[What changes when psychotherapy works? Memory reconsolidation as the basis for the profound transformation of predictive models]

Contemporary psychotherapy relies on a diversity of empirically validated methods, yet it continues to face a central challenge: clearly identifying what actually changes when treatment produces durable effects. Despite decades of research, symptom reduction is still frequently observed without a precise understanding of which underlying processes have been altered in the patient, thereby limiting both the precision of clinical interventions and the ability to reliably anticipate the long-term stability of treatment outcomes. Advances in affective neuroscience now provide a robust explanatory framework for addressing this question. Emotional memory reconsolidation allows reactivated emotional learning to become transiently malleable and to be modified when specific experiential conditions are met. Unlike approaches centered on regulation, inhibition, or compensation, which rely on a conscious, voluntary effort that is generally context-dependent, reconsolidation enables a direct transformation of the implicit emotional learning responsible for the automatic predictions that generate symptoms. This framework is supported by recent work on the predictive brain, consciousness, and the organizing role of emotional learning in subjective experience. These perspectives converge in showing that implicit learned models are transformed when lived experience sharply contradicts the predictions on which they are based. The present article proposes Coherence Therapy as a structured clinical operationalization of reconsolidation through the Therapeutic Reconsolidation Process. This transdiagnostic framework targets the durable transformation of underlying emotional learning rather than the ongoing management of symptoms, and its implications for clinical practice and mental health research are examined.