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Memory is such an everyday thing
that we almost take it for granted.

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We all remember what we had
for breakfast this morning

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or what we did last weekend.

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It's only when memory starts to fail

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that we appreciate just how amazing it is

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and how much we allow
our past experiences to define us.

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But memory is not always a good thing.

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As the American poet and clergyman
John Lancaster Spalding once said,

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"As memory may be a paradise
from which we cannot be driven,

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it may also be a hell
from which we cannot escape."

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Many of us experience
chapters of our lives

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that we would prefer
to never have happened.

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It is estimated that
nearly 90 percent of us

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will experience some sort of
traumatic event during our lifetimes.

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Many of us will suffer acutely
following these events and then recover,

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maybe even become better people
because of those experiences.

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But some events
are so extreme that many --

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up to half of those who survive
sexual violence, for example --

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will go on to develop
post-traumatic stress disorder,

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or PTSD.

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PTSD is a debilitating
mental health condition

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characterized by symptoms
such as intense fear and anxiety

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and flashbacks of the traumatic event.

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These symptoms have a huge impact
on a person's quality of life

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and are often triggered
by particular situations

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or cues in that person's environment.

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The responses to those cues may have been
adaptive when they were first learned --

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fear and diving for cover
in a war zone, for example --

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but in PTSD,

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they continue to control behavior
when it's no longer appropriate.

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If a combat veteran returns home
and is diving for cover

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when he or she hears a car backfiring

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or can't leave their own home
because of intense anxiety,

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then the responses
to those cues, those memories,

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have become what we would
refer to as maladaptive.

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In this way, we can think of PTSD
as being a disorder of maladaptive memory.

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Now, I should stop myself here,

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because I'm talking about memory
as if it's a single thing.

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It isn't.

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There are many different types of memory,

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and these depend upon different circuits
and regions within the brain.

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As you can see, there are two
major distinctions in our types of memory.

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There are those memories
that we're consciously aware of,

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where we know we know

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and that we can pass on in words.

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This would include memories
for facts and events.

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Because we can declare these memories,

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we refer to these as declarative memories.

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The other type of memory
is non-declarative.

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These are memories where we often
don't have conscious access

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to the content of those memories

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and that we can't pass on in words.

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The classic example
of a non-declarative memory

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is the motor skill for riding a bike.

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Now, this being Cambridge,
the odds are that you can ride a bike.

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You know what you're doing on two wheels.

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But if I asked you to write me
a list of instructions

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that would teach me how to ride a bike,

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as my four-year-old son did
when we bought him a bike

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for his last birthday,

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you would really struggle to do that.

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How should you sit on the bike
so you're balanced?

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How fast do you need to pedal
so you're stable?

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If a gust of wind comes at you,

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which muscles should you tense
and by how much

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so that you don't get blown off?

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I'll be staggered if you can give
the answers to those questions.

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But if you can ride a bike,
you do have the answers,

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you're just not consciously aware of them.

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Getting back to PTSD,

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another type of non-declarative memory

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is emotional memory.

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Now, this has a specific
meaning in psychology

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and refers to our ability
to learn about cues in our environment

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and their emotional
and motivational significance.

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What do I mean by that?

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Well, think of a cue
like the smell of baking bread,

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or a more abstract cue
like a 20-pound note.

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Because these cues have been pegged
with good things in the past,

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we like them and we approach them.

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Other cues, like the buzzing of a wasp,
elicit very negative emotions

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and quite dramatic
avoidance behavior in some people.

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Now, I hate wasps.

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I can tell you that fact.

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But what I can't give you
are the non-declarative emotional memories

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for how I react
when there's a wasp nearby.

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I can't give you the racing heart,

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the sweaty palms,
that sense of rising panic.

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I can describe them to you,

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but I can't give them to you.

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Now, importantly,
from the perspective of PTSD,

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stress has very different effects on
declarative and non-declarative memories

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and the brain circuits
and regions supporting them.

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Emotional memory is supported
by a small almond-shaped structure

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called the amygdala

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and its connections.

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Declarative memory, especially the what,
where and when of event memory,

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is supported by a seahorse-shaped
region of the brain

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called the hippocampus.

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The extreme levels of stress
experienced during trauma

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have very different effects
on these two structures.

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As you can see, as you increase
a person's level of stress

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from not stressful to slightly stressful,

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the hippocampus,

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acting to support the event memory,

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increases in its activity

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and works better to support
the storage of that declarative memory.

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But as you increase to moderately
stressful, intensely stressful

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and then extremely stressful,
as would be found in trauma,

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the hippocampus
effectively shuts down.

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This means that under
the high levels of stress hormones

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that are experienced
during trauma,

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we are not storing the details,

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the specific details
of what, where and when.

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Now, while stress is doing that
to the hippocampus,

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look at what it does to the amygdala,

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that structure important
for the emotional, non-declarative memory.

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Its activity gets stronger and stronger.

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So what this leaves
us with in PTSD

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is an overly strong emotional --
in this case fear -- memory

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that is not tied
to a specific time or place,

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because the hippocampus
is not storing what, where and when.

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In this way, these cues
can control behavior

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when it's no longer appropriate,

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and that's how
they become maladaptive.

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So if we know that PTSD
is due to maladaptive memories,

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can we use that knowledge
to improve treatment outcomes

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for patients with PTSD?

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A radical new approach being developed
to treat post-traumatic stress disorder

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aims to destroy those maladaptive
emotional memories

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that underlie the disorder.

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This approach has only
been considered a possibility

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because of the profound changes
in our understanding of memory

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in recent years.

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Traditionally, it was thought
that making a memory

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was like writing in a notebook in pen:

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once the ink had dried,
you couldn't change the information.

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It was thought that all
those structural changes

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that happen in the brain
to support the storage of memory

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were finished within about six hours,

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and after that, they were permanent.

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This is known as the consolidation view.

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However, more recent research suggests
that making a memory

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is actually more like writing
in a word processor.

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We initially make the memory
and then we save it or store it.

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But under the right conditions,
we can edit that memory.

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This reconsolidation view suggests
that those structural changes

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that happen in the brain to support memory

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can be undone,

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even for old memories.

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Now, this editing process
isn't happening all the time.

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It only happens under
very specific conditions

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of memory retrieval.

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So let's consider memory retrieval
as being recalling the memory

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or, like, opening the file.

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Quite often, we are simply
retrieving the memory.

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We're opening the file as read-only.

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But under the right conditions,

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we can open that file in edit mode,

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and then we can change the information.

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In theory, we could delete
the content of that file,

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and when we press save,

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that is how the file -- the memory --

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persists.

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Not only does this reconsolidation view

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allow us to account for some
of the quirks of memory,

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like how we all sometimes
misremember the past,

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it also gives us a way to destroy
those maladaptive fear memories

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that underlie PTSD.

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All we would need would be two things:

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a way of making the memory unstable --
opening that file in edit mode --

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and a way to delete the information.

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We've made the most progress

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with working out
how to delete the information.

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It was found fairly early on

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that a drug widely prescribed
to control blood pressure in humans --

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a beta-blocker
called Propranolol --

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could be used to prevent
the reconsolidation

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of fear memories in rats.

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If Propranolol was given
while the memory was in edit mode,

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rats behaved as if they were no longer
afraid of a frightening trigger cue.

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It was as if they had never learned
to be afraid of that cue.

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And this was with a drug
that was safe for use in humans.

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Now, not long after that,

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it was shown that Propranolol could
destroy fear memories in humans as well,

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but critically, it only works
if the memory is in edit mode.

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Now, that study was with
healthy human volunteers,

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but it's important because it shows
that the rat findings

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can be extended to humans
and ultimately, to human patients.

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And with humans,

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you can test whether destroying
the non-declarative emotional memory

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does anything to
the declarative event memory.

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And this is really interesting.

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Even though people
who were given Propranolol

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while the memory was in edit mode

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were no longer afraid
of that frightening trigger cue,

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they could still describe the relationship

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between the cue
and the frightening outcome.

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It was as if they knew
they should be afraid,

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and yet they weren't.

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This suggests that Propranolol
can selectively target

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the non-declarative emotional memory

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but leave the declarative
event memory intact.

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But critically, Propranolol can only have
any effect on the memory

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if it's in edit mode.

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So how do we make a memory unstable?

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How do we get it into edit mode?

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Well, my own lab has done
quite a lot of work on this.

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We know that it depends on introducing
some but not too much new information

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to be incorporated into the memory.

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We know about the different
chemicals the brain uses

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to signal that a memory
should be updated

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and the file edited.

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Now, our work is mostly in rats,

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but other labs have found the same factors
allow memories to be edited in humans,

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even maladaptive memories
like those underlying PTSD.

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In fact, a number of labs
in several different countries

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have begun small-scale clinical trials
of these memory-destroying treatments

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for PTSD

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and have found really promising results.

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Now, these studies need replication
on a larger scale,

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but they show the promise
of these memory-destroying treatments

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for PTSD.

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Maybe trauma memories do not need to be
the hell from which we cannot escape.

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Now, although this memory-destroying
approach holds great promise,

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that's not to say
that it's straightforward

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or without controversy.

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Is it ethical to destroy memories?

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What about things
like eyewitness testimony?

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What if you can't give someone Propranolol

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because it would interfere
with other medicines that they're taking?

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Well, with respect to ethics
and eyewitness testimony,

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I would say the important
point to remember

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is the finding from that human study.

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Because Propranolol is only acting
on the non-declarative emotional memory,

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it seems unlikely that it would affect
eyewitness testimony,

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which is based on declarative memory.

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Essentially, what these
memory-destroying treatments

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are aiming to do

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is to reduce the emotional memory,

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not get rid of the trauma
memory altogether.

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This should make the responses
of those with PTSD

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more like those who have
been through trauma

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and not developed PTSD

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than people who have never
experienced trauma in the first place.

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I think that most people would find that
more ethically acceptable

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than a treatment that aimed
to create some sort of spotless mind.

248
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What about Propranolol?

249
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You can't give Propranolol to everyone,

250
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and not everyone wants to take drugs
to treat mental health conditions.

251
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Well, here Tetris could be useful.

252
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Yes, Tetris.

253
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Working with clinical collaborators,

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we've been looking at whether
behavioral interventions

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can also interfere with
the reconsolidation of memories.

256
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Now, how would that work?

257
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Well, we know that
it's basically impossible

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to do two tasks at the same time

259
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if they both depend on
the same brain region for processing.

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Think trying to sing along to the radio

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while you're trying to compose an email.

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The processing for one
interferes with the other.

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Well, it's the same when
you retrieve a memory,

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especially in edit mode.

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If we take a highly visual symptom
like flashbacks in PTSD

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and get people to recall
the memory in edit mode

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and then get them to do
a highly engaging visual task

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like playing Tetris,

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it should be possible to introduce
so much interfering information

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into that memory

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that it essentially becomes meaningless.

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That's the theory,

273
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and it's supported by data
from healthy human volunteers.

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00:14:22,823 --> 00:14:26,748
Now, our volunteers watched
highly unpleasant films --

275
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so, think eye surgery,
road traffic safety adverts,

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Scorsese's "The Big Shave."

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These trauma films produce
something like flashbacks

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in healthy volunteers
for about a week after viewing them.

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We found that getting people
to recall those memories,

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the worst moments
of those unpleasant films,

281
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and playing Tetris at the same time,

282
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massively reduced the frequency
of the flashbacks.

283
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And again: the memory had to be
in edit mode for that to work.

284
00:15:00,063 --> 00:15:03,769
Now, my collaborators have since
taken this to clinical populations.

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They've tested this in survivors
of road traffic accidents

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00:15:06,837 --> 00:15:10,081
and mothers who've had
emergency Caesarean sections,

287
00:15:10,105 --> 00:15:14,200
both types of trauma
that frequently lead to PTSD,

288
00:15:14,224 --> 00:15:17,087
and they found really promising
reductions in symptoms

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00:15:17,111 --> 00:15:19,489
in both of those clinical cases.

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So although there is still much to learn
and procedures to optimize,

291
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these memory-destroying treatments
hold great promise

292
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for the treatment
of mental health disorders

293
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like PTSD.

294
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Maybe trauma memories do not need
to be a hell from which we cannot escape.

295
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I believe that this approach

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should allow those who want to

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to turn the page
on chapters of their lives

298
00:15:45,103 --> 00:15:47,761
that they would prefer
to never have experienced,

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and so improve our mental health.

300
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Thank you.

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(Applause)