Journal of Abnormal Psychology
2001, Vol. 110, No. 1,76-82
Copyright 2001 by the American Psychological Association, Inc.
0021-843X/01/S5.00 DOI: 10.1037//0021-843X.110.1.76
The Effect of Practice on Recall of Emotional Information
in Individuals With Generalized Social Phobia
Nader Amir
University of Georgia
Meredith E. Coles
Temple University
Bartholomew Brigidi
Edna B. Foa
University of Vermont
University of Pennsylvania
Understanding memory processes in social anxiety is important because these individuals often report
negative memories of anxiety-provoking situations and because of the recent emphasis on learning and
memory in models of anxiety. The authors examined the effect of learning on memory for negative social,
positive social, and nonsocial information using the retrieval-induced forgetting paradigm in individuals
with generalized social phobia (GSPs) and in nonanxious controls (NACs). Words were presented in 1
of 3 practice conditions: practiced words from a practiced category, unpracticed words from a practiced
category, and unpracticed words from an unpracticed category. GSPs and NACs showed the same
patterns of memory for practice categories for positive social and nonsocial words. However, for negative
social words, GSPs benefited less from practice and were hurt less from the effect of practicing
competing negative social information than were NACs. This pattern of processing may hamper GSPs'
learning of, and habituation to, negative social information.
Psychopathologists have postulated that preferential processing
of threat-relevant information may play a role in the maintenance
and possibly the etiology of emotional disorders (e.g., Williams,
Watts, MacLeod, & Mathews, 1988, 1997). Consequently, researchers examined whether individuals with different anxiety
disorders are characterized by attention, interpretation, or memory,
biases for threat-relevant information. For example, individuals
with social phobia have been shown to have an attentional bias for
socially threatening information (e.g., Amir et al., 1996; Hope,
Rapee, Heimberg, & Dombeck, 1990). Socially anxious individuals also interpret ambiguous information as threatening (e.g.,
Amir, Foa, & Coles, 1998b; Stopa & Clark, 1993). Preferential
memory for threat-relevant information, however, has received
mixed support (e.g., Amir, Foa, & Coles, 2000; Claeys, 1989;
Rapee, McCallum, Melville, Ravenscroft, & Rodney, 1994).
Other investigators examined specific mechanisms that may be
involved in the maintenance of social anxiety. For example, various researchers (e.g., Amir, Foa, & Coles, 1998b; Mogg,
Mathews, & Weinman, 1987) suggested that anxiety may involve
inhibitory abnormalities during the automatic (i.e., early, parallel,
and capacity-free) and strategic (i.e., late, sequential, and limitedcapacity) stages of processing of threat-relevant information. More
specifically, Amir et al. (1998b) showed that individuals with
generalized social anxiety may show enhanced automatic activation of threat-relevant information that is later inhibited during the
strategic stage of information processing. This strategic inhibition
may cause difficulties in learning and remembering information
about negative social interactions in socially anxious individuals.
Understanding the role of learning and memory in social anxiety
is important for at least three reasons. First, learning principles
figure prominently in recent animal models of fear acquisition,
suggesting the involvement of multiple stages and multiple brain
pathways (e.g., Armony & LeDoux, 1997; Damasio, 1994). This
research has direct implications for the study of learning and
memory in anxiety, because the model delineated by LeDoux
(1996, p. 164) emphasizes the role of learning in the acquisition of
fear. Second, studies of memory bias in anxiety have produced
inconsistent results. Although some have suggested that inconsistent results are an artifact of assessing different types of memory
processes in various studies (e.g., implicit vs. explicit memory;
Amir, McNally, Riemann, & Clements, 1996; Schacter, 1987), this
explanation itself has received mixed support. Third, clients with
social anxiety and other anxiety disorders often report that they are
plagued by memories of anxiety-provoking situations. For example, anecdotal clinical observations suggest that individuals with
generalized social phobia (GSP) often report intrusive memories of
negative social interactions, individuals with posttraumatic stress
disorder often report intrusive memories of their traumatic experience, and individuals with panic disorder often report intrusive
memories of their first, or worst, panic attack. These clinical
reports of intrusive memories of anxiety-provoking situations may
Nader Amir, Department of Psychology, University of Georgia;
Meredith E. Coles, Department of Psychology, Temple University; Bartholomew Brigidi, Department of Psychology, University of Vermont;
Edna B. Foa, Department of Psychology, University of Pennsylvania.
This study was supported by an Institute for Behavioral Research,
University of Georgia, faculty development grant to Nader Amir and
National Institute of Mental Health Grant MH49340 to Edna B. Foa. We
thank Lori Zoellner for her help during the early conceptualizations of this
project.
Correspondence concerning this article should be addressed to Nader
Amir, Department of Psychology, University of Georgia, Athens, Georgia
30606. Electronic mail may be sent to [email protected].
76
77
RETRIEVAL-INDUCED FORGETTING
suggest preferential learning and memory of negative events,
which may play a fundamental role in the pathogenesis of these
disorders. Indeed, in individuals with GSP, exaggerated ruminations and rehearsal of negative social interactions may lead to more
practice of this information compared with positive or neutral
information. This relative increased practice of negative information may interfere with remembering positive or neutral information (Anderson, Bjork, & Bjork, 1994). For example, if an individual with social fears were repeatedly to recall an incident in
which a member of the audience yawned during a speech, this
practice may interfere with remembering the faces of people who
were listening intently.
This explanation regarding the role of practice on memory is
consistent with current models of long-term recall (e.g., Anderson
et al., 1994). Anderson and Spellman (1995) used the retrievalinduced forgetting paradigm to examine long-term memory. They
presented individuals with category-plus-exemplar pairs (e.g.,
fruit-orange). They then asked the participants to practice remembering half of the items from half of the categories. Later, a final
cued-recall test examined the effect of retrieval practice on memory. In other words, these researchers were able to examine the
effect of practice of certain exemplars (e.g., orange) of a category
(e.g., fruit) on the recall of other nonpracticed exemplars (e.g.,
apple) from that same category (Anderson & Spellman, 1995).
More specifically, the experiment involved three phases. In the
first phase, individuals studied several category-plus-exemplar
pairs (e.g., fruit-orange, fruit-apple, furniture-table). In the second phase, they practiced remembering half of the items from half
of the categories (e.g., fruit or
). In the third phase, participants
performed a cued-recall test and were asked to write down all
studied exemplars of the category cue. The impact of the retrieval
practice (e.g., fruit or
) on the recall of the remaining unpracticed exemplars (e.g., apple) was the focus. If practiced items (e.g.,
orange) inhibit recall of unpracticed items (e.g., apple), then the
recall of unpracticed items from practiced categories should be
worse than performance on unpracticed items (e.g., table) from
baseline categories (e.g., furniture) in which no items were
practiced.
Anderson et al. (1994) found that for practiced categories practiced items were recalled better than unpracticed items. More
importantly, the recall of the latter was inferior to the recall of
items from unpracticed categories, thus implying active inhibition
of the unpracticed items. Many studies examined impairments in
memory from practice of semantically related material (e.g., Blaxton & Neely, 1983; Brown, 1968; Karchmer & Winograd, 1971)
and illuminated various characteristics of the retrieval-induced
forgetting effect. For example, actively generating items enhances
the retrieval-induced forgetting effect (Blaxton & Neely, 1983),
impairment from this effect can last beyond short-term memory
and endure over time (e.g., 20 min; Anderson et al., 1994), and
inhibitory processes, rather than changes in associative weights
and activations, are involved in producing the effect (Anderson &
Spellman, 1995).
In the current study, we used a modified version of the retrievalinduced forgetting paradigm to examine the effect of practice of
negative social, positive social, and nonsocial information on the
subsequent recall of this information as well as unpracticed but
related information in individuals with GSP. We hypothesized that
because these individuals show enhanced inhibition of negative
social information (e.g., Amir et al., 1998a), they would benefit
less from practicing negative social information compared with
controls. As a result of this reduced learning, individuals with GSP
would show less inhibition of the unpracticed negative social
exemplars. This bias would be specific, pertaining to negative
social material, and not general, pertaining to positive social and
nonsocial material.
Method
Participants
This experiment included two samples: individuals with GSP (GSPs)
and nonanxious controls (NACs). The GSP group comprised 25 individuals
(20% female) who were recruited from consecutive treatment referrals.
These individuals met Diagnostic and Statistical Manual of Mental Disorders (fourth edition; DSM-IV; American Psychiatric Association, 1994)
criteria for social phobia using the Structured Clinical Interview for DSMIV—Patient Edition (SCID-P; Spitzer, Williams, Gibbon, & First, 1994).
SCID interviews were conducted by trained doctorate-level psychologists
experienced in the differential diagnosis of social anxiety and trained to
reliability standards. Socially anxious individuals reported difficulties in
multiple social domains; thus, they meet criteria for GSP according to the
SCID interview. GSPs participated in the current study before entering a
clinical trial comparing cognitive-behavioral therapy and medication, thus
at the time of the current study subjects were not receiving any type of
treatment.
The NAC group comprised 25 community volunteers (44% female) who
had never met DSM-IV criteria for any Axis I disorder. All controls
reported English as their first language, normal or corrected-to-normal
vision, and no known memory impairments.
Participants completed the State-Trait Anxiety Inventory (Spielberger,
Gorsuch, Lushene, Vagg, & Jacobs, 1983), the Beck Depression Inventory
(Beck & Steer, 1987), and the Anxiety Sensitivity Index (Reiss, Peterson,
Gursky, & McNally, 1986). These data are presented in Table 1.
As expected, GSPs were more depressed, more generally anxious, and
more sensitive to anxiety than the NACs. Groups did not differ in years of
education; however, the GSP group was older on average and was composed of a larger percentage of men than the NAC group.
Materials
We used eight categories and 96 words in this experiment. These words
are presented in Table 2.
The nonsocial categories and exemplars were based on those used by
Anderson et al. (1994) and included four categories, each composed of 12
Table 1
Demographic and Psychometric Data
GSP
NAC
Variable
M
SD
M
SD
df
Age (years)
Education (years)
ASI
BDI
STAI-T
39.05
15.55
27.35
16.50
51.37
9.3
2.4
11.9
8.2
11.2
28.20
15.60
11.63
3.17
27.83
7.3
2.7
8.3
6.8
6.5
43
43
39
38
41
4.39*
0.06
4.99*
7.00*
8.66*
Note. Degrees of freedom vary as a result of missing data. GSP =
generalized social phobia group; NAC = nonanxious control group; ASI =
Anxiety Sensitivity Index; BDI = Beck Depression Inventory; STAI-T =
State-Trait Anxiety Inventory—Trait.
* p < .05.
78
AMIR, COLES, BRIGIDI, AND FOA
Table 2
Words Used in the Experiment
Social words
Category
Party
Job
Dating
Conversation
Negative
Positive
Boring, dull, greetings, handshake, quiet, tense
Bosses, evaluation, interview, review, stress, supervision
Annoyed, appearance, clumsy, discussions, performance,
rejection
Argue, babble, criticism, nowhere, silence, sustain
Entertainment, friends, funny, laughter, snacks, songs
Accomplishment, award, camaraderie, networking, paycheck, praise
Activity, attraction, caring, empathy, sharing, togetherness
Animated, connected, enjoy, flattery, humor, lively
Nonsocial words
Set I
Drinks
Weapons
Fish
Fruits
Cognac, Drambuie, Kahlua, moonshine, sake, tequila
Arrow, dagger, foot, hatchet, lance, nail
Angler, muskie, puffer, snapper, walleye, yellowtail
Coconut, guava, kiwi, mango, nectarine, raisin
words for a total of 48 words. We constructed the social categories for the
current study using words within each category that would be representative of a superordinate category. To identify these words, we conducted a
pilot study using a separate group of GSPs (n = 5). These individuals were
presented with social categories and asked to list the first 6 positive and
first 6 negative words that came to mind. For each word, participants were
also asked to rate its-emotionally on a scale ranging from -3 (very
disturbing emotional meaning for you) to +3 (very pleasant emotional
meaning for you). On the basis of this pilot work, we chose four social
categories (12 words each, 6 negative and 6 positive) that gave preference
to exemplars that were listed most frequently and belonged to only one
category. Finally, we attempted to match all word types on word length and
frequency (Francis & Kucera, 1982). Words ranged in length from 4 to 14
letters; the mean numbers of letters by word type were as follows: negative
social = 7.6, positive social = 7.9, and nonsocial = 6.2. Mean word
frequencies by word type were as follows: negative social = 31.7, positive
social = 34.8, and nonsocial = 20.6.
Procedure
Words were presented in black lowercase letters (3-5 mm in height)
against a white background on a Macintosh computer. Participants were
seated approximately 30 cm from the screen. The procedure involved three
phases: a study phase, a retrieval practice phase, and a final test phase.
In the study phase, participants studied category-plus-exemplar pairs
(e.g., party-happy); all participants practiced the same pairs from the same
categories. After the study phase, participants engaged in directed "retrieval practice" on half of the items from half of the studied categories.
Participants practiced retrieving exemplars by completing category-plusexemplar stems (e.g., Party-Ha ) followed by feedback (e.g., partyhappy) and then a final category-plus-exemplar stem (e.g., party-ha )
practice. They were asked to read the category out loud and then say what
they thought the second word was. The participants were instructed to read
the word out loud when the feedback was given if they were not sure of the
word during practice. Participants then performed a filler task consisting of
listing all the states and all the state capitals they could remember (20 min).
They were then administered a free-recall test in which they were given
category cues (e.g., party, fruits) and asked to recall all exemplars for that
category.
Results
For each participant we calculated percent correct recall by
word type and practice condition. These data were submitted to a 2
Set 2
Beer, bourbon, scotch, schnapps, vodka, whiskey
Bomb, club, pistol, rifle, sword, tank
Bluegill, catfish, flounder, guppy, herring, trout
Banana, lemon, orange, pineapple, strawberry, tomato
(group: GSP, NAC) X 3 (practice condition: practiced categorypracticed word, practiced category-unpracticed word, unpracticed
category-unpracticed word) X 3 (word type: negative social,
positive social, nonsocial) analysis of variance (ANOVA). Significant interactions were followed up with simple main effects
analyses and paired comparisons using the protected significant
difference method (Kepple & Zedeck, 1989, p. 117) to protect for
familywise Type I error.
The overall analysis revealed significant main effects of word
type, F(2, 96) = 86.61, p < .001, and practice condition, F(2,
96) = 114.44, p < .001, which were modified by a trend toward
a Group X Practice Condition interaction, F(2, 96) = 2.62, p =
.07, and a Group X Practice Condition X Word Type interaction,
F(4, 192) = 3.55, p < .01. To explore the three-way interaction of
Group X Practice Condition X Word Type further, we conducted
separate 2 (group) X 3 (practice condition) mixed ANOVAs for
each word type.
Negative Social Words
For negative social words there was a main effect of practice
condition, F(2, 96) = 32.99, p < .001, that was modified by a
Group X Practice Condition interaction, F(2, 96) = 5.74,p < .01.
Mean percentages of negative social words recalled by group,
word type, and practice condition are presented in Figure 1.
Simple main effects of practice condition revealed that NACs
recalled significantly more negative social words from the practiced category-practiced words condition, /(48) = 2.22, p < .04,
than did GSPs. The opposite pattern was found for the practiced
category-unpracticed words condition; GSPs recalled more negative social words than NACs, f(48) = 2.40, p < .03.
Simple main effects of group revealed that GSPs responded
differently to the various practice conditions, F(2, 48) = 5.60, p <
.01. Paired comparisons revealed that GSPs recalled more negative
social words from the practiced category-practiced word condition
than from the unpracticed category-unpracticed word condition,
t(24) = 2.53, p < .02, and from the practiced categoryunpracticed word condition, t(24) = 2.87, p < .01. GSPs did not
differ in their recall of negative social words from the unpracticed
category-unpracticed and practiced category-unpracticed conditions, /(24) = .29, n*.
79
RETRIEVAL-INDUCED FORGETTING
60 T
50 • •
40 • •
30 - •
20 - -
10 • •
Practiced category^
practiced words
Unpracticed categoryunpracticed words
Practiced categoryunpracticed words
Practice type
Figure 1. Recall of negative social words by practice condition and group. GSP = generalized social phobia
group; NAC = nonanxious control group.
Parallel analyses for NACs revealed that they also responded
differently to the various practice conditions, F(2, 48) = 34.71,
p < .001. NACs recalled more negative social words from the
practiced category-practiced condition than from the unpracticed
category-unpracticed condition, t(24) = 4.53, p < .001, and from
the practiced category-unpracticed word condition, f(24) = 8.12,
p < .001. NACs also recalled more negative social words from the
unpracticed category-unpracticed condition than from the practiced category-unpracticed condition, f(24) = 3.74, p < .001.
Follow-up paired comparisons revealed that all individuals recalled more nonsocial words from the practiced category-practiced
condition than from the unpracticed category-unpracticed word
category, f(49) = 10.62, p < .001, and the practiced categoryunpracticed condition, f(49) = 11.73, p < .001. Individuals also
recalled more nonsocial words from the unpracticed categoryunpracticed condition than from the practiced categoryunpracticed condition, t(\, 49) = 3.38, p < .001. Therefore, the
patterns of results for the nonsocial words and positive words were
identical.
Positive Social Words
For positive social words there was a main effect of practice
condition, F(2, 96) = 39.03, p < .001. None of the other main
effects or interactions were significant for positive social words.
Mean percentages of positive social words recalled by group, word
type, and practice condition are presented in Figure 2.
Follow-up paired comparisons revealed that all individuals recalled significantly more positive social words from the practiced
category-practiced condition than from the unpracticed categoryunpracticed condition, 7(49) = 5.67, p < .001, or the practiced
category-unpracticed condition, f(49) = 7.65, p < .001. Individuals also recalled significantly more words from the unpracticed
category-unpracticed condition than the practiced categoryunpracticed condition, ((49) = 3.29, p < .01.
Nonsocial Words
For nonsocial words there was a main effect of practice condition, F(2, 96) = 97.78, p < .001. None of the other main effects
or interactions were significant for nonsocial words. Mean percentages of nonsocial words recalled by group, word type, and
practice condition are presented in Figure 3.
Controlling for Effects of Age and Gender
Although groups differed on recall of negative social words, as
was noted in the Participants section, the GSP group was significantly older and composed of a larger percentage of men than the
NAC group. To examine the effect of these variables on the
obtained results, we conducted analyses of covariance controlling
for age and gender. These analyses revealed an identical pattern of
results; groups differences remained significant when these variables were partialed out.
Discussion
We found a standard retrieval-induced forgetting effect for all
individuals and all word types except for GSPs when recalling
negative words. These results suggest that GSPs do not benefit
from practicing recall of negative social words as much as NACs.
Further, GSPs' memory for negative social words was more resistant to the effect of practicing competing negative social information than NACs' memory. These findings suggest that in GSPs
memory for negative social words is more stable and less influ-
80
AMIR, COLES, BRIGIDI, AND FOA
50 •
40 -
DGSP
DNAC
"ra
o
£30-
I
i
•v?
1
o~-
20 -
I
1
Practiced category_
practiced words
T
Unpracticed categoryunpracticed words
Practiced categoryunpracticed words
Practice type
Figure 2. Recall of positive social words by practice condition and group. GSP = generalized social phobia
group; NAC = nonanxious control group.
enced by practice than in NACs. For positive and nonsocial words,
however, no such group differences emerged.
What are the implications of our results for experimental psychopathology research and treatment interventions? First, the current results for nonsocial words replicate previous research
(Anderson & Spellman, 1995) showing additional evidence for the
utility of the retrieval practice paradigm. As noted earlier, this
paradigm is potentially very informative for psychopathologists in
light of the emphasis on the role of learning of threat-related
information in various models of psychopathology (e.g., Davey,
1992) as well as neuroscience (e.g., LeDoux, 1996).
If generalized social phobics do not learn threat-related information as well as normals, what may account for the exaggerated
salience of these memories of negative social interactions (e.g.,
coming to mind)? One possible explanation is that this pattern of
information processing may hamper the full recall of negative
events. As a result, partial recollections of the event are represented in memory. For example, if a generally socially anxious
60 -r
50-
I
1
I
1
DGSP
DNAC
40-
30-
I
1
I
1
20-
I
1
I
1
10-
Practiced category_
practiced words
Unpracticed categoryunpracticed words
Practiced categoryunpracticed words
Practice type
Figure 3. Recall of nonsocial words by practice condition and group. GSP = generalized social phobia group;
NAC = nonanxious control group.
RETRIEVAL-INDUCED FORGETTING
person were to give a talk and see an audience member yawn, the
practice of this negative interaction may leave him or her with an
incomplete memory of the event.
Thus, one implication of lack of complete memory is that these
individuals are left with partial representations of negative social
events. These partial representations then need to be interpreted
later, and because of their interpretation bias in favor of threat,
generally socially anxious individuals will likely produce more
negative than neutral or positive recollections. In addition, generalized social phobics may complain about memories of negative
social interactions always coming to mind, even in light of their
relatively decreased learning of threat-related information, because
of an increase in the distress associated with these memories. This
elevated distress may lead to increased salience of the memories
even when they are not as fully formed as the nonthreat memories.
Another finding of this study was the lack of inhibition of
negative social material when alternative negative social material
is practiced. This lack of inhibition may also have negative consequences. Returning to the prior example, being confronted with
multiple sources of feedback, a degree of inhibition of one, in the
favor of the other, may be adaptive. If generally socially anxious
individuals do not inhibit additional sources of threat, they are left
with multiple and possibly incomplete representations of negative
information that need to be processed. As a result, they will again
have to use interpretive processes to disambiguate this information
later, leading to additional negative recollection.
Our results for negative social words demonstrate the potential
role of learning and memory abnormalities in individuals characterized by diffuse social anxiety (i.e., GSP). Consistent with our
previous work (Amir et al., 1998b), we found that GSPs may
strategically inhibit threatening information. GSPs' better memory
for unpracticed words from practiced categories may be driven by
their vigilance for threatening stimuli. This is consistent with the
literature showing that GSPs initially allocate preferential attention
to socially threatening information (e.g., Asmundson & Stein,
1994; Hope et al., 1990). Further, GSPs' poorer memory for
negative social words that were practiced is consistent with models
that propose strategic avoidance of threatening information (e.g.,
Mogg, Bradley, Bono, & Painter, 1997; Mogg et al., 1987).
Our results also have tentative treatment implications. For example, it may be useful to help GSPs encode information in their
environment more accurately. This suggestion is consistent with
research showing that decreases in internal focus of attention (and
presumably increases in attention on external input) are related to
decreases in speech anxiety among patients with public speaking
fears (Woody, Chambless, & Glass, 1997).
Our study has limitations. First, the structured rehearsal of word
pairs used in this study may differ from the mental reviewing of
real-life negative social events. For example, although the systematic presentation of words allows for experimental control, it is
unlikely to produce levels of negative affect experienced in social
situations. A second limitation of this study was the difficulty in
matching social and nonsocial words. Although we attempted to
construct cohesive categories of social words through piloting, the
words in the social categories were less cohesive with respect to
their superordinate categories than were the nonsocial words. This
increased cohesiveness of nonsocial words may have enhanced
their memorability. However, the finding that group differences
emerged only for negative social words and not positive social
81
words argues against a simple explanation based on cohesiveness
of categories. Finally, although we have proposed possible interpretations of the current findings, possible alternative explanations
exist. For example, we interpreted our results as suggesting that
GSPs show less inhibition of negative social words when related
words are practiced. However, an equally plausible interpretation
is that NACs show more inhibition of negative words.
In summary, results of this study suggest that practicing negative social information has less influence on the memories of GSPs
than NACs. We propose that this pattern of processing may hamper GSPs' learning of and habituation to negative social information, playing a role in the maintenance of their anxiety. This
conceptualization of anxiety is consistent with models of emotional disorders that posit a lack of emotional processing as the
cause of pathological anxiety (Foa & Kozak, 1986; Rachman,
1980). Memory biases that may be partly responsible for the
development and maintenance of anxiety disorders are likely to
involve multiple processes. Future studies should address the specificity of these biases by examining other anxious populations
(e.g., including individuals with specific or nongeneralized social
phobia) and including threatening stimuli of a nonsocial nature.
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Received April 12, 1999
Revision received February 24, 2000
Accepted June 8, 2000