth here to help you evoke the power of simple neuroplasticity techniques rooted in shame free curiosity.
[00:00:29] So you can feel more better. more of the time in the body you have today and build the rich, full life that you want to live. A quick disclaimer, this podcast is not a replacement for medical care. I am here to provide insights and techniques that can compliment your healthcare journey, but always consult with your healthcare provider for personalized advice.
[00:00:56] Hi, my feelers and healers. I hope that you are doing well today. This episode is going to be weaving story and science together. So I am taking a little journey through information about memory, cue conditioning, neuroplasticity, and this came up because I had a session with a client and we were really working on changing those foundational conditioned responses to triggers. And we all know what a trigger is. Usually we think that our job is to be avoiding triggers as often as possible, we don't like the feeling of being triggered emotionally or physically by something that feels bad. And I get it, but in this weaving of some science, I'm going to make the case that we should think about triggers as cues. That avoiding our triggers is bad for our brain and body and pain.
[00:02:08] Now it doesn't mean like run headlong into a trigger, right? I'm talking about creating a plan. Using science as a foundation for learning how to unlearn, update and, unwire this conditioning, cue conditioning. And that's what we're doing in pain reprocessing therapy, in pain coaching.
[00:02:32] Some of it is just like that buy in, that willingness. When I talk to my client about thinking about this experience, we were talking about a high intensity, high arousal emotional experience. And I was talking about, well, what if it's a cue and not a trigger? And in that moment, I saw her body relax. I saw her prefrontal cortex, her brain, her thinking mind be able to be accessed. And a little bit of curiosity came into the frame. And so even as we are thinking about things differently, putting a different frame on a physiological experience, even that is a process of neuroplasticity.
[00:03:18] So, I've mentioned before pain is a message from the body. It is often an opinion. It is the brain's best guess as to what the body should be doing in relationship to any nociceptive input, in relationship to its internal and external perception of sensory input.
[00:03:43] When we think about it as a cue, not as a trigger, like trigger equals avoid, cue equals curiosity. When I offered to my client that this was really a cue and not a trigger, we were able to unpack it. We were able to approach with building a resource of safety. And for me, that was a in the moment reorientation to a physical, emotional experience. That's what led me here today, because I absolutely think understanding things in a new way creates a new experience of what is happening inside of our bodies.
[00:04:23] And that includes emotions. So it's not just physical experiences. Emotions are felt in our body. Anything that is experienced in our body, that is an assessment of some kind of sensory input, whether that's internal or external.
[00:04:39] So, I'm just going to read you some selections, they're not the entire article or study.
[00:04:46] This is about giving you, some context to understand how the brain works and about learning, conditioning, the relationship between the brain and the nervous system. This is from, changing minds. org and each of these links I will put in the show notes.
[00:05:07] Description. A cue is a stimulus that leads to a desired action. It is put in place by the use of pairing, in particular, pairing of reward with the action. Pairing the cue with the reward and action and fading away the reward so that the cue leads to the action without the need for reward. So this is a basic example of how the Pavlovian, experiment was done where ringing the bell leads to dog salivating.
[00:05:41] So the reward may be paired with the action and later the cue added or the pairing may be all done together. Ways to introduce a cue include repeatedly introduce the cue just as the action is beginning. Introduce the cue gradually, for example, alternating the cue with a lure.
[00:06:01] Using the cue when the subject naturally performs the action of their own accord. Like you're giving a reward for the action that you want to be experiencing most. And I've seen people talk about this in regards to relationships, right? Which is rewarding the behavior that you want to be experiencing more often. That's an aside. But we can even think about that with ourselves, rewarding ourselves for the behavior that we want to be experiencing more often.
[00:06:27] Traditional training often starts with a cue, sit, says the trainer, and seems to expect the dog to know what to do. When there is no appropriate response, the trainer keeps repeating the cue and may even get angry. Meanwhile, the subject is baffled as to what the trainer wants.
[00:06:46] Even if the trainer pushes the dog into a sit and it learns to pair sitting with a cue, it may still only be doing so in order to avoid being pushed down. Conditioning introduces cues later. First, pairing the action with the reward and only later pairing the cue with the action. Establishing cues are often the primary purpose of conditioning, such that they may be used as commands.
[00:07:12] The reliability of cues, for example, calling a dog will depend not only on the effectiveness of the conditioning, but also the willfulness of the dog. Some subjects and some cues are easy to teach, while others may be frustratingly ununreliable. The potential number and complexity of cues will vary with the intelligence of the subject.
[00:07:36] Some animals can be taught to perform a sequence of actions on a single cue, or may understand compound cues such as lie down and roll over. Other subjects may find such complexity too much to handle. Cues are also known by various other words, including command, prompt, signal, and trigger. The classic name for a cue is a conditioned stimulus. In other words, it is a stimulus that leads to the desired action that is put in place by the act of conditioning.
[00:08:09] So now we think about fear conditioning, because pain is a part of our safety system and is a part of our fear response system. This is from Stanford. Fear conditioning is a type of associative learning task in which mice learn to associate a particular neutral conditioned stimulus, often a tone with an aversive unconditional stimulus, often a mild electrical foot shock.
[00:08:38] So let's go back through this, a neutral conditioned stimulus, often a tone. So when we talk about nociception, we're talking about the experience of these receptors being able to evaluate sensory information. We've got pressure, chemical and temperature. We're talking about what our senses are experiencing and when we're looking at it as the neutral conditional stimulus, beyond just noting it, a tone is neutral in this study, and then they're pairing it with an aversive, unconditional stimulus.
[00:09:21] So the foot shock is unconditional and that's unpleasant and then it shows a conditional response. So the conditional response is freezing. That's like that nervous system, like not moving. So the conditional response of the mouse is to freeze when they are pairing a tone and this aversive stimulus.
[00:09:46] So they're pairing these two things together, right? So the aversive stimulus. Which is the unconditional stimulus, which is the foot shock is being paired with the neutral stimulus because without the foot shock, the tone itself is not going to create the conditioned response of freezing. After repeated pairings of the conditional stimulus and the unconditional stimulus, the animal learns to fear both the tone and training context.
[00:10:17] Fear conditioning is learned rapidly, and after one conditioning session, a very stable and long lasting behavioral change is produced, which is useful for neurobehavioral, genetic and pharmacological studies.
[00:10:32] So when we're thinking about our triggers, if we're thinking about them as cues for neuroplastic rewiring, instead of experiences to be avoided, what if you thought of yourself, both as the scientist and as the subject, the rat, mouse, dog, and starting to get curious about that condition stimulus and that unconditioned stimulus?
[00:10:59] What's the foot shock? And what's it paired with? Right, so if we think about the foot shock being the pain in your back and it's being paired with that chair, how often do we associate these two things together so that then when you sit in that chair, you feel that pain?
[00:11:20] This is why getting curious and starting to kind of slow our process down and use practices like somatic tracking and my, I notice practice is that we can begin to unravel this cue conditioning that we have subconsciously created for ourselves.
[00:11:42] So there is an article in Science Direct about rodent behavior learning and memory models, mechanisms of memory. Cue plus contextual fear conditioning is one variation of fear conditioning that is widely used in studies of rodent learning and memory. A typical cue plus contextual fear conditioning experiment proceeds as follows.
[00:12:10] Animals are placed in a fear conditioning apparatus for about two minutes. Then a 30 second acoustic conditioned stimulus, tone, or preferably white noise, but light cues can also be used, right? So we're talking about our senses. We've got a tone or a light cue that is the conditional stimulus. During the last 2 seconds of the tone, a mild foot shock, the unconditional stimulus is applied to the floor grid of the apparatus. This pairing protocol can be repeated with a brief intervening period. Like 2 minutes between pairings, the stimulus strength and the number of training pairs are typically chosen based on pilot experiments to optimize learning without over training the animals. When trained in this fashion, the animals learn at least 2 things. 1. they learn that the training chamber is bad news. That is that the context in which they are trained is a place to be feared. So, maybe check in about that when you're thinking about your back hurting when you're thinking about going to work.
[00:13:22] But like, when you're thinking about going on vacation, your back isn't hurting or when you're actually on vacation, your back isn't hurting. And then when you're at work, your back is hurting. So we've got the context in which the fear you know, in which the conditioned response is being triggered.
[00:13:42] Another thing that they learn is that the noise or light conditional stimulus predicts an upcoming foot shock, and thus it also is to be feared, right? So this speaks about that anticipatory experience of fear. Right now, the mouse is not getting a foot shock. And so what's basically an innocuous stimuli, a noise or a light is triggering or cuing a fear response, but it hasn't happened yet.
[00:14:14] The brain is paired these two things together and is already ahead of the game. And so this is when, we as human beings, because we have the ability to reflect on things and we're also not mice in an experiment. We're able to kind of reverse engineer it. So these 2 components of the learning are referred to as contextual and cued fear conditioning, respectively.
[00:14:39] I love that description, we can imagine and see how we've inadvertently paired things together and then we've trained our brain to respond to the conditional stimulus with the condition response of the unconditional stimulus. So maybe I should say like, the neutral stimulus and the painful stimulus, right?
[00:15:03] When we meet the neutral stimulus, we're already anticipating and experiencing the conditioned response, which is pain because our brain has linked these things together and thinks that this unconditional stimulus, this pain stimulus is coming or this unpleasant stimulus is coming.
[00:15:22] Here's another article from Science Direct and is called avoidance. And this was one thing that I talked to my client about, when we only relate to a trigger by avoiding, we never get a chance to update it. We don't really get to either look at it, create a sense of safety around it or self compassion.
[00:15:43] We just are like, nope. I don't want to, and my client is so beautiful in the way that she represents these things somatically and physically. So, you know, we're on zoom and I'm watching her body move. And like, I could see this kind of nope response. There's like, hell no response come in. Before she's even creating words, even speaking what she's trying to explain, her body is doing a movement and I thought that was fascinating.
[00:16:12] I was like, yeah, there's already this kind of fast physiological response coming in. So we played a little bit with the tempo of that. We played with moving her hands differently. We were really able to change the frame of that really fast, habitual conditioned response to this trigger, without talking about the trigger, we just changed her body's, I'm just going to keep saying frame because that's the word that's coming to my mind, but we just changed the way that her body related to a trigger.
[00:16:46] We slowed it down. We created safety in the body. We had a good laugh, not laughing at her, but just laughing at, like, the ways that our bodies are, way ahead of us and are doing things and we don't even notice it.
[00:16:59] So I want to read this thing about avoidance. So fear conditioning paradigms are used to investigate the conditioning of emotional processes.
[00:17:10] During conditioning, the individual cannot avoid the aversive stimulus, which is usually announced by a signal. During retention testing, the signal itself elicits the fear response, which is invariably immobility, which is freezing accompanied by high blood pressure and tachycardia. So that is a physiological response to an emotional process and an aversive stimulus.
[00:17:38] Fear conditioning paradigms have incorporated the complexity of the physical or social environment. These latter paradigms are called contextual fear conditioning. Anatomical pathways are well described emotional response circuits, including amygdala, brainstem nuclei, hippocampus and prefrontal cortex.
[00:18:02] Likewise, molecular mechanisms have been reported knowledge of neuro endocrine changes in the rise in plasma prolactin, adrenal corticotropin corticosterone and catecholamines. Plasma, corticosterone levels in rats are positively correlated with the extent of contextual conditioned fear.
[00:18:28] Freezing is of obvious adaptive value. It not only decreases the probability of acoustic or visual detection, but also conserves energy in situations where action is inefficient, like in fear conditioning. Ah, this is so important, right? This is saying freezing happens when we can't take an action to change the stimuli. So this often is a thing that we can learn when we're young, when we're not in charge of ourselves, our bodies, the world around us. I mean, it happens now when you're in any difficult situation and you feel like you have no agency, and that is often a correlation for pain.
[00:19:20] It's one of the things that we see shows up quite often with fibromyalgia, but with any kind of pain, when we feel helpless, our physiology adapts to that because fighting when you don't believe that you can make any change is like metabolically draining and so, you know, your brain's job is to keep you alive. And so that's why freezing has an adaptive value.
[00:19:52] So, formally, freezing was considered as a non functional coping response. Individuals may use one or the other coping strategy, depending on genetic makeup and life experiences influenced by the physical and social environment. Active avoidance paradigms select for active fight or flight strategies, while fear conditioning paradigms select for passive conservation and withdrawal oriented approaches.
[00:20:24] So just think about yourself as you are thinking about your coping mechanisms, as you're coming in contact with triggers, which I'm now calling cues. As we're thinking about ourselves in this context and exploring our coping strategies. Like the coping strategy that we use tells us something about our relationship to the experience and to the condition response.
[00:20:53] The basis of rewiring our neurological and physiological responses is called neuroplasticity and there are certain things that need to be in place for neuroplasticity to be activated. So, there's an interesting article study about the role of pro inflammatory cytokines in memory processes and neuroplasticity. So, again, we're talking about fear conditioning.
[00:21:24] Fear conditioning is the learning that a neutral stimulus predicts the appearance of an aversive event. I'm going to say that again. Fear conditioning is the learning that a neutral stimulus predicts the appearance of an aversive event. So when we're thinking about our responses to sight, sound, smells, touch, and taste, when we're looking to rewire our physiological response to anything that is triggering us to believe that there's an aversive event, we can just start to learn yeah, maybe this is some fear conditioning. All brains do fear conditioning. That's 1 way it keeps us safe. So starting to explore it in that way as a scientist.
[00:22:12] So the combination of a neutral condition stimulus, and an aversive unconditioned stimulus renders the formerly neutral stimulus a frightful quality so that even when it appears by itself without the aversive stimulus, it will elicit a fearful conditioned response.
[00:22:33] Fear conditioning can be rapidly formed in humans and animals, even following a single conditioning trial and is usually maintained for long periods.
[00:22:44] The conditioning process itself, i. e. the association between the neutral and aversive stimuli, is mediated primarily by the amygdala, which is a part of our brain.
[00:22:56] Here's another abstract that goes a little bit more into how we can change memory reconsolidation window. So this is called prevention of recurrent affective episodes using extinction training in the reconsolidation window, a testable psychotherapeutic strategy.
[00:23:16] It says the abstract stressors may initially precipitate affective episodes and that's affective episodes, not effective episodes with sufficient numbers of recurrences, episodes can occur more autonomously. It is postulated the memory engram for these recurrent depressions moves from the conscious representational memory system to the unconscious habit memory system encoded in the striatum. So if this were the case, cognitive behavioral therapy targeted towards extinction of habit memories could be an effective maneuver for helping reverse the automaticity of affective episode recurrence. Extinction training in the reconsolidation window, which opens about 5 minutes to 1 hour after active memory recall.
[00:24:15] So if we're talking about when we're in a session, coaching session, and we open up this reconsolidation window with this active memory recall, there's this window. And it says can revise, reverse or eliminate long term memories associated with PTSD and other anxiety disorders, and with drug abuse craving. We hypothesize that similar cognitive behavioral work in the reconsolidation window could inhibit stress induced and spontaneous affective episodes.
[00:24:49] So, let's see, it talks about a little bit of background on memory. So memory formation goes through successive stages of encoding. Hippocampically based short term memory has been known to require consolidation into long term memory in the cerebral cortex by a process that requires gene expression and new protein synthesis. In 2000, Nader discovered a new, later phase in memory storage called reconsolidation.
[00:25:21] Reconsolidation occurs after a long term memory is actively recalled and the old memory is reprocessed in such a way that it again requires new protein synthesis. In addition to the memory recall, there must be novel information or context for opening the reconsolidation window. There are two phases of memory consolidation, short term memory requires new protein synthesis for consolidation into long term memory.
[00:25:57] Active recall of the long term memory in the presence of new information, what has been called mismatch prediction error. So this is what we're creating with the brain and the new information we're trying to update the brain's predictive coding. So we are trying to create a mismatch, a prediction error with this presence of new information.
[00:26:25] So that activates phase two reconsolidation, which renders the old memory amenable to revision during a window of about five minutes to several hours after recall. Which makes me think about how I want to assign work to my clients and thinking about doing it within this window of reconsolidation. In the reconsolidation phase the memory can either remain intact and be strengthened if there is no mismatch or revised in the presence of new information.
[00:27:03] So, in the study shows that in normal volunteers, extinction training within the reconsolidation window, the 10 minute group, reduces condition fear and eliminates the associated amygdala activation seen on the fMRI. These positive results do not occur if the same extinction training is conducted outside of the reconsolidation window.
[00:27:27] During this phase of reconsolidation, the memory trace becomes labile and subject to long term revision by psychological processes occurring within the reconsolidation window, which lasts approximately 10 minutes to 1 hour and possibly up to 5 hours after the active memory recall. The original memory trace can either be further strengthened with each new reconsolidation experience, Or modified and revised if the circumstances and requirements for new learning are met.
[00:28:02] Ecker describes reconsolidation as having two biological functions. A, it preferentially strengthens recent learnings that are most frequently reactivated and destabilized, and B, it allows new learning experiences to update, strengthen, weaken, modify, or nullify an existing learning. So when we think about my story, when I went on my safety walk with my knee pain, which is kind of got me started down this road, I was not strengthening my memory. I was not doing the same thing. I was completely introducing new information as I was walking, which allowed it to change its predictive code and update the learning. So I didn't act in the same way that I had acted before. I didn't have the same learning or assumptions or beliefs about my pain as I did before.
[00:29:04] I did not exhibit the same pain behaviors as I did before. And what I really did was try to target this sense of safety facilitate this felt sense of safety rather than alienation. And that prediction of what I thought was going to be happening, which was the knee pain got updated with no pain, with ease of movement and walking and friendship and kindness and relaxation.
[00:29:34] So this article also goes into conditioned fear, goes further into erasure of conditioned fear in the reconsolidation window. So I'm going to link to this. You can go read it. I've already said so much. But there's this amazing science out there that's really showing us that it is possible to change, is possible to change our experience, our physiological experience without doing something to the body, without getting surgery, without taking a medication, and I'm not against those, but this mind body work is a brain first approach. What we are trying to do is create those mismatched prediction errors and update the brains learning as to what is going to be happening. So that we can teach the brain that we're safe, that doing these activities is fine and safe and available to you.
[00:30:38] So guess what we're doing in pain neuroscience education, in mind body work, in pain reprocessing, we are in this window of reconsolidation and those reactivated memories can be changed. So that's why, long story short, I want to encourage you to think about your triggers differently. Think about them as cues and start to explore this idea that we have inadvertently created this cycle of cue conditioning in our relationship to unpleasant stimuli.
[00:31:20] So If that's work that you have found frustrating to do on your own, I really want to encourage you to reach out and book a curiosity call and let's explore what working together looks like, because it's important to do this process safely, with kindness, it helps to have an outside observer, just like with my client who was just kind of in it. Right? She was in the experience of not wanting to experience something and together we were able to observe the behavior, observe the cue and the conditioning and with good humor and warmth and connection and a desire and a willingness for things to be different start to unwire that process, unwire that like fast as lightning, habituated response, that emotional response to the stimuli. And when we do that in the sessions, both through talking, somatic work, hypnosis, our brain changes. And then our experience of memories, or that cue conditioning, or that conditioned response, changes.
[00:32:37] And that's how we rewire our brains. And it can be done for strong, aversive emotions, as well as physiological experiences. So I hope that this ramble through some sciencey stuff has turned your brain on and your curiosity on, and you're now thinking of yourself as a scientist and also as the subject of the experiment and just starting to look at things through this different lens. Always with self-love, self-kindness, a sense of lightness and humor when possible, but always with love. All of a sudden I just got this flash of thinking of myself as a little mouse, which just made me laugh.
[00:33:25] And if you're not on my email list, I really would love for you to hop on there because I started this email on Mondays called Musical Mondays, and we're talking about musicals and I'm sharing a song with everybody from a musical that helps evoke a certain feeling state and there's some prompts to get you to invite you to be curious and to notice the feelings and sensations and the thoughts that are coming up when you're listening to this song, even just noticing a state change in your body as you're listening to this song. And I love musicals and I also pick musicals because on purpose, they are specifically designed to evoke or relay a strong emotion.
[00:34:14] It's that feeling of whatever feeling is going on inside of me. It cannot be contained and I must burst into song and dance. It's a heightened experience, but you know, it's not your heightened experience. It's a heightened experience with a particular story and a narrative and a character. I don't know if that makes any sense to you, but also I just love a musical.
[00:34:39] Um, yeah. And if you love a musical, please make sure that you are on my email list so that you can receive my Musical Monday email.
[00:34:49] I think I've gotten to a place where I'm like, okay, I've said maybe the same thing eight times, but I know for myself and for learning, I need to hear things multiple times. That is just also a normal human process about learning. It is why one of the underpinnings of pain reprocessing is pain neuroscience education. The more we learn, the more we experience things differently. It's not to say that you have to know everything, right? There's no test. There's never a test. You work with me and we're learning stuff together, there is no test. You come in with an A. You leave with an A. There is no failure. You will not be graded. There is no real way to fail. What we're trying to do is create curiosity and create a new way of experiencing some old things. So that's my invitation to you. Thank you so much for listening. I look forward to talking to you and sharing with you every single week. And if you are interested in working with me, please book a curiosity call. The link is in the show notes. Thank you.