Overgeneral and specific autobiographical memory predict the course of depression: an updated meta-analysis

Improving usual care outcomes in major depression in youth by targeting memory specificity: A randomized controlled trial of adjunct computerized memory specificity training (c-MeST)

OBJECTIVE

Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment.

METHODS

Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups.

RESULTS

The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05).

CONCLUSIONS

c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.

Specificity and valence of adolescents' turning point memory narratives: Relationships with depressive symptoms over time

Although recent research suggests that, for community youth, greater specific (episodic) detail in self-relevant turning point memory narratives predicts depressive symptoms over time, no research has investigated whether the narratives' specificity similarly predicts depression. Therefore, we investigated whether recalling a specific (unique, 24-hour or less) turning point narrative predicted youth depressive symptoms concurrently and across 6 months (Study 1), and, for a subset of participants, three years (Study 2). We also examined whether the valence of the implication of the experience for self (the resolution) explained additional variance and interacted with memory specificity. For Study 1 (N = 320, M = 16.9 years, 81% female), a specific (rather than a non-specific) turning point predicted greater depressive symptoms concurrently but not longitudinally, whereas a negative resolution predicted both concurrent and longitudinal depressive symptoms. The moderation result showed that a specific turning point predicted escalating depressive symptoms across six months when the resolution was negative. Study 2 (N = 68) additionally showed that a specific turning point predicted increased depressive symptoms three years later. These findings contrast with research suggesting that specific memories are related to better mental health and highlight the complexity of the role of memory in emerging youth depression.

Recalling and anticipating positive events to improve the positive affect and mental health of adolescents: A cluster randomized controlled trial in secondary schools

This cluster randomized controlled trial examined the effectiveness of Positive Events Training (PET), a combined group training aimed at simultaneously improving positive autobiographical memory (AM) and episodic future thinking (EFT) among adolescents (12-16 years). Delivered as a universal school-based program, PET was compared with an active (creative writing) control group (CREAT). Effects on resilience, wellbeing, positive emotions, emotional response styles towards positive emotions (savoring, dampening), anhedonia, depressive symptoms, and multiple AM and EFT indices were examined. Adolescents (NPET = 95, NCREAT = 93) completed self-report scales at baseline, post-training and two-month follow-up. Multilevel models revealed that PET led to significant improvements in certain AM and EFT skills. Moreover, a decrease in anhedonia was observed at post-training. However, this effect did not withstand correction for multiple testing. Absence of changes in the other outcomes should be interpreted within the context of the universal school-based approach and the potential limited scope for detectable changes. Exploratory analyses suggest the importance of further investigating PET's potential in addressing positive affect dysregulations in indicated samples, and exploring perceived likelihood of generated future events and dampening as potential underlying mechanisms. Study limitations and future directions to maximize the demonstrated potential of PET are discussed.

Neurobiology and systems biology of stress resilience

Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.

Transdiagnostic and transtherapeutic strategies for optimising autobiographical memory

Our memories for past personally experienced autobiographical events play an important role in therapy, irrespective of presenting issue, diagnoses or therapeutic modality. Here, we summarise evidence for how autobiographical memory abilities can influence our mental health and the relevance of this for the treatment of mental health problems. We then guide the reader through principles and strategies for optimising autobiographical memory within treatment. We ground these recommendations within research for stand-alone interventions for improving autobiographical memory and from studies of how to support the formation and retrieval of therapeutic memories. Options are given for clinicians to guide clients in improving retrieval of autobiographical memories within treatment, for improving autobiographical memory for the therapeutic experience itself, and for creating improvements in autobiographical memory that endure post-treatment. We also provide worksheets for clinicians to use within treatment.

Improving access to psychological intervention in low-middle income settings: Results from a waitlist-controlled, proof-of-concept trial of the MemFlex intervention for trauma-exposed Afghan youth

BACKGROUND

Low-intensity interventions targeting a range of mental health issues offer a scalable approach for young trauma survivors in low-middle income countries.

AIMS

Here, we present results from a proof-of-concept, randomized, waitlist-controlled trial evaluating MemFlex, an autobiographical memory-based intervention, for trauma-exposed Afghan youth residing in Iran. MemFlex seeks to reduce the negative and overgeneral memory biases which maintain and predict poor mental health.

MATERIALS AND METHODS

Young people aged 12-18 years (N = 40) with parents who had experienced forced migration from Afghanistan were recruited from high schools in Karaj City in Iran. All had experienced a traumatic event in the last year. Participants were randomized to receive four weeks of a group-based delivery of MemFlex or Waitlist. Our primary cognitive outcome was autobiographical memory flexibility, that is, the ability to deliberately retrieve any memory type on demand. Primary clinical outcome was emotional distress, measured on the Farsi version of the Hopkins Symptom Checklist.

RESULTS

Results indicated that MemFlex participants demonstrated large effect sizes for pre-to-post improvement in memory flexibility (d = 2.04) and emotional distress (d = 1.23). These improvements were significantly larger than Waitlist (ds < .49), and were maintained at three-month follow-up.

DISCUSSION

Positive benefits were observed for completion of MemFlex, and future comparison against an active intervention appears warranted.

CONCLUSION

Further evaluation of MemFlex in this context may offer a low-cost, and low-resource intervention to improve access to psychological intervention for young migrants in low-middle income countries.

Can neutral episodic memories become emotional? Evidence from facial expressions and subjective feelings

Maladaptive emotional memories are a transdiagnostic feature of mental health problems. Therefore, understanding whether and how emotional memories can change might help to prevent and treat mental disorders. We tested whether neutral memories of naturalistic events can retroactively acquire positive or negative affect, in a preregistered three-day Modification of Valence in Episodes (MOVIE) paradigm. On Day 1, participants (N = 41) encoded memories of neutral movie scenes, representing lifelike naturalistic experiences. On Day 2, they retrieved each episode before viewing a happy, sad, or neutral scene from the same movie (yielding a within-subjects design with a neutral-negative, neutral-positive, and neutral-neutral condition). On Day 3, participants again retrieved each memory from Day 1. We assessed the affective tone of episodes through facial expressions of positive and negative affect (using facial electromyography, fEMG) and through self-reported feelings. Positive updating of neutral episodes led to increased expressions of positive affect, whereas negative updating led to increased self-reported negative feelings. These results suggest that complex neutral episodic memories can retroactively acquire an affective tone, but the effects were modest and inconsistent across affect readouts. Future research should investigate alternative approaches to updating emotional memories that produce more profound changes in the valence of memories.

A deep learning quantification of patient specificity as a predictor of session attendance and treatment response to internet-enabled cognitive behavioural therapy for common mental health disorders

BACKGROUND

Increasing an individual's ability to focus on concrete, specific detail, thus reducing the tendency toward overly broad, decontextualised generalisations about the self and world, is a target within cognitive behavioural therapy (CBT). However, empirical investigation of the impact of within-treatment specificity on treatment outcomes is scarce. We evaluated whether the specificity of patient dialogue predicted a) end-of-treatment symptoms and b) session completion for CBT for common mental health issues.

METHODS

This preregistered (https://osf.io/agr4t) study trained a deep learning model to score the specificity of patient dialogue in transcripts from 353,614 internet-enabled CBT sessions for common mental health disorders, delivered on behalf of UK NHS services. Data were from obtained from 65,030 participants (n = 47,308 female, n = 241 unstated) aged 18-94 years (M = 34.69, SD = 12.35). Depressive disorders were the most common (39.1 %) primary diagnosis. Primary outcome was end-of-treatment score on the Patient Health Questionnaire-9 (PHQ-9). Secondary outcome was number of sessions attended.

RESULTS

Linear mixed-effects models demonstrated that increased patient specificity significantly predicted lower post-treatment symptoms on the PHQ-9, although the size and direction of the effect varied depending on the type of therapeutic activity being completed. Effect sizes were consistently small. Higher patient specificity was associated with completing a greater number of sessions.

LIMITATIONS

We are unable to infer causation from our data.

CONCLUSIONS

Although effect sizes were small, an effect of specificity was observed across common mental health disorders. Further studies are needed to explore whether encouraging patient specificity during CBT may provide an enhancement of treatment attendance and treatment effects.

Cognitive factors as mediators of the relationship between childhood trauma and depression symptoms: the mediating roles of cognitive overgeneralisation, rumination, and social problem-solving

Background: Childhood trauma has negative immediate and long-term impacts on depression. Questions remain, however, regarding the cognitive factors influencing this relationship. This study aimed to investigate the role of three cognitive factors - cognitive overgeneralisation, rumination and social problem-solving - as mediating factors in the relationship between childhood trauma and symptoms of depression.Methods: We conducted a cross-sectional study in Iran from March to July 2023. Participants (N = 227; Mean age 32.44 ± 8.95 years) with depression completed measures of childhood trauma, depression, self-overgeneralisation, cognitive errors, memory specificity, rumination and social problem-solving. The conceptual model was assessed using structural equation modelling.Results: Structural equation modelling indicated that childhood trauma had a positive direct effect on depression symptoms. Childhood trauma had a positive indirect effect on depression symptoms through both self-overgeneralisation and rumination and a negative indirect effect on depression through effective social problem-solving strategies.Conclusions: The findings suggest increased exposure to childhood trauma may be associated with elevated depression and self-overgeneralisation, rumination, and effective social problem-solving strategies may play an important role in this relationship. These findings hold potential implications for those working with patients with depression and a history of childhood trauma.

Addressing global cognition and ineffective depressogenic discrimination strategies with clinical hypnosis

It is a fundamental truth in living that the quality of your decisions shapes the quality of your life. One's cognitive style determines whether one is more likely to be detailed and linear in thinking or more general and impressionistic, obvious influences on the way experiences are interpreted and reactions formed. Global thinking, also referred to as over-general thinking, has been linked to depression for several reasons. These include the lack of detail in making important discriminations that would reduce or eliminate the kind of self-injurious and depressogenic decisions described in the "stress generation" model of depression. The importance of having meaningful strategies for making effective decisions on a situation-by-situation basis cannot be overstated. Cognitive psychologists and cognitive neuroscientists use the term "discrimination" to describe the process of making distinctions between different situations that give rise to one's reactions. In this article, hypnosis is described as a vehicle for teaching global thinkers to be more skilled in making important discriminations. A sample hypnosis script is provided to illustrate the process.

Study protocol for a randomized controlled trial of the RASPERA project: recalling and anticipating specific positive events to boost resilience in adolescents

Background

Many stress-related mental health problems, like depression and anxiety, emerge during adolescence, with some recent studies suggesting numbers are increasing. One possible way to reduce adolescents' vulnerability to stress-related mental health problems is to increase their resilience by training them in recalling specific positive memories and anticipating specific positive future events. Therefore, an innovative combi-training (called Positive Events Training; PET) was developed, focusing on the enhancement of the specificity of both past and future positive autobiographical events in adolescents. Its effects on adolescents' resilience and mental wellbeing will be examined.

Methods

A cluster randomized controlled trial with a 2 (condition) × 3 (time-point) factorial design was conducted. Classes of adolescents were randomized to either a PET program (intervention) or a CREAtive writing Training (CREAT) program (active control). Both trainings consisted of four sessions of 50 min (one session, weekly, for four consecutive weeks) and were delivered in schools. Before (pre-training, T1), immediately after (post-training, T2), and 2 months after the training (follow-up, T3), participants completed a series of self-report questionnaires. Primary outcomes are resilience and mental wellbeing. Secondary outcomes are positive affect, positive affect regulation and anhedonia. CONSORT criteria for conducting and reporting RCTs will be used.

Ethics and dissemination

Ethical approval was obtained from the Social and Societal Ethics Committee (SMEC) and the study has been preregistered on Open Science Framework (OSF) and ClinicalTrials.gov (Trial registration number: NCT05757180). We plan to develop a free, online, web-based self-directed PET protocol for teachers if the study provides evidence for the effectiveness of the PET program in increasing adolescents' resilience and mental wellbeing, so teachers can deliver the program to future students without the need of professional external trainers.

Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study

BACKGROUND

Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success.

OBJECTIVE

The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success.

METHODS

We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks.

RESULTS

The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs.

CONCLUSIONS

The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.

CBT for difficult-to-treat depression: self-regulation model

BACKGROUND

Cognitive behavioural therapy (CBT) is an effective treatment for depression but a significant minority of clients do not complete therapy, do not respond to it, or subsequently relapse. Non-responders, and those at risk of relapse, are more likely to have adverse childhood experiences, early-onset depression, co-morbidities, interpersonal problems and heightened risk. This is a heterogeneous group of clients who are currently difficult to treat.

AIM

The aim was to develop a CBT model of depression that will be effective for difficult-to-treat clients who have not responded to standard CBT.

METHOD

The method was to unify theory, evidence and clinical strategies within the field of CBT to develop an integrated CBT model. Single case methods were used to develop the treatment components.

RESULTS

A self-regulation model of depression has been developed. It proposes that depression is maintained by repeated interactions of self-identity disruption, impaired motivation, disengagement, rumination, intrusive memories and passive life goals. Depression is more difficult to treat when these processes become interlocked. Treatment based on the model builds self-regulation skills and restructures self-identity, rather than target negative beliefs. A bespoke therapy plan is formed out of ten treatment components, based on an individual case formulation.

CONCLUSIONS

A self-regulation model of depression is proposed that integrates theory, evidence and practice within the field of CBT. It has been developed with difficult-to-treat cases as its primary purpose. A case example is described in a concurrent article (Barton et al., 2022) and further empirical tests are on-going.

My Turning Point Tells the Story: A Longitudinal Examination of Greater Episodic Detail and Youth Depressive Symptoms

Although research findings show that the personal memories of people who are depressed are characterized by sparse episodic detail, under some circumstances, the opposite pattern emerges. Specifically, a recent study (Salmon et al., 2021) has shown that for community youth, greater episodic detail in a highly self-relevant narrative (a life turning point) predicted increased depressive symptoms concurrently and one year later. In a new longitudinal study of young people (N = 320 at Time 1, M = 16.9 years; 81% female) followed up over six months, we aimed to replicate and extend this finding. In Study A, we compared the turning point with a narrative about a conflict event, to establish whether the detail in a turning point memory uniquely predicted depressive symptoms. Supporting the first hypothesis, at both time-points, greater episodic detail was concurrently positively associated with depressive symptoms for turning point narratives only. Contrary to our second hypothesis, greater detail did not predict increased depressive symptoms longitudinally. The reverse pattern was significant, however, in that greater initial depressive symptoms predicted greater detail uniquely in the turning point narrative six months later. In Study B, we determined that the concurrent association between episodic detail and depressive symptoms in turning points (but not conflict events) was exacerbated by linguistic markers of self-focus (greater I-talk and lower distancing language). These findings suggest that greater detail in a turning point narrative may uniquely signify risk of psychological distress when youth narrate the experience with heightened self-focus.

Back to the future: Progressing memory research in eating disorders

OBJECTIVE

Human behaviors, thoughts, and emotions are guided by memories of the past. Thus, there can be little doubt that memory plays a fundamental role in the behaviors (e.g., binging), thoughts (e.g., body-image concerns), and emotions (e.g., guilt) that characterize eating disorders (EDs). Although a growing body of research has begun to investigate the role of memory in EDs, this literature is limited in numerous ways and has yet to be integrated into an overarching framework.

METHODS

In the present article, we provide an operational framework for characterizing different domains of memory, briefly review existing ED memory research within this framework, and highlight crucial gaps in the literature.

RESULTS

We distinguish between three domains of memory-episodic, procedural, and working-which differ based on functional attributes and underlying neural systems. Most recent ED memory research has focused on procedural memory broadly defined (e.g., reinforcement learning), and findings within all three memory domains are highly mixed. Further, few studies have attempted to assess these different domains simultaneously, though most behavior is achieved through coordination and competition between memory systems. We, therefore, offer recommendations for how to move ED research forward within each domain of memory and how to study the interactions between memory systems, using illustrative examples from other areas of basic and clinical research.

DISCUSSION

A stronger and more integrated understanding of the mechanisms that connect memory of past experiences to present ED behavior may yield more comprehensive theoretical models of EDs that guide novel treatment approaches.

PUBLIC SIGNIFICANCE

Memories of previous eating-related experiences may contribute to the onset and maintenance of eating disorders (EDs). However, research on the role of memory in EDs is limited, and distinct domains of ED memory research are rarely connected. We, therefore, offer a framework for organizing, progressing, and integrating ED memory research, to provide a better foundation for improving ED treatment and intervention going forward.

The influence of induced dysphoria on autobiographical memory specificity and social problem solving: Examining the role of executive function

Negative mood induction leads to reductions in autobiographical memory specificity (AMS) and social problem-solving (SPS). The aim was to establish if executive function contributes to changes in AMS and SPS following negative mood induction. Forty-four participants (study 1) completed the autobiographical memory test and measures of executive function (letter & category fluency) before and after a positive or negative mood induction (MI). Forty participants (study 2) completed the means-end problem solving task (MEPS) and (letter & category) fluency tasks before and after a positive or negative MI. In study 1, participants exhibited impaired AMS and fluency performance following a sad MI. Decrease in memory specificity pre-to post-MI was related to reductions in happy mood and letter fluency. In study 2, participants exhibited poorer performance on the MEPS and fluency tasks following a sad MI. Decreases in the number of relevant solutions generated on the MEPS pre-to post-MI was linked to increases in sad mood and decreases in letter fluency. In both studies, the influence of mood became non-significant once the effect of executive function was accounted for, which suggests that changes in AMS and SPS in response to induced mood were related to concomitant changes in executive function.

Characteristics of positive and negative autobiographical memories central to identity: emotionality, vividness, rehearsal, rumination, and reflection

Introduction

Some events are remembered as more central to a person's identity than others. However, it is not entirely clear what characterizes these autobiographical memories central to one's identity. In this study, we examined the effects of various characteristics on centrality to identity of positive and negative memories. Characteristics such as emotionality, vividness, and how frequently a memory is retrieved and shared with others as well as ruminative and reflective self-foci were studied.

Methods

The sample included 356 participants (18-92 years of age). First, participants responded to demographic questions and individual difference questionnaires. Next, they recalled memories in response to 12 emotional cue words. The cue words were balanced for emotional valence (i.e., six positive and six negative) and presented in a random order. After retrieving all memories, participants rated them regarding centrality, using the short seven-item Centrality of Event Scale and other memory characteristics, on a seven-point Likert scale. Multivariate multilevel regression was used for data analyzes, to consider multiple characteristics at the same time and account for data dependency within individual.

Results

The results showed that emotionality, vividness, and frequency of memory retrieval contributed to higher centrality of memories, and employing a reflective self-focus resulted in rating memories as more central. In specific cases, these characteristics were associated differently with centrality of positive and negative memories.

Discussion

Central memories can be perceived as markers in a person's life story. The findings of this study suggest that these marker events are also highly available in a person's memory system, by being actively emotional, visually rich, and frequently retrieved. Moreover, not only memory characteristics but also individual's features are important to fully understand the autobiographical memory centrality.

Social operant conditioning of autobiographical memory sharing

The memories for past autobiographical experiences that we share can influence relationship formation and consolidation with important implications for our mental health. However, little is known about how people's responses to our memories can influence subsequent memory sharing. Previous research examined how operant processes (i.e., punishment with aversive sounds) influence the sharing of memories for specific events from our past. Understanding the (social) mechanisms associated with difficulty sharing specific autobiographical memories is important given the association between these difficulties and a range of psychiatric diagnoses. We investigate the effects of verbal and non-verbal social operants on the willingness to share specific autobiographical memories. Participants shared memories with a confederate who coded their memories as specific or non-specific and responded in either an engaged/attentive, dismissive manner or gave no feedback depending on participants' assigned condition. Participants who were reinforced for sharing specific memories and punished for sharing non-specific memories, were more likely to share specific than non-specific memories compared to those who received no feedback. Reinforcement alone was not sufficient for modifying specificity. The ways that we respond to people when they share memories with us can influence their subsequent willingness to share specific events from their past.

From basic science to clinical practice: Can cognitive behavioural therapy tasks be augmented with enhanced episodic specificity?

Individuals with depression typically remember their past in a generalised manner, at the cost of retrieving specific event memories. This may impair engagement with cognitive behavioural therapy (CBT) tasks that use concrete episodic information to challenge maladaptive beliefs, potentially limiting their therapeutic benefit. Study 1 demonstrated that an episodic specificity induction increased detail and specificity of autobiographical memory in people with major depression, relative to control conditions (N = 88). We therefore examined whether the induction enhanced the efficacy of CBT tasks that depend on episodic memory - cognitive reappraisal (Study 2, N = 30), evidence gathering (Study 2, N = 30), and planning behavioural experiments (Study 3a, N = 30). Across all three tasks, there were no significant differences in emotion- or belief-change between the specificity and control conditions. Although the induction temporarily enhanced specificity in depressed individuals, it did not significantly augment the efficacy of CBT tasks theorised to benefit from the use of specific mnemonic information.

Autobiographical memory and psychopathology: Is memory specificity as important as we make it seem?

Several decades of research have established reduced autobiographical memory specificity, or overgeneral memory, as an important cognitive factor associated with the risk for and maintenance of a range of psychiatric diagnoses. In measuring this construct, experimenters code autobiographical memories for the presence or absence of a single temporal detail that indicates that the remembered event took place on a single, specific, day (Last Thursday when I rode bikes with my son), or multiple days (When I rode bikes with my son). Studies indicate that the specificity of memories and the amount of other episodic detail that they include (e.g., who, what, and where) are related and may rely on the same neural processes to elicit their retrieval. However, specificity and detailedness are nonetheless separable constructs: imperfectly correlated and differentially associated with current and future depressive symptoms and other associated intrapersonal (e.g., rumination) and interpersonal (e.g., social support) outcomes. The ways in which the details of our memories align with narrative themes (i.e., agency, communion, identity) and the coherence with which these details are presented, are also emerging as important factors associated with psychopathology. The temporal specificity of autobiographical memories may be important, but other memory constructs warrant further attention in research and theory, especially given the associations, and dependencies, between each of these constructs. Researchers in this area must consider carefully whether their research questions necessitate a focus on autobiographical memory specificity or whether a more inclusive analysis of other autobiographical memory features is necessary and more fruitful. This article is categorized under: Psychology > Memory.

An Updated Account of Overgeneral Autobiographical Memory in Depression

Previous meta-analyses on Overgeneral Autobiographical Memory (OGM) and depression have emphasized clinically diagnosed current depression, leaving questions about subthreshold and remitted depression. Further, numerous studies of OGM remain unconsidered due to a focus on one testing paradigm, the Autobiographical Memory Test (AMT). We conducted a meta-analysis on OGM in depression including remitted, subthreshold, and currently depressed samples and incorporating non-AMT studies. Our novel use of three-level models enabled robust variance analyses with multiple effect sizes from each study while controlling for dependencies across effect sizes. With results from 67 published and unpublished works, ours is the largest meta-analysis to date on OGM in depression. We identified decreased autobiographical memory specificity (Hedges' g = -0.73) and increased categoricity (Hedges' g = 0.77) for depressed individuals over controls. Moderator analyses suggested more severe OGM in current, clinical MDD than subthreshold and remitted depression, although deficits were still present in the latter groups. Our results highlight the importance of utilizing a broader range of testing paradigms and considering non-clinical depression in future work.

Lower memory specificity in individuals with dysphoria is not specific to autobiographical memory

BACKGROUND

A core cognitive attribute of depression is lower specificity in the expression of autobiographical memories. Despite interventions targeting memory specificity in depression, its underlying mechanisms are not yet fully understood. Depression also relates to poorer memory for episodic details; here we examine whether reduced specificity might simply reflect broader episodic memory deficits and weakened memory traces with the passage of time.

METHODS

Undergraduate students with and without symptoms of depression completed the Autobiographical Interview and prose-reading episodic memory tasks to assess both same-day and delayed memory.

RESULTS

Dysphoria and nondysphoria groups performed similarly on the tasks of immediate episodic and autobiographical memory; notably, the dysphoria group did not display evidence of lower specificity at this time point. After a delay, however, both groups demonstrated less specific memory responses on both memory tasks, and these declines were more pronounced in the group with dysphoria. That is, after a delay, individuals high in dysphoria showed a greater decrease in the quantity of specific event details reported on both the episodic and the autobiographical memory task. Additional analyses incorporating other clinical and cognitive measures indicated that these relations are largely unique to symptoms of depression.

LIMITATIONS

The sample comprised mostly female students; the study should be replicated with more diverse samples.

CONCLUSIONS

These findings support the claim that lower memory specificity is not peculiar to autobiographical memory, but rather, reflects impoverished memory more generally. This is an important consideration for theories and remedial strategies targeting memory specificity.

Earliest versus other autobiographical memories of school-age children

Earliest memories have been the topic of scientific research for over a century and seen use as tools of clinical assessment. Still, it remains unclear whether they are in some way distinct or revealing about the person reporting them. This preregistered study examined whether children’s self-reported earliest memories differ from other memories, and how their features link with mood and gender. Urban 9–13-year-old children in Finland (N = 166) reported on their earliest memory and another old autobiographical memory, and mood. Memories were coded for specificity, thematic content, social orientation, and emotional content. No differences between earliest and other memories were noted in specificity, trauma- and accident-related content, or emotional content. However, earliest memories had more play- and less visit-related content and were less likely to be social. Negative mood did not generally correlate with features of memories. Girls reported more social earliest and other memories, and more positive earliest memories. The findings are compared to research in other cultural environments. Overall, they do not support a privileged position for the earliest memory as an object of scientific research or clinical assessment.

More than meets the eye: emotional stimuli enhance boundary extension effects for both depressed and never-depressed individuals

Boundary extension is a memory phenomenon in which an individual reports seeing more of a scene than they actually did. We provide the first examination of boundary extension in individuals diagnosed with depression, hypothesising that an overemphasis on pre-existing schema may enhance boundary extension effects on emotional photographs. The relationship between boundary extension and overgeneralisation in autobiographical memory was also explored. Individuals with (n = 42) and without (n = 41) Major Depressive Disorder completed a camera paradigm task utilising positive, negative, and neutral stimuli. Across all participants, positive (d = 0.37) and negative (d = 0.66) stimuli were extended more than neutral stimuli. This effect did not differ between depressed and never-depressed participants. Across all participants, images containing objects were extended more than images containing faces. An association was also evident between extension effects in memory for perceptual space and extensions of autobiographical memory across time.

A systematic review of the pharmacological modulation of autobiographical memory specificity

Background

Over-general autobiographical memory (AM) retrieval is proposed to have a causal role in the maintenance of psychological disorders like depression and PTSD. As such, the identification of drugs that modulate AM specificity may open up new avenues of research on pharmacological modeling and treatment of psychological disorders.

Aim

The current review summarizes randomized, placebo-controlled studies of acute pharmacological modulation of AM specificity.

Method

A systematic search was conducted of studies that examined the acute effects of pharmacological interventions on AM specificity in human volunteers (healthy and clinical participants) measured using the Autobiographical Memory Test.

Results

Seventeen studies were identified (986 total participants), of which 16 were judged to have low risk of bias. The presence and direction of effects varied across drugs and diagnostic status of participants (clinical vs. healthy volunteers). The most commonly studied drug-hydrocortisone-produced an overall impairment in AM specificity in healthy volunteers [g = -0.28, CI (-0.53, -0.03), p = 0.03], although improvements were reported in two studies of clinical participants. In general, studies of monoamine modulators reported no effect on specificity.

Conclusion

Pharmacological enhancement of AM specificity is inconsistent, although monaminergic modulators show little promise in this regard. Drugs that reduce AM specificity in healthy volunteers may be useful experimental-pharmacological tools that mimic an important transdiagnostic impairment in psychological disorders.

Systematic review registration

PROSPERO, identifier CRD42020199076, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020199076.

The power of negative and positive episodic memories

The power of episodic memories is that they bring a past moment into the present, providing opportunities for us to recall details of the experiences, reframe or update the memory, and use the retrieved information to guide our decisions. In these regards, negative and positive memories can be especially powerful: Life’s highs and lows are disproportionately represented in memory, and when they are retrieved, they often impact our current mood and thoughts and influence various forms of behavior. Research rooted in neuroscience and cognitive psychology has historically focused on memory for negative emotional content. Yet the study of autobiographical memories has highlighted the importance of positive emotional memories, and more recently, cognitive neuroscience methods have begun to clarify why positive memories may show powerful relations to mental wellbeing. Here, we review the models that have been proposed to explain why emotional memories are long-lasting (durable) and likely to be retrieved (accessible), describing how in overlapping—but distinctly separable—ways, positive and negative memories can be easier to retrieve, and more likely to influence behavior. We end by identifying potential implications of this literature for broader topics related to mental wellbeing, education, and workplace environments.

Sluggish retrieval of positive memories in depressed adults

Although depression is associated with poor memory for positive material, the underlying mechanisms remain unclear. We used the Hierarchical Drift Diffusion Model (HDDM) to determine whether slow evidence accumulation at retrieval contributes to depressed individuals' difficulty remembering positive events. Participants completed the Beck Depression Inventory-II and were stratified into High BDI (HBDI; BDI-II > 20, n = 49) and Low BDI (LBDI; BDI-II < 6, n = 46) groups. Next, participants completed an oddball task in which neutral, negative, and positive pictures served as rare targets. One day later, recognition memory was tested by presenting the encoded ("old") pictures along with closely matched ("new") lures. Recognition accuracy was analyzed with a generalized linear model, and choice and response time data were analyzed with the HDDM. Recognition accuracy for old positive pictures was lower in HBDI versus LBDI participants, and the HDDM highlighted slow evidence accumulation during positive memory retrieval in the HBDI group. Impaired memory for positive material in depressed adults was related to slow evidence accumulation at retrieval. Because oddballs should elicit prediction errors that normally strengthen memory formation, these retrieval findings may reflect weak positive prediction errors, at encoding, in depressed adults.

Cognitive-Emotional Benefits of Weekly Exposure to Nature: A Taiwanese Study on Young Adults

Empirical evidence of nature’s benefits to cognitive and emotional well-being is emerging. In this study, 48 Taiwanese young adults (24 indoors and 24 outdoors in urban greenspace) completed four weekly 45 min exposure sessions. The study explores whether the outdoor group surpasses the indoor group in cognitive and emotional well-being and nature connectedness. There were no significant differences for the indoor group across different measurements of rumination and connectedness to nature. However, the outdoor group displayed a significant reduction in rumination post-test compared to the one week prior and the first session. Similarly, for sessions two, three, and four and one month post-test, the outdoor group’s connectedness to nature was significantly higher than pre-test. Specific autobiographical memory was enhanced while overgeneral autobiographic memory was reduced during the third and fourth sessions, though these changes were not sustained at one-month follow-up. Surprisingly, both groups yielded similar results in decreased depression, anxiety, and stress. A significantly higher number of outdoor group participants had employed nature exposure for coping with stress or emotions after the program. We discuss the implications of this for counseling services for young adults and highlight future research possibilities, including formulating a nature-exposure protocol and a program evaluation for consolidating evidence-based nature prescription.

Direct retrieval bias for general and specific memories for negatively valenced cues in major depression

Major depressive disorder (MDD) is associated with reduced specificity in autobiographical memory. It has been argued that this tendency occurs through a failure of effortful generative retrieval, regardless of valence of cue word. However, we propose that in MDD general memories are likely to be recalled via direct retrieval, and direct retrieval is more likely for negatively valenced cues. To provide a preliminary test of this, a large sample with MDD (N = 298; M age = 47.2) completed the autobiographical memory test and indicated whether retrievals were generative or direct. Categoric and extended memories for negatively valenced cues were more often directly retrieved than generatively retrieved, and more often than direct retrieval for positively valenced cues. In contrast, categoric and extended memories for positively valenced cues were more often generatively retrieved relative to generative retrieval for negatively valenced cues. Relative to non‐clinical samples, direct retrieval for negatively valenced cues was high. Retrieval method and valence may be moderating processes in the type of memories recalled. This preliminary work presents the possibility of an extension of theory on retrieval tendencies in MDD.

A comparison of the safety, feasibility, and tolerability of ECT and ketamine for treatment-resistant depression

INTRODUCTION

Treatment-resistant depression (TRD) is a problematic and prevalent public health and societal concern. Although electroconvulsive therapy (ECT) is the gold standard TRD intervention, the treatment evokes apprehension due to public perceptions, feasibility, and tolerability. Despite significant medical advancements, few medications have been approved by the U.S. Food and Drug Administration for TRD. In 2019, intranasal esketamine, the S-isomer of racemic ketamine, was approved for TRD, garnering significant excitement about the potential for the drug to act as an alternative treatment to ECT.

AREAS COVERED

The goal of this narrative review is to compare the safety, efficacy, and tolerability of ketamine and ECT; clarify whether ketamine is a reasonable alternative to ECT; and to facilitate improved treatment assignment for TRD. Empirical quantitative and qualitative studies and national and international guidelines these treatments are reviewed.

EXPERT OPINION

: The field awaits the results of two ongoing large comparative effectiveness trials of ECT and IV ketamine for TRD, which should help guide clinicians and patients as to the relative risk and benefit of these interventions. Over the next five years we anticipate further innovations in neuromodulation and in drug development which broadly aim to develop more tolerable versions of ECT and ketamine, respectively.

Emotional autobiographical memory impairment features in three mental disorders

We proposed the Emotional Autobiographical Memory Test (EAMT) as a specialized method for measuring emotional autobiographical memory impairment in patients with mental disorders. The EAMT was tested with 32 patients with schizophrenia, 18 patients with bipolar disorder, 32 patients with depression, and 42 people undiagnosed with such disorders. We extracted 13 indices of five kinds of features from participants' emotional autobiographical memory and compared them among the four groups. The overgeneralization result in the schizophrenia and depression groups was consistent with previous results, supporting the EAMT's validity. However, inconsistent with previous results, overgeneralization was not found in the bipolar disorder group. Further, the count of involuntary memories in the patient groups (vs. control group) was significantly smaller, which can guide future researchers in investigating the psychopathology of mental disorders.

Reduced specificity and increased overgenerality of autobiographical memory persist as cognitive vulnerabilities in remitted major depression: A meta-analysis

Difficulty in accessing specific memories, referred to as reduced memory specificity or overgeneral memory (OGM), has been established as a marker of clinical depression. However, it is not clear if this deficit persists following the remission of depressive episodes. The current study involved a systematic review and meta-analysis of empirical studies with the aim of establishing whether remitted depression was associated with retrieving fewer specific and more overgeneral autobiographical memories. Seventeen studies were identified as eligible. The results indicated that people with remitted depression recalled fewer specific memories (k = 15; g = -0.314, 95% CI [-0.543; -0.085], z = -2.69, p = .007) and more categoric memories (k = 9; g = 0.254, 95% CI [0.007; 0.501], z = 2.02, p = .043) compared to people who had never been depressed. Given these deficits have elsewhere been shown to be prognostic of future depressive symptoms, these findings suggest that reduced memory specificity/overgeneral memory persists following remission and may be a risk factor for future episodes of depression in those that are in remission. The findings are discussed in terms of how this knowledge might influence clinical understanding of relapse prevention and maintenance of remission in those with a history of depression.

Brief inductions in episodic past or future thinking: effects on episodic detail and problem-solving

Episodic specificity inductions, involving brief training in recollecting episodic details, have been shown to improve subsequent performance on tasks involving remembering the past, imagining the future and problem solving. The current study examined if specificity inductions targeting self-referential past or future episodic thinking would have dissociable effects on generating past and future episodic detail and problem solving. Sixty-three participants were randomised to either a past self-referential or future self-referential episodic induction. All participants also completed a control task. Participants randomised to the self-referential future thinking induction generated more episodic details on past and future narrative tasks compared to a control task, whereas participants randomised to a self-referential past thinking induction showed similar performance to the control task. When examining within-group performance of participants randomised to the past or future induction, we found some evidence of dissociable effects of inductions on narrative generation tasks, but not on problem solving outcomes. Our findings suggest that self-referential inductions may be useful for increasing episodic specificity, but that the temporal distance and direction of the induction matters. We discuss our results in the context of the potential clinical utility of this approach for populations vulnerable to autobiographical memory disruption.