Memory biases in remitted depression

J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
Contents lists available at ScienceDirect
Journal of Behavior Therapy and
Experimental Psychiatry
journal homepage: www.elsevier.com/locate/jbtep
Memory biases in remitted depression: The role of negative cognitions
at explicit and automatic processing levels
Nuria Romero a, *, Alvaro Sanchez b, Carmelo Vazquez a
a
b
Department of Psychology, Complutense University of Madrid, Spain
Department of Psychology, University of Ghent, Belgium
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 8 February 2013
Received in revised form
15 September 2013
Accepted 18 September 2013
Background and objectives: Cognitive models propose that depression is caused by dysfunctional schemas that endure beyond the depressive episode, representing vulnerability factors for recurrence.
However, research testing negative cognitions linked to dysfunctional schemas in formerly depressed
individuals is still scarce. Furthermore, negative cognitions are presumed to be linked to biases in
recalling negative self-referent information in formerly depressed individuals, but no studies have
directly tested this association.
In the present study, we evaluated differences between formerly and never-depressed individuals in
several experimental indices of negative cognitions and their associations with the recall of emotional
self-referent material.
Methods: Formerly (n ¼ 30) and never depressed individuals (n ¼ 40) completed measures of explicit
(i.e., scrambled sentence test) and automatic (i.e., lexical decision task) processing to evaluate negative
cognitions. Furthermore participants completed a self-referent incidental recall task to evaluate memory
biases.
Results: Formerly compared to never depressed individuals showed greater negative cognitions at both
explicit and automatic levels of processing. Results also showed greater recall of negative self-referent
information in formerly compared to never-depressed individuals. Finally, individual differences in
negative cognitions at both explicit and automatic levels of processing predicted greater recall of
negative self-referent material in formerly depressed individuals.
Limitations: Analyses of the relationship between explicit and automatic processing indices and memory
biases were correlational and the majority of participants in both groups were women.
Conclusions: Our findings provide evidence of negative cognitions in formerly depressed individuals at
both automatic and explicit levels of processing that may confer a cognitive vulnerability to depression.
Ó 2013 Elsevier Ltd. All rights reserved.
Keywords:
Depression
Vulnerability to depression
Negative schemas
Memory biases
1. Introduction
Cognitive models of depression (Beck, 1967; Teasdale, 1988)
propose that depressed mood states are maintained by biases in
cognitive processing in favor of mood-congruent information.
Beck’s model (1967) postulates that existing schemas lead individuals to select and remember information congruent with their
schemas. This theory proposes that schemas of depressed people
include themes of loss, separation, failure, worthlessness, and
rejection; consequently, depressed individuals are hypothesized to
* Corresponding author. School of Psychology, Complutense University of Madrid,
Campus de Somosaguas, Madrid 28223, Spain. Tel.: þ34 91 394 3131; fax: þ34 91
394 3189.
E-mail address: [email protected] (N. Romero).
0005-7916/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jbtep.2013.09.008
remember information relevant to and congruent with those
schemas. Research has consistently shown that depressed
compared to nondepressed individuals are characterized by greater
retrieval of negative material (Gotlib & Joormann, 2010; Matt,
Vazquez, & Campbell, 1992). Furthermore, this mood-congruent
memory bias has been found to be stronger when depressed individuals have to retrieve negative self-referent information
(Wisco, 2009).
Dysfunctional schemas and cognitive biases are presumed to
endure beyond a depressive episode, representing stable vulnerability factors for depression recurrence (Beck, 1967). Thus,
formerly depressed individuals are expected to maintain these
biases after the depressive episode remits. Memory biases in
remitted depressed samples have been mostly evaluated through
the incidental recall of positive and negative adjectives previously
presented. Empirical evidence of memory biases in formerly
N. Romero et al. / J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
depressed individuals has been mixed. Some studies have shown
that formerly depressed individuals do not differ from neverdepressed individuals in their retrieval of negative material (e.g.,
Bradley & Mathews, 1988; Teasdale & Dent, 1987). Other studies
have revealed that formerly compared to never-depressed individuals show memory biases for negative material but only after
receiving a negative mood induction (see Scher, Ingram, & Segal,
2005 for review). These findings have been interpreted as
dysfunctional schemas might be not stable structures. For
instance, Beck’s reformulated model (Beck, 1987; Clark, Beck, &
Alford, 1999) proposes that once depression has remitted,
dysfunctional schemas are dormant until activated in response to
negative stressors. Thus, once a negative mood is experienced in
response to stress, dysfunctional schemas in formerly depressed
individuals would become more accessible, generating negative
memory biases (Gilboa & Gotlib, 1997; Timbremont & Braet, 2004).
Furthermore, the differential activation hypothesis (Teasdale,
1988) assumes that during a depressive episode an association
between depressed mood and negative thinking patterns is
established. According to this model, when depression has
remitted, a subsequent depressed mood could re-activate those
negative thinking patterns, which in turn would generate memory
biases to negative information. In contrast, other current accounts
(e.g., Joormann, Yoon, & Zetsche, 2007) do not specify that a
depressed mood state is required to activate memory biases in
formerly depressed. These accounts propose that cognitive biases
may operate as a function of the capacity to control for the
accessibility of negative cognitions. Thus, memory biases would
operate as a function of formerly depressed individuals’ capacity to
control or inhibit the activation of negative cognitions in working
memory (Joormann, 2010).
A critical issue in clarifying the role of depressive schemas in
memory processing once depression has remitted is how negative
cognitions have been assessed. Previous studies have mostly
employed self-report measures of depressive cognitions, such as
the Dysfunctional Attitudes Scale (Weissman, 1979), a scale intended to measure dysfunctional beliefs that are thought to reflect a
person’s self-evaluation. Studies using this scale have reported that
formerly depressed individuals did not differ from never-depressed
individuals in their levels of dysfunctional attitudes (e.g., Miranda,
Persons, & Byers, 1990). However, Hedlund and Rude (1995) suggested that the use of self-reported measures may be relatively
insensitive to the detection of negative cognitions in remitted individuals. Furthermore, consistently with recent views that propose that cognitive biases depend upon individuals’ available
cognitive control (Joormann et al., 2007), some authors have
argued that the failure to find evidence of dysfunctional schemas in
formerly depressed individuals may be due to effortful mental
strategies used to reduce the report of unwanted negative thinking
(Wegner, 1994; Wegner & Wenzlaff, 1996). To overcome this issue,
researchers have developed experimental tasks to detect depressive cognitions through the assessment of cognitive processes under conditions that interfere with vulnerable individuals’ attempts
to control the mind (Wenzlaff & Wegner, 2000). For instance, the
scrambled sentence test (SST; Wenzlaff & Bates, 1998) is a task
aimed to assess interpretation processes, in which individuals have
to use scrambled words to form self-referent statements in a positive or negative way while performing an additional task (e.g.,
keeping a number in mind) that interferes with cognitive control.
Using this approach, research has shown that formerly compared to
never depressed individuals form more negative statements (Rude,
Covich, Jarrold, Hedlund, & Zentner, 2001; Watkins & Moulds,
2007; Wenzlaff & Bates, 1998). In fact, some studies have found
that whereas formerly and never depressed individuals did not
differ on the DAS, they did differ on this interpretation measure
129
under reduced cognitive control (e.g., Hedlund & Rude, 1995; Rude
et al., 2001).
A more direct approach to detect negative cognitions uninfluenced by cognitive control has involved the use of priming tasks.
These tasks assess activation of negative meanings in the absence of
conscious information processing (Phillips, Hine, & Thorsteinsson,
2010). For instance, in the lexical decision task (LDT), participants
have to identify if verbal stimuli previously presented subliminally
represent real words or nonwords. Using this paradigm, studies
have shown that depressed compared to nondepressed participants are faster at responding to negative adjectives (Bradley,
Mogg, & Millar, 1996; Bradley, Mogg, & Williams, 1995; Scott,
Mogg, & Bradley, 2001). These results suggest that automatic activation of negative concepts in depression facilitates the processing
of that negative information. However, no studies have used this
approach to test if an effect of automatic activation to negative
cognitions is also evident once depression has remitted.
Further research is necessary to clarify the presence of negative
cognitions in formerly depressed individuals at both automatic and
explicit processing levels under reduced cognitive control. The
present study was aimed at examining these questions by
comparing cognitive processing of formerly and never-depressed
individuals. First, as shown by previous research (e.g., Hedlund &
Rude, 1995; Rude et al., 2001), we hypothesized that formerly
compared to never-depressed individuals would complete more
negative sentences in the SST (Wenzlaff & Wegner, 2000), showing
negative interpretation biases under reduced cognitive control.
Second, we expected that negative cognitions activation would be
evident in formerly depressed individuals at an automatic processing level. We hypothesized that formerly compared to neverdepressed individuals would show a greater detection of subliminally primed negative words in the LDT.
We also aimed to test how negative cognitions detected by these
methods may be linked to memory biases for negative information
in formerly depressed individuals. As proposed by Joormann et al.
(2007), memory biases to negative information may be not only
dependent on negative mood states, as explained by traditional
cognitive models of depression (Clark et al., 1999; Teasdale, 1988),
but also operate as a function of individuals’ capacity to inhibit
negative processing. Consequently, individuals characterized by
higher negative processing under reduced cognitive control (i.e., in
the SST and the LDT) should be those who would exhibit higher
memory for negative material. Thus, we expected that higher
negative processing observed under reduced mental control in
these tasks would predict individuals’ retrieval of negative selfreferent material in a subsequent memory task. Specifically, we
expected that higher levels of negative processing in the SST and
the LDT would predict greater retrieval of negative self-referent
material in formerly depressed individuals.
2. Methods
2.1. Participants
Two hundred eight undergraduate students were initially contacted to complete the Diagnostic Inventory for Depression (DID;
Zimmerman, Sheeran, & Young, 2004) and the second edition of the
Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996).
These instruments were used to divide participants into the
formerly and never-depressed groups. The DID was used to diagnose lifetime history of major depression according to DSM-IV
criteria. The formerly depressed group comprised participants
reporting a past major depressive episode. Participants whose
depressive symptoms had been due to physical illness or substance
abuse were excluded, and a minimum recovery time of 2 months
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N. Romero et al. / J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
was required to ensure that residual depressive symptoms would
not confound results. The never-depressed group comprised participants reporting a lack of lifetime history of depressive episodes.
BDI-II was used to control for group differences in current
depressive symptoms and to assure that participants were not
currently in a depressed mood. Following criteria used in previous
research (e.g., Mackinger, Pachinger, Leibetseder, & Fartacek, 2000),
participants in both groups reporting scores of higher than 11 on the
BDI-II scale were excluded from the study. According to DID and BDIII criteria, the formerly depressed group comprised 30 participants
and the never-depressed group comprised 40 participants. Thus, the
final sample of study participants consisted of 70 undergraduate
students (80% female). The mean age was 21.87 years (SD ¼ 1.76).
2.2. Questionnaires
2.2.1. Current depressive symptoms
The BDI-II (Beck et al., 1996), a 21-item self-report measure of
the severity of depressive symptoms, was used to determine current depressive symptom levels. Respondents reported how much
they have been bothered by each depression symptom on a 4-point
scale, ranging from 0 to 3 in severity. This measure has shown
excellent reliability and validity (Beck et al., 1996). In the current
study, internal consistency was good (a ¼ .84).
2.2.2. Lifetime history of major depression
DID (Zimmerman et al., 2004) is a 38-item self-report scale
designed to assess the DSM-IV symptom inclusion criteria for a
major depressive episode, psychosocial impairment due to
depression, and subjective quality of life at the time of the assessment. Respondents reported how much they have been bothered
by each depression symptom during the last 2 weeks on a 5-point
scale, ranging from 0 to 4 in severity. Only symptoms reported for
more than 2 weeks duration were included in the total score. DID
was adapted to assess lifetime history of major depression by
asking participants to note how they felt for each item during the
period of time in which they felt most depressed in their life. This
method to detect past major depressive episodes has been
employed in a previous version of the DID instrument, the Inventory to Diagnose Depression, Lifetime Version (IDD;
Zimmerman & Coryell, 1987). The DID and IDD have shown excellent reliability in diagnosing past and current major depressive
episodes in previous research (e.g., Zimmerman et al., 2004, 2006).
2.3. Experimental tasks
2.3.1. Scramble sentence test
The SST (Wenzlaff & Bates, 1998) is a task aimed to measure
interpretation processes. In our study this task served to evaluate
negative processing under reduced cognitive control, as employed
in previous research (e.g., Rude et al., 2001; Watkins & Moulds,
2007). In this task, 20 different scrambled sentences of six words
each were presented (e.g., failure I a am generally success). Participants were asked to unscramble five words in each sentence to
form a statement, by placing a number over each of five words to
indicate the proper order. Scrambled sentences could be
unscrambled to form a positive (e.g., I am generally a success) or
negative (e.g., I am generally a failure) statement. Participants had
to complete as many of the sentences as possible during a 2.5 min
period. A negativity score was produced by calculating the ratio of
negative sentences to total sentences completed.
Following previous research evaluating vulnerable individuals
(e.g., Rude et al., 2001), a cognitive load procedure was used in
which participants were required to retain and remember a 6-digit
number during the completion of the task.
2.3.2. Lexical decision task
The LDT was used in our study to evaluate automatic activation
of negative meanings. This task involves the presentation of a
randomly ordered set of 72 words comprising adjectives with
different emotional content (24 positive, 24 negative, 24 neutral)
and 72 nonwords. Ten additional words were used as stimuli for
practice trials. Words were selected from a standardized list of
words (Jiménez, Vázquez, & Hernangómez, 1998). According to
these criteria, adjective categories showed significant differences in
term of emotionality/valence, F(2, 71) ¼ 3214.94, p < .001, but were
similar in terms of word length, F(2, 71) ¼ 1.66, p ¼ .20, and frequency of use, F(2,71) ¼ 2.31, p ¼ .11.
The LDT comprised the random presentation of words and
nonwords on a computer screen. For each stimulus, participants
were asked to respond as quickly as possible on whether the
stimulus was a legitimate word or not by pressing the corresponding key.
There were two conditions: A primed and an unprimed condition
that included both word and nonword trials (see Fig. 1). For word
trials in the primed condition, a fixation cross was shown for 800 ms
followed by the prime word displayed in uppercase. This was
replaced by a mask that was a string of letters in uppercase (e.g.,
YCQVDJ) matched with the word in length. The stimulus onset
asynchrony (SOA) between the prime and mask was 28 ms. The same
word used as the prime was then displayed again in lowercase (i.e.,
target word), and the SOA between the mask and target word was
28 ms. To minimize priming effects due to the superficial physical
characteristics of the words (e.g., Bradley et al., 1996), the prime and
target words were presented in upper and lower case respectively.
The target word remained on the screen until the participant’s
Primed word condition:
Fixation
Prime
Mask
Target
+
ALONE
KTRLE
alone
800 ms
28 ms
28 ms
Primed nonword condition:
Fixation
Prime
Mask
Target
+
TRAIB
PFTHK
traib
800 ms
28 ms
28 ms
Unprimed word condition:
Fixation
Letter String
Mask
Target
+
PFLIRTN
MTOIPIJ
hopeful
800 ms
28 ms
28 ms
Unprimed nonword condition:
Fixation
Letter String
Mask
Target
+
OPTYNH
JTYPAT
pentil
800 ms
28 ms
28 ms
Fig. 1. Primed and unprimed conditions in the lexical decision task.
N. Romero et al. / J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
response and then a new trial started, indicated by the appearance of
the next fixation cross (i.e., fixation / prime / mask / target). The
intertrial interval was 250 ms. For nonword trials in the primed
condition, the stimulus sequence was the same except that nonwords
were used as prime and target stimuli.
For word and nonword trials in the unprimed condition, the
sequence of stimuli was the same as described in the primed
condition except that a random letter string was presented instead
of a prime word (i.e., fixation / letter string / mask / target, see
Fig. 1).
The measure of priming effects was obtained by subtracting
lexical decision latencies for primed words from unprimed words
for each emotion category (i.e., positive, negative, neutral). Positive
scores on these indices denote faster lexical decisions due to
priming (e.g., Bradley et al., 1996), indicating the magnitude by
which prior activation of automatic self-referent concepts facilitates subsequent processing of that information.
2.3.3. Self-referent incidental recall task
The SRIRT was used to evaluate memory for emotional selfreferent material. The task started with the presentation of a
randomly ordered set of 36 adjectives (12 positive, 12 negative, 12
neutral). In the self-endorsement part of the task, participants
responded by indicating whether each adjective described them or
not. Six additional adjectives were used as stimuli for practice trials.
Stimulus words were selected from a standardized list of words
(Jiménez et al., 1998). According to these criteria adjective categories showed significant differences in term of emotionality/
valence, F(2, 35) ¼ 1127,49, p < .001, but were similar in terms of
word length, F(2, 35) ¼ .65, p ¼ .53, and frequency of use, F(2,
35) ¼ 1.81, p ¼ .18. Each trial started with a blank computer screen
presented for 500 ms, followed by the appearance of an adjective
for 2000 ms in the center of the screen. Participants then indicated
if the adjective described them or not by pressing the corresponding yes or no key. An index of self-referent endorsement was
computed by dividing the number of self-endorsed adjectives in
each emotion category (i.e., positive, negative, neutral) by the total
number of self-endorsed adjectives. This index has been employed
in previous research in both formerly and currently depressed individuals (e.g., Dozois & Dobson, 2001; Gotlib et al., 2004).
Immediately after completing the self-endorsement task, participants were asked to recall as many of the adjectives presented
during 3 min as possible. Indices of retrieval were calculated by
dividing the number of self-endorsed and subsequently recalled
adjectives from each emotion category by the total number of selfendorsed and recalled adjectives. This index has been employed in
previous research (e.g., Gotlib et al., 2004; Joormann, Dkane, &
Gotlib, 2006).
3. Procedure
All participants completed the session individually. After
providing informed consent, participants were asked to complete
the DID and BDI-II. Then, the experimenter scored the DID and BDIII while participants completed two other tasks. First, participants
completed a filler task, a verbal fluency test (Lezak, 1995) in which
they were asked to write as many words beginning with the letter s
as they could in 7 min. Second, participants completed the SST.
After completing those two tasks and being scored on the DID and
BDI-II measures, participants who met criteria of presence or
absence of past history of depression in the DID, and with BDI-II
scores equal to or less than 11, completed the LDT and then the
SRIRT. Participants who did not meet participation criteria were not
allowed to continue in the study. At the end of the experimental
session, participants were thanked and debriefed.
131
4. Results
4.1. Participant characteristics
Demographic and clinical characteristics of the two participant
groups are presented in Table 1. Formerly and never-depressed
participants did not significantly differ in age, gender, or current
severity of depression.
4.2. Negative processing under reduced cognitive control
We conducted a one-way analysis of covariance (ANCOVA) with
group (formerly depressed, never depressed) as the independent
variable, and the proportion of negative unscrambled sentences as the
dependent variable. Current depressive symptoms were used as a
covariate to further control for their influence between groups in the
proportion of negative unscrambled sentences. The covariate showed
a marginally significant effect, F(1, 67) ¼ 3.05, p ¼ .08, h2 ¼ .04. Analyses also revealed a significant group main effect, F(1, 67) ¼ 4.23,
p < .05, h2 ¼ .06. Formerly depressed participants completed a
significantly higher proportion of negative sentences, M ¼ .22,
SD ¼ .26, than completed by never-depressed participants, M ¼ .10,
SD ¼ .14.
4.3. Negative processing under automatic activation of negative
meanings
In accordance with previous studies, trials comprising nonwords and incorrect lexical decisions to words were removed from
the analyses (Bradley et al., 1996). To minimize the influence of
outlier responses, we excluded reaction times of more than 2.0
standard deviations above or below the mean for each participant
(e.g., Carreiras, Mechelli, Estévez, & Prize, 2007). The remaining
latency data were further inspected using box plots to detect outlier
responses (Bradley et al., 1996). The total percentage of invalid trials
removed was 3.7%.
Means and standard deviations of lexical decision times and
priming scores are presented in Table 2. To test differences between
groups in the priming effects in reaction times, we conducted a
2 3 mixed design ANCOVA with Group (formerly depressed,
never depressed) as a between-subjects factor and Emotion Category (positive, negative, neutral) as a within-subjects factor. Current depressive symptoms were used as a covariate. The covariate
did not show a significant effect of emotion category, F(2,
134) ¼ 1.71, n.s., h2 ¼ .02. Analysis showed a significant interaction
of Group Emotion Category, F(2, 134) ¼ 3.02, p < .05, h2 ¼ .05.
Bonferroni tests revealed that formerly and never-depressed participants did not significantly differ in priming effects in reaction
times for positive and neutral words, p ¼ .82 and p ¼ .61, respectively. However, formerly compared to never-depressed participants showed a significantly greater priming effect in reaction
times for negative words, p < .01.
Table 1
Differences in demographic and clinical characteristics between groups.
Variables
Formerly depressed
(n ¼ 30)
Never depressed
(n ¼ 40)
M
M
Gender (%)
Female 80%
Male
20%
Age
21.57
BDI-II
6.13
SD
Statistics
SD
X2 ¼ .001; p ¼ .99
1.43
3.39
80%
20%
22.10
4.73
Note. BDI-II ¼ Beck Depression Inventory-II.
1.95
3.61
t(68) ¼ 1.26; p ¼ .21
t(68) ¼ 1.65; p ¼ .10
132
N. Romero et al. / J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
Table 2
Mean proportions and standard deviations of lexical decision latencies.
Formerly depressed (n ¼ 30)
Never depressed (n ¼ 40)
M
M
SD
Reaction time (ms) for primed words
Positive
96.59
643.56
696.27
Negative
114.35
691.46
727.96
Neutral
96.57
647.70
704.72
Reaction time (ms) for unprimed words
Positive
108.18
674.44
728.22
Negative
120.52
700.17
765.67
Neutral
130.99
688.09
743.78
Priming effects (unprimed wordsprimed words)
Positive
42.88
30.86
31.94
Negative
40.48
8.70
37.71
Neutral
66.09
40.39
39.06
SD
79.54
105.01
4.5. Memory for emotional self-referent material
87.41
89.71
108.23
104.94
47.31
41.80
48.08
To assess if group differences reflected a specific priming effect
for negative words in formerly depressed participants, priming
scores were contrasted against a value of zero using a one-sample t
test (a priming score of 0 ms indicates no priming effect; see
Bradley et al., 1996). These analyses showed a significant priming
effect in reaction times for negative words in the formerly
depressed group, t(29) ¼ 5.05, p < .001, whereas the priming effect
did not reach significance in the never-depressed group,
t(39) ¼ 1.32, p ¼ .19.
4.4. Self-referent endorsement
We examined the self-referential SRIRT encoding data to
determine if formerly and never-depressed participants differed in
the proportion of self-endorsed adjectives. Mean proportions and
standard deviations of self-endorsed adjectives in each emotion
category are presented in Table 3. We conducted a 2 3 mixed
design ANCOVA with Group (formerly depressed, never depressed)
as a between-subjects factor and Emotion Category (positive,
negative, neutral) as a within-subjects factor. Current depressive
symptoms were used as a covariate. The covariate showed a
marginally significant effect of emotion category, F(2, 134) ¼ 2.96,
Table 3
Mean proportions and standard deviations of endorsed adjectives and endorsed and
recalled adjectives in each group.
Formerly depressed (n ¼ 30)
Never depressed (n ¼ 40)
M
M
SD
Proportion of endorsed adjectives
Positive
.17
.65
Negative
.16
.11
Neutral
.07
.24
Proportion of endorsed and recalled adjectives
Positive
.25
.59
Negative
.22
.14
Neutral
.15
.27
p ¼ .055, h2 ¼ .04. Analyses also showed a significant interaction of
Group Emotion Category, F(2, 134) ¼ 9.45 p < .001, h2 ¼ .12.
Bonferroni tests revealed that formerly compared to neverdepressed participants self-endorsed a higher proportion of negative adjectives and a lower proportion of positive adjectives, p < .01,
in both cases. No differences between groups were found for
neutral adjectives, p ¼ .12.
SD
.76
.08
.02
.05
.22
Mean proportions and standard deviations of recall of selfendorsed adjectives in each emotion category in the SRIRT are
presented in Table 3. We conducted a 2 3 mixed design ANCOVA
with Group (formerly depressed, never depressed) as a betweensubjects factor and Emotion Category (positive, negative, neutral)
as a within-subjects factor, controlling for the influence of current
depressive symptoms as a covariate. Current depressive symptoms
did not show a significant effect of emotion category, F(2, 134) ¼ .99,
n.s., h2 ¼ .01. Analysis revealed a significant Group Emotion
Category interaction, F(2, 134) ¼ 4.76, p < .01, h2 ¼ .07.1 Bonferroni
tests showed that, within the total number of endorsed and
recalled adjectives, formerly compared to never-depressed participants showed a higher proportion of negative adjectives and a
lower proportion of positive adjectives, p < .01 and p < .05
respectively. No differences between groups were found in the
recall of neutral adjectives, p ¼ .95.
4.6. Association between negative processing indices and memory
for negative self-referent material
We examined the relationships between negative processing
indices (i.e., SST scores and LDT priming effects for negative words)
and memory for negative self-referent material in the SRIRT, controlling for BDI-II scores. Partial correlation analyses controlling for
current depressive symptoms showed that SST scores and LDT
priming effects for negative words had a significant positive association with self-endorsed and recalled negative adjectives in the
SRIRT, r ¼ .38, p < .01 and r ¼ .37, p < .01, respectively. On the
contrary, SST scores and LDT priming effects for negative adjectives
did not show a significant correlation, r ¼ .13, p ¼ .27.
To test if negative processing indices predicted the proportion of
self-endorsed and recalled negative adjectives, we conducted a series
of regression analyses with the standardized proportion of negative
self-referent recall as dependent variable, and group and each standardized index of negative processing. Standardized BDI-II scores
were entered in the models’ first step to control for the influence of
current depressive symptoms. Main effects of group and the corresponding standardized index of negative processing (i.e., SST scores
and LDT priming effects for negative words in each regression model
respectively) were entered in the second step, followed by their twoway interaction in the third step (see Tables 4 and 5).
As can be seen in Table 4, the relationship observed between SST
scores and the proportion of self-endorsed and recalled negative
adjectives was accounted by the participants’ group condition. We
conducted simple slopes analyses to examine this interaction effect.
These analyses indicated that for participants in the neverdepressed group, higher negative processing under reduced
.07
.71
.15
.02
.05
.27
.14
1
To overcome possible primacy and recency effects, we conducted a complementary analysis controlling the effect of the first and last words presented in the
encoding and recall task for each participant. These further analyses produced
identical results to those considering the total amount of words in the encoding and
recall task, showing a significant Group Emotion Category interaction, F(2,
134) ¼ 4.51, p < .01, h2 ¼ .06.
N. Romero et al. / J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
Table 4
Regression analyses with SST scores.
Step 1
Step 2
BDI-II (z)
DR2
b
p
.082
.172
.287
.016*
.249
.301
.029*
.011*
.406
.043*
Group
SST (z)
Step 3
.046
Group SST (z)
Note. BDI-II ¼ Beck Depression Inventory-II; SST ¼ Scrambled Sentence Test.
*p < .05.
cognitive control did not predict the proportion of self-endorsed
and recalled negative adjectives, DR2 ¼ .01, b ¼ .069, p ¼ .66.
However, higher negative processing under reduced cognitive
control in the formerly depressed group did significantly predict
the proportion of self-endorsed and recalled negative adjectives,
DR2 ¼ .14, b ¼ .428, p < .05.
As can be seen in Table 5, the relationship observed between
LDT priming effects and the proportion of self-endorsed and
recalled negative adjectives was accounted by the participants’
group condition. Simple slopes analyses indicated that for participants in the never-depressed group, automatic activation of negative meanings did not predict the proportion of self-endorsed and
recalled negative adjectives, DR2 ¼ .01, b ¼ .087, p ¼ .58. However,
automatic activation of negative meanings in the formerly
depressed group did significantly predict the proportion of selfendorsed and recalled negative adjectives, DR2 ¼ .20, b ¼ .450,
p < .05.
5. Discussion
Cognitive models propose that depression is caused by
dysfunctional schemas that endure beyond the depressive episode,
representing vulnerability factors for recurrence (Beck, 1967).
However, research using self-report measures of dysfunctional attitudes (Weissman, 1979) has not found differences between
formerly and never-depressed individuals in their levels of negative
cognitions (e.g., Miranda et al., 1990). It has been argued that
negative cognitions in vulnerable individuals may be observed under conditions that interfere with their attempts to reduce unwanted negative thinking (e.g., Watkins & Moulds, 2007; Wenzlaff &
Bates, 1998). The present study was aimed at testing this possibility.
Congruent with our first hypothesis, analyses on the SST showed
that formerly compared to never-depressed individuals unscrambled more negative self-referent sentences while performing an
additional secondary task. Our results replicate previous SST findings in vulnerable individuals (e.g., Rude et al., 2001; Watkins &
Moulds, 2007). These findings indicate that negative processing in
formerly depressed individuals is observable in conditions that
interfere with attempts to suppress negative thinking (e.g.,
Wenzlaff, Rude, Taylor, Stultz, & Sweatt, 2001).
Table 5
Regression analyses with LDT priming effects for negative words.
Step 1
Step 2
BDI-II (z)
DR2
b
p
.082
.175
.287
.016*
.215
.300
.066
.010*
.403
.005**
Group
LDT (z)
Step 3
.086
Group LDT (z)
Note. BDI-II ¼ Beck Depression Inventory-II; LDT ¼ Lexical decision task.
*p < .05; **p < .01.
133
Furthermore, we investigated if negative cognitions in vulnerable individuals may also be observed under other conditions uninfluenced by mental control, such as at automatic activation levels.
Previous research has shown that currently compared to nondepressed individuals are faster at detecting negative words that have
been previously presented subliminally (Phillips et al., 2010). To our
knowledge, no studies have evaluated this priming effect in
formerly depressed individuals. In our study, we analyzed if activation of subliminal negative words in the absence of conscious
processing led to a faster detection of those negative words, as
found in clinically depressed samples (e.g., Scott et al., 2001). LDT
results revealed that formerly compared to never-depressed individuals showed a greater facilitation effect to detect subliminally
primed negative words. This finding confirmed our second hypothesis that, in formerly depressed individuals, negative cognitions are observed not only in conditions with a lowered level of
conscious processing but also in conditions where more automatic
levels of processing intervene.
These results are congruent with current accounts (i.e.,
Joormann, 2010) that argue that biases in cognitive processing may
operate as a function of the capacity to control for the accessibility
of negative cognitions, without needing that those cognitions are
activated by stressors, as proposed by former cognitive models (e.g.,
Clark et al., 1999). Our results also support a dual-process theory of
cognitive vulnerability to depression (Beevers, 2005; Phillips, Hine,
& Bhullar, 2012). According to this perspective, cognitive vulnerability to depression involves two modes of information processing.
An associative mode implies automatic negative self-referential
processing that may provide the foundation for cognitive vulnerability to depression whereas a reflective mode involves controlled
and explicit processing. According to this model, cognitive vulnerability occurs when this reflective mode cannot correct negative
processing generated at an automatic level. Our results indicate
that negative processing in formerly depressed individuals can be
observed in both the associative mode of automatic processing and
the reflective mode of explicit processing when cognitive resources
are depleted.
Cognitive models also postulate that negative cognitions leads
individuals to show biases in their cognitive processing, by selecting
and remembering information congruent with those negative cognitions (Beck, 1967). It has been well established that currently
compared to nondepressed individuals show greater recall for information congruent with their negative schemas (Gotlib &
Joormann, 2010). We extended this finding to formerly depressed
individuals: In our study, formerly compared to never-depressed
participants showed greater recall of negative self-referent adjectives and lower recall of positive self-referent adjectives. This
finding is noteworthy given that a number of previous studies have
not been able to reveal memory biases in vulnerable individuals
(Bradley & Mathews, 1988; Teasdale & Dent, 1987). Previous
research has provided more consistent evidence of memory biases
following recovery when participants received a negative mood
induction (Scher et al., 2005), intended to reactivate negative
schemas (Clark et al., 1999; Teasdale, 1988). It should be noted that
the index of memory for emotional material used in the present
study differs from the index typically used in previous studies that
have failed to find memory biases in formerly depressed individuals.
Whereas other studies computed the total recall of negative adjectives previously presented, in the present study we calculated the
recall of negative adjectives that had been previously encoded as
self-referent. This method has shown to be effective in finding
memory biases for self-referent information in clinically depressed
individuals (Gotlib et al., 2004; Joorman et al., 2006). The present
results indicate that, even without manipulating mood, memory
biases can be observed in formerly depressed individuals. These
134
N. Romero et al. / J. Behav. Ther. & Exp. Psychiat. 45 (2014) 128e135
results are consistent with recent research reporting cognitive biases in formerly depressed without using mood induction procedures
(Hanking, Gibb, Abela, & Flory, 2010; Joormann & Gotlib, 2007;
Sears, Newman, Ference, & Thomas, 2011). For instance, Joormann
and Gotlib (2007) and Hanking et al. (2010) found that formerly
depressed showed greater attention to sad faces compared to never
depressed individuals. Sears et al. (2011) also reported a higher
detection of negative images in formerly depressed compared to
never depressed individuals using eye movement measures. Our
findings extend these results from attention processes by showing
that memory biases appear in formerly depressed individuals
without using mood manipulations.
Moreover, our results are consistent with results from Alloy,
Abramson, Murray, Whitehouse, and Hogan (1997) showing that
individuals with higher cognitive vulnerability to depression (as
assessed with negative thinking measures) showed lower recall of
positive self-referent processing than individuals with lower
cognitive vulnerability to depression. These results are consistent
with the proposal that memory biases are linked to negative cognitions generated by depressive schemas (Holland & Kensinger,
2010). The present study was aimed at evaluating this association
by testing if negative cognitions (assessed by negative processing
indices in the SST and the LDT) were associated with memory
biases for negative information in formerly depressed individuals.
To our knowledge, no previous studies have examined this association in vulnerable individuals. We also confirmed our third hypothesis, showing that greater negative processing at both
automatic activation of negative meanings and explicit processing
under reduced cognitive control were linked to greater recall of
negative self-referent material. Importantly, these associations
were specifically found in formerly depressed individuals. This
suggests that individual differences in the activation of negative
cognitions at both automatic and explicit processing levels may
confer vulnerability to depression by facilitating the retrieval of
negative self-referent information. Furthermore, our results also
suggest that memory biases to negative information may be not
only dependent on negative mood states, as explained by traditional cognitive models of depression (Clark et al., 1999; Teasdale,
1988), but also operate as a function of formerly depressed individuals’ capacity to control negative processing (Joormann, 2010).
Interestingly, our results did not reveal significant associations
between automatic and explicit measures of negative processing.
This result is consistent with previous research evaluating associations between automatic and explicit indicators of self-esteem
(e.g., Creemers, Scholte, Engels, Prinstein, & Wier, 2012;
Greenwald & Farnham, 2000; Haeffel et al., 2007) that reported
weak associations between these factors. However, research on
self-esteem has also revealed that both unrelated modes of automatic and explicit processing are implicated in the generation of
vulnerability to depression (Haeffel et al., 2007; Phillips et al.,
2012). Taken together, these findings suggest that negative processing at automatic and explicit processing levels may reflect
different mechanisms by which dysfunctional schemas facilitate
the recall of negative self-referent information in vulnerable individuals. However, it should be noted that analyses of the relationship between negative processing indices and memory biases
in our study were correlational and that we employed different
tasks and stimuli materials to test the link between negative processing and memory biases. Further research should directly
examine the causal links between negative cognitions and accessibility vs. availability biases. This could be implemented, for
instance, by experimentally control the encoding of negative
stimuli that are part of formerly depressed individuals’ memory
representation and then test if differential accessibility for these
negative stimuli leads to different patterns of negative retrieval.
Further research should also examine if vulnerable individuals’
accessibility to self-referent cognitions and memory processing
interact to predict prospective depressive symptomatology.
Another limitation in our study was that the majority of participants in both groups were women. Although this is a common
characteristic of studies evaluating memory biases in currently and
formerly depressed samples (e.g., Dozois & Dobson, 2001; Gotlib
et al., 2004), this may limit the generalizability of our results.
However, it should be noted that no gender differences were found
between groups in the study.
Despite these limitations, the present results have relevant
clinical implications. Our findings suggest that negative processing,
as detected by the SST and LDT tasks, may lead vulnerable individuals to recall more negative self-referent information in
comparison to never depressed individuals. Based on our findings,
negative biases observed through both interpretation task (SST)
and automatic activation task (LDT) may affect subsequent processing of self-referent material (i.e., memory retrieval). This suggests that manipulating the activation of negative meanings as well
as promoting more positive patterns of interpretations may help to
reduce negative memory biases, which have been found to be
predictive of depressive symptoms over time (e.g., Beeney & Arnett,
2008). For instance, recent studies have shown that the manipulation of interpretative bias can result in changes in memory, which
suggests a causal relation between both cognitive processes
(Salemink, Hertel, & Mackintosh, 2010; Tran, Hertel, & Joormann,
2011). Taken together, these results suggest that it might be
possible to reduce cognitive vulnerability to depression by training
vulnerable individuals to change rather automatic negative interpretation patterns. Furthermore, modifying negative self-referent
aspects at early stages of cognitive processing may also be a potential way of intervention in vulnerable individuals, as this
modification might also favor important changes in the later processing of self-referent information, as proposed by current accounts of vulnerability to depression (Beevers, 2005).
6. Conclusion
Our study provides evidence of negative processing in formerly
depressed individuals at both automatic and explicit levels of
processing under reduced cognitive control. Furthermore, to the
best of our knowledge, the present study is the first to demonstrate
an association between both modes of negative processing and
memory biases for negative self-referent information in formerly
depressed individuals. In our opinion, these findings increase our
understanding of the processes that intervene in how dysfunctional
schemas confer vulnerability to depression.
Acknowledgments
This work was partially supported by a Spanish Ministry of
Education Predoctoral Fellowship (ref. AP2007-01141) to the first
author, and research grants from the Ministry of Research, Science,
and Innovation (PSI2009-13922) and Ministry of Economy and
Competitiveness (PSI2012-35500) to the third author.
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