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    Becker Et Al. (1999) - Explicit Memory in Anxiety Disorders PDF

    Загружено:

    Kairo Albernaz

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    © All Rights Reserved
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    NS ART Cop 9 own Psa a Explicit Memory in Anxiety Disorders Eni S. Becker Dresden University of Technology Matthias Andrich Dresden University of Technology Walton T. Roth Veterans Affairs Palo Alto Health Care System Jiirgen Margrat Dresden University of Technology ‘Two experiments were conducted 1 study seletive memocy bias favoring anxity-selevant materials in patients with anxiety disorders. Inthe 1st experiment, 32 pationts with generalized anxie disorder (GAD), 30 with social phobia (speaking anxiety), and 31 contol purcipants incidentally eared GAD-televant words, speech anxiety relevant wor, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patents suffering from panic disorder (PD) with agoraphobia and 30 controls took pat inthe 2nd experiment. The ‘design was similar to the Ist experiment. This me a highly specific selective memory bias for ‘yeatening words was found, Words describing symptoms of anxiety were beter recalled by PD patents Results re consistont with previous findings but are inexplicable by euisting theories Cognitive processes have attracted considerable interest in re- search on anxiety disorders. Most psychological models of anxiety disorders (Barlow, 1988; Beck, Emery, & Greenberg, 1985; Ey- senck, 1992; Foa & Kozak, 1986) postulate that cognitive pro- ‘cesses are erucial forthe origin of these disorders. In addition 10 selective attentional and interpretational biases, interest has fo- ceused on a possible selective memory bias in anxious individuals, that is, improved retention of threat-related materials. Two theories hhave been influential: Bower's network theory of mood and mem- cory (Bower, 1981, 1987) and Beck's schema theory (Beck et 1985). Both predict that anxious individuals will show enhanced memory for anxiety-relevant information. ‘Surprisingly, the predicted selective memory for threat-elated ‘materials has rarely been found (Williams, Watts, MacLeod, & Mathews, 1988, 1997). Instead, such memory biases have been documented almost exclusively in depressed patients, who, on the [Eni S, Becker and Sirgen Margraf, Department of Clinical Psycbology and Psychotherapy, Dresden University of Technology, Dresden, Ger- rmany: Walton T, Rot, Psyehiaeie Consltaton Service, Veterans Aftsits Palo Alto Health Care System, Palo Alto, Califor; Matthias Andrich, Department of Psyehology, Dresden University of Technology, Dresden, Germany. Preparation of this article was supported by a fellowship from the German Academic Exchange Service (DAAD), a gran from the Cristop- ‘Domiee Stiftung, andthe suppor ofthe Veterans Administration. We thank (Cassandra Lehman for renting and diagnosing the generalized anxiety sorder patients and Cheryl Post for her help in conducting the fit ‘experiment, We also thank the Christoph-Domier Center for ther iaval= able help in recruiting and diagnosing the agoraphobic patients. Spec thanks go to Mike Rinek fr helpful commeats on an eater version ofthe article and t Ulrich Glowall, Joachim Hasebrook, and Gilbert Ferd for supplying the software used to conduet Experiment 1 CComespondence conceming this article should be addressed (© Bai Becker. Department of Clinical Psychology and Psychotherapy. Dresden Univesity of Technology. D-01062 Dresden, Germany. Electonic mail may be seat to ebecker@res.urzt-dresden le 153 other hand, rarely have shown the attentional biases observed fairly regularly in anxiety patients. Based on these findings, Wil- liams et al, (1988) concluded that anxiety leads to an attentional bias, whereas depression leads to a memory bias. Depressed pa tients are assumed to elaborate sad themes and thus show a good memory for them. Apparently, anxiety patients attend to threaten- ing stimuli to avoid feared situations and objects but donot laborate on these stimuli because that Would be too frightening. ‘Thus they show no disorder-congruent memory bias. In addition, they may avoid searching their memory for threatening stimuli, causing a disorderineongruent memory bias. The above explana- tion for good memory in depression is somewhat less convincing ‘when applied 10 major depression, however, because patients suffering from major depression are almost always anxious as well, To test the Williams etal. theory, implicit memory tests were introduced, Mathews, Mogg, May, and Eyseack (1989) conducted ‘one ofthe first studies that used an implicit as well as an explicit ‘memory test, namely word stem completion and cued recall. They found that generalized anxiety disorder (GAD) patients showed no explicit memory bias for threat-related words but did show en- hhanced retention of these words on the implicit memory test. Subsequent studies testing anxiety patients of various kinds used ‘the same paradigm, and their results often have been interpreted as ‘confirmation of the theory proposed by Williams et al. (1988, 1997), However, in some anxiety disorders, selective memory was found for both explicit and implicit tess. In general, studies of memory biases have given different results in different disonders, a Table 1 illustrates. Patients with panic disorder (PD) or agoraphobia have had enhanced memory for threat related materials in explicit memory tests (Becker, Rinck, & Margraf, 1994; Cloitre, Cancienne, Heim- berg, Holt, & Liebowitz, 1995; Cloitre & Liebowitz, 1991; Me- Nally, Foa, & Donnell, 1989; Nunn, Stevenson, & Whalan, 1984). Only two studies failed to find an explicit memory bias in panic patients (Otto, MeNally, Pollack, Chen, & Rosenbaum, 1994; 154 Table 1 Overview of Studies on Memory Biases in Anxiety Disorders Anxiety disorder and BECKER, ROTH, ANDRICH, AND MARGRAF Disorder congruent aricipant group ” Materials ‘Memory tsk ‘emo bite Authors Panic disorder (PD) ®D 30 Panic Fre recall Yes Becker eta. (1998) Control 20 Positive Negative PD 4 Threat Free recall Yes Cloite & Liebowitz Control 14 Postive (991) Negative PD 24 Threat Yes Coie eta, (1998) Control 24 Postive Therapists 24 Negative Yes PD 2x12 Ansiey Yes MeNally eta, (1989) Contot 2x12 Positve PD 2 Panic No 0 eta. (1994), Gap 12 Threat Contol 2 Positive ‘Neutral Agoraphobia 9 Anxiety Free recall Yes Nona eal (1984) Control 9 Neutral Agoraphobia 12 Phobic Free recall No Pickles & van den Brock GAD 1 Neutra 11988) Control 2 Generalized anxiety disorder (GAD) GAD 17 Anxiety Free recall Anxiety: no Bradley et al (1995) Depression 19 Depression Depression: yes Control 18 Neu Positive GAD 16 Threat Recognition No MacLeod & McLaughlin Control 16 Nontteat Implicit Yes 11995) GAD 2% 18 Social threat —_Explciteued reel No ‘Mathews etl. (1989) Contr 18 Physical threat Nevtal Positive Implicit Yes Anxiety state 16 Anxiety Free recall Yes Mogg & Mathews Control 16 Nonantieyy 1890) GAD lo Threat Recognition No Mogg etal. (1987) Control 10 Negative Positive Specific phobia ‘Spider phobia 35 Spiers Recognition Big spiders: no Warts el (1986) Control 18 Smal spiders: yos Socal phobia Social phobia 21 Social heat roe recall No Coit eta. (1995) Control Di Neutral Positive Recognition No Social phobia 45 Social eat Cued recall No ‘Lundh & Ost (1997), Control 45 Physical threat Positive Implicit No (only a subgroup) Neutral Social phobia 32° Physical teat ree recall No Control 21 Sovial teat, ‘Neutral Recognition No Rapes eta, (1994) Positive Social phobia 20 Social threat Cued reall No Control 20 Neutral Posttraumatic stress dsorder (PTSD) 42, Emotional ree recall Yes (for emotional) Vrana tal (1995) 13 Nevin EXPLICIT MEMORY IN ANXIETY DISORDERS. 155 Pickles & van den Broek, 1988), These exceptions could be due to small sample sizes or, inthe case of Otto etal. (1994), to the use fof a cued recall test, which is suboptimal for showing effects of smiood on memory. In fact, ina later article (Mathews & MacLeod, 1994), two of the authors of the Williams et al. theory acknowl- ledge that PD patients might indeed differ from other anxiety patients in showing an explicit memory bias for threat-related materials ‘A cifferent picture emerges for GAD. Most studies didnot find an explicit memory bias in these patients (Bradley, Mogg, & Williams, 1995; MacLeod & McLaughlin, 1995; Mathews et al., 1989; Mogg, Mathews, & Weinman, 1987), but they often found an implicit bias (MacLeod & MeLaughlin, 1995; Mathews et al., 1989). Only one experiment using an explicit rest showed beter ‘memory for anxiety-related words in GAD patients (Mogg & Mathews, 1990), Hardly any studies address specific phobias, except for an early siudy oF spider phobies (Wats, Trezise, & Sharrock, 1986), the results of which are not easily interpreted. Spider phobies recog. nized fewer large spiders than did controls, but they recognized ‘more small spiders than did controls. None of the several studies ‘on patients with social phobia (SP) found enhanced memory for words denoting social threat (Cloite et al., 1995; Lundh & Ost, 1997; Rapee, MeCallum, Melville, Ravenscroft, & Rodney, 1994), although one identified a subgroup of patients (those with specific social fears) who did show seleotive memory in an implicit mem. cory test (Lundh & Ost, 1997), ‘The one study with posttraumatic stress disorder (PTSD) pa- tients that used a free recall test found better retention for emo- tional words in veterans with PTSD, although not a specific bias for tauma-related stimuli (Vrana, Roodman, & Beckham, 1995) With respect to implicit memory in PTSD, the results are sparse and ambiguous: One study failed to demonstrate enhanced reten= tion of PTSD-relevant words in an implicit perceptual memory test (McNally & Amir, 1996); a second found a better implicit memory for combat-relevant sentences in PTSD patients compared with veterans without PTSD (Amir, MeNally, & Wiegartz, 1996). Several studies have been done with nonpatiens, for example, people with panic attacks (Norton, Schaefer, Cox, Dorward, & Weorney, 1988) or high wait anxiety (e.g, Bradley, Mogg, & Williams, 1994; Reidy & Richards, 1997) or with socially anxious students (Foa, MeNally, & Murdock, 1989; Sanz, 1996). These studies show patterns of results very similar to those of patient populations. In summary, panic patients show enhanced retention of relevant ‘materials whether or not an implicit or explicit memory test is given; GAD patients show no such memory bias in explicit tests but tend 10 remember threatening material in implicit tests; SP patients show no bias for social threat words. What uncontrolled factors might explain such inconclusive results? First, it may be easier to construct appropriate materials for PD patients than for GAD patients because the former fear a few topics but the latter fear a wide range of topies. Second, disorder relevance and emo- tionality may have been confounded, atleast in the experiments of Marin, Williams, and Clark (1991), in which anxiety patients were partial to all words with high emotionality, nt just to threat words, Studies by other researchers (Becker et al, 1994; Cloitre & Liebowitz, 1991; Cloitze, Shear, Cancienne, & Zeitlin, 1994), however, did not always give this result. In these studies, specific biases toward threat words were found. Third, statistical power may have been insufficient. Mood congruency or schema congr cency effects are typically not very large (©.8. Coben's f = 2 Becker et al., 1994), so samples must contain at least 20, oF better 30 participants per group in order to have a realist chance of finding memory biases. However, power does not explain all the ‘observed differences between disorders because the sample sizes for GAD patients were often adequate Fourth, the kind of encoding task, the kind of explicit test, and the nature of their combination seem important. Several studies hhave found that incidental learning tasks and free recall tests ‘optimize the chances of finding mood effets, Free recall has been extensively and successfully used in research on mood and mem: ory (e.g, Bower & Cohen, 1982; Eich, 1980: Eich, Weingartner, 1975; Fiedler & Sthm, 1986). Explicit learn ing tasks and cued recall tests, on the other hand, seem to involve too many cues, which may override any effect mood has. Only two studies of GAD used a free recall test (Bradley, Mogg, & Wil- liams, 1995; Mogg & Mathews, 1990) and one of them did find an explicit disorder-congruent memory bias (Mogg & Mathews, 1990). On the otber hand, both SP studies that used free recall failed to show selective memory (Cloitre etal, 1995; Rapee eta 1994), In addition, suboptimal encoding tasks were sometimes chosen, for example, a modified Stroop test (MacLeod & MeLaughlin, 1995). Finally, the congruency of encoding task and rettioval task seems to be of major importance; that is, both should be either conceptual or perceptual (Eysenck & Byrne, 1994). Fifth, the high comorbidity between anxiety and depression (Sanderson & Wetzler, 1991) needs to be taken into account Sometimes, inthe studies cited, significant correlations of anxiety scores and depression scores were recorded (Bradley, Mogg, & Williams, 1994, 1995), and in others depression was excluded (Bysenck & Byme, 1994; Reidy & Richards, 1997). Overall, one cean conclude that memory effects are indeed due to anxiety, although itis still unclear whether state or trait anxiety is more {important and whether depression has an additional effect. ‘The two experiments reported in this article were an attempt 10 ‘overcome some of the uncontrolled factors listed above, Patients with three different anxiety disorders (GAD, SP, and PD) partic- pated. Memory biases in all three patient groups were tested using almost identical methods. In addition, the materials and procedures used in the two experiments were chosen to maximize the chances of observing memory biases: Incidental learning tasks and free recall tests were used, sample sizes were adequate, the verbal stimuli were specific to the disorders, and patient groups rather than analog populations were tested. In both experiments, the participants lamed each word incidentally by generating an imag. inary scene that combined the word with themselves. This com ceptual fearing task was combined with a conceptual memory testa free recall test that followed a distractor task. We chose verbal materials that were rated by experts as especially relevant to the disorders, rying to match the threat schemata inherent in the disorders. The disorder-relevant words were matched to highly Positive and neutral words, thereby controlling for emotionality effects. Thus we hoped to maximize the chance of finding an explicit memory bias for disorder-relevant words in all three patient groups, 156 BECKER, ROTH, ANDRICH, AND MARGRAF Experiment 1 Method Participants. The participants in this experiment were recrited by advertisements ie local newspapers in Palo Alto, California The sample ‘comprised 32 GAD patients, 20 SP patents, and 31 contol participants Patients were offered treatment aftr taking part in the experiment, and ‘control partiepants were paid. All candidates were interviewed using the Structural Clinical Imerview for DSM-II-R, Upjohn version (SCID-UP; ‘Spitzer, Williams, & Gibbon, 1987) by 2 master's level psychologist and 2 _rauate student in psychology who were extensively trained tefore the ‘study. Unfocunately, the improved DSM-V diagnoses were not available at the time ofthis study. However, a major problem with the DSM=I-R iagnosis of GAD, namely its separation ftom depression, was avoided by excluding all participants who suffered from a curent episode of major depression or dysthymia Sil, it i possible that some patients were included in the GAD sample who would have been excluded according t0 the improved eritria of DSM-IV, Several other potential participants were excluded fora variety of reasons, stch a medical lass, substance abuse, and past or curtentpsyehotic episodes, Four GAD patents had major

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