Retrieval properties of negative vs. positive mental images and autobiographical memories in social anxiety: Outcomes with a new measure
Highlights
► Examined images and memories in social anxiety (SA) with new interview measure. ► High SA participants reported more frequent and aversive negative images and memories. ► High SA participants also showed impoverished retrieval of positive images. ► Findings complement and extend psychological models of emotional disorders and SA.
Introduction
Cognitive models of social anxiety disorder (SAD) emphasize the central role of negative self-perception in the development and maintenance of anxiety symptoms (Clark and Wells, 1995, Hofmann, 2007, Moscovitch, 2009, Rapee and Heimberg, 1997). Negative self-perception in social anxiety is often represented in the form of intrusive, negatively distorted mental self-images that are viewed from the perspective of a critical observer and are erroneously perceived by socially anxious individuals as representing how they actually appear to others in social situations (Coles et al., 2002, Coles et al., 2001, Hackmann and Holmes, 2004, Hackmann et al., 1998, Wells et al., 1998). When these images are held in mind, they have been shown to increase anxiety and self-concealment behaviors, facilitate negative interpretations of social events, and impair both subjectively-perceived and objectively-rated social performance (Hirsch et al., 2003, Hirsch et al., 2005, Hirsch et al., 2006, Stopa and Jenkins, 2007, Vassilopoulos, 2005).
Negative self-images in social anxiety are believed to be rooted in earlier experiences of social humiliation, criticism, or rejection (Hirsch & Clark, 2004). In an oft-cited study, Hackmann, Clark, and McManus (2000) interviewed participants with SAD and reported that 100% of them endorsed experiencing negative images in anxiety-provoking social situations. Furthermore, all participants but one (96%) were able to recall specific negative autobiographical events that they believed led to the formation of their images and occurred around the time of the initial onset of their social anxiety symptoms. These remarkable findings are consistent with the notion that studying the recall and content of autobiographical memories in individuals with problematic social anxiety may facilitate our understanding of their life-story narratives that are based on internal representations of the self and become accessible (i.e., are brought to mind) within the context of particular emotional states (e.g., Blinder, 2007, Conway and Pleydell-Pearce, 2000). Indeed, such studies have helped generate new clinical insights into how best to treat the distortions in self-perception that characterize SAD (Morgan, 2010, Stopa, 2009), with preliminary research indicating that patients with SAD (and related emotional disorders) may benefit significantly from learning during therapy to access and rescript the negative images and autobiographical memories that underlie their negative views of self and concomitant symptoms of social anxiety (Holmes et al., 2007, Wild, Hackmann, & Clark, 2007, Wild et al., 2008).
Despite these advances in our understanding and treatment of social anxiety, it is surprising that individuals with SAD would universally experience negative images in social situations and that they are able, with very few exceptions, to link such images to earlier, specific conditioning events that are encoded as traumatic memories. Indeed, this conclusion is at odds with results of other studies, which, using varied assessment methods, have shown far more conservative rates of recalled negative social conditioning events in socially anxious samples. For example, memories of socially traumatic events were endorsed as the cause of symptom onset in only 13% of individuals with SAD in a study by Harvey, Ehlers, and Clark (2005), and in none of the participants with “speech phobia” who were interviewed by Hofmann, Ehlers, and Roth (1995).
To be fair, it is hard to compare the endorsement rates of memories across studies because of the methodological differences between them, including discrepancies in methods used to cue memory retrieval, as well as the inherent difficulties involved in verifying the authenticity of participants’ retrospectively reported autobiographical experiences (Brewin, Gregory, Lipton, & Burgess, 2010). Nevertheless, a closer look at the methodological features of Hackmann et al.’s (2000) seminal study does raise some concern, specifically about the possibility that their interview may have generated an inflated number of false positive responses. Hackmann et al.’s (2000) participants were individuals with SAD who had undergone a full course of cognitive behavioral therapy (CBT) beginning six months prior to the interview and were instructed to reflect back in a retrospective fashion on their experiences before they began treatment and describe any images and memories they may have had at that time. Because participants had just completed a highly efficacious treatment (i.e., Clark et al., 2003) that significantly improved their symptoms (Hackmann et al., 2000; p. 603, Table 1), their responses may have been contaminated by a retrospective bias (i.e., now that their symptoms had improved, believing that their experiences prior to treatment were more negative than they actually were). Moreover, Hackmann et al. (2000) reported that, prior to being interviewed, the typical participant in their study was not consciously aware of the link between his or her negative images and earlier autobiographical experiences. This is concerning because the interviewers in the Hackmann et al. study were not blind to the diagnostic status of participants or to study hypotheses and, thus, may have probed in an overly keen manner for phenomena they believed, a priori, to exist but of which the participants either were not aware or whose import they did not appreciate. Furthermore, if patients were eager to please the interviewer and avoid appearing contrary, they may have over-endorsed the sorts of experiences for which the interviewers probed.
Thus, a crucial next step in this area of research involves establishing a new paradigm for measuring images and memories in socially anxious individuals in a manner that is not hampered by unreliable measurement and related methodological problems. To this end, several studies have investigated the nature of autobiographical memory recall in clinical and analog samples using the standardized Autobiographical Memory Test (AMT; Williams & Broadbent, 1986), in which participants are instructed to retrieve and describe a specific personal memory that comes to mind within a specified time period (e.g., 30 s) in response to several negative and positive cue words (see Williams et al., 2007, for a review). Retrieved memories are later coded as being specific (i.e., an event that happened at a particular place and time and lasted for a day or less) or general (i.e., any non-specific event) by research assistants blind to the group status of participants. The percentage of specific memories that participants retrieve in response to the AMT cue words is calculated and used as the primary dependent variable in subsequent analyses. Although a comprehensive review of the literature is beyond the scope of this article, the emerging pattern of results across numerous studies (see Williams et al., 2007) is that people with a history of depression and post-traumatic stress have difficulty retrieving specific autobiographical memories (a phenomenon that has become known as an overgeneral memory bias), but people with other clinical diagnoses, including SAD, have not demonstrated this bias (Heidenreich et al., 2007, Wenzel and Cochran, 2006, Wenzel et al., 2002, Wenzel et al., 2004).
For the purpose of investigating autobiographical recollections in social anxiety, however, the AMT is limited by: (a) its use of single words as cues for the generation of memories, which may not activate the retrieval of autobiographical memories that are associated with salient mental images; (b) its relatively minimal and subjective coding system, which requires coders to make a holistic judgement about the retrieved memory as being specific or general without taking into consideration the complexity of memory narratives that typically contain both specific and general components (e.g., Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002); and (c) its operationalization of specific memory retrieval as a binary, categorical outcome measure (i.e., present or absent), which precludes the possibility that memory accessibility may be better conceptualized as a dimensional phenomenon, which would, in turn, enable descriptions of autobiographical memories as being partially accessible or degraded in detail.1
In the present study, we introduce the Waterloo Images and Memories Interview (WIMI), a modified version of the Autobiographical Interview (AI; Levine et al., 2002). The AI has been widely used over the past decade in memory research to measure the properties of participants’ autobiographical memory narratives, to quantify the components of autobiographical memory recall (e.g., episodic vs. semantic details),2 and to examine the impact of neuropsychiatric conditions (e.g., amnesia) on the types of details recalled (e.g., Rosenbaum et al., 2008). The WIMI protocol is administered by trained interviewers who are blind to the group status of participants. Retrieval of mental images and associated autobiographical memories for both anxiety-provoking (negative) and non-anxiety-provoking (positive) social situations is examined in each participant across two conditions: (a) recall, in which participants are instructed to speak in an extemporaneous manner without interviewer questioning or cuing; and (b) specific probe, in which the interviewer asks several follow-up questions to encourage participants to provide more elaborate detail on their images and memories. As in the AI, participants’ narratives are audio-recorded, transcribed, and later coded by trained research assistants who are also blind to study parameters. Alongside the interview, participants also complete a number of self-report measures to assess their subjective experiences related to bringing their images and memories to mind (see Method section, below, for a more complete description). The WIMI enables researchers to investigate the impact of different moderators, including psychiatric diagnoses (e.g., SAD), on the types of details that participants retrieve across positive and negative social images and memories.
In this study, the WIMI was administered to high and low socially anxious (SA) participants. We hypothesized that relative to low SA participants, high SA participants would: (a) endorse experiencing a greater number of negative images and memories, as well as fewer positive ones; (b) show enhanced recollection of episodic details for negative images and memories, as well as diminished recollection of such details for positive images and memories; (c) report that their negative images and memories are more vivid and intrusive and more likely to be viewed from an observer’s perspective; (d) report that negative images and memories are characterized by themes of concern about the self (e.g., Moscovitch, 2009); and (e) report that bringing negative images and memories to mind leads to increases in subjective negative affect and decreases in positive affect. Finally, we wished to explore whether endorsement rates of negative images and memories among high SA participants on the WIMI resembled those of previous reports using different interview procedures (e.g., Hackmann et al., 2000).
Section snippets
Participants
Several standardized prescreening questionnaires, including the Social Phobia Inventory (SPIN; Connor et al., 2000), were administered by faculty researchers to all potentially eligible participants in the undergraduate Psychology research pool at the University of Waterloo in Canada. High and low SA individuals from that pool were invited to participate if their scores on the SPIN met a cutoff of above 30 or below 12, respectively, as described in more detail below. Eighty individuals (41 high
Descriptive group characteristics
Descriptive characteristics of participants in both groups are presented in Table 1. Groups did not differ significantly in age, t(76) = 1.15, p = .25, ethnic composition (Caucasian, Asian, Other), χ2(2) = 2.49, p = .29, or gender composition, χ2(2) = 2.43, p = .17. Participants in both groups identified public speaking as their most anxiety-provoking social situation and interacting with close friends as their least anxiety-provoking social situation.
As displayed in Table 2, high and low SA participants
Discussion
In this study, we used the newly developed WIMI to examine the nature and accessibility of negative and positive social images and associated autobiographical memories in high and low SA participants. Contrary to Hackmann et al.’s (2000) findings that 100% of the SAD patients they interviewed endorsed experiencing negative images, with all but one of these further able to link such images to past autobiographical experiences, the results of the present study indicated that 76% of high SA (and
Acknowledgements
This research was undertaken, in part, thanks to funding from the Canada Research Chairs Program and an operating grant from the Social Sciences and Humanities Research Council of Canada awarded to D.A. Moscovitch, and a Canadian Institutes of Health Research grant to M. Moscovitch.
We are very grateful to Darius Fathi, Maureen Stafford, Sarah Herron, and Caitlin Wright for their assistance with various aspects of this study, to our coders, Jennifer Allman, Daniel Etigson, and Kayla Sherborn,
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