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The Journal of Psychology, 2007, 141(3), 229–239
Copyright © 2007 Heldref Publications

Memory Distortions and Anxiety
in Alcoholism:
A Directed-Forgetting Investigation
IOANA TODOR
University of Alba Iulia, Romania

ABSTRACT. Alcohol-dependent individuals and healthy social drinkers differ in their
physiological, cognitive, and subjective reactivity to alcohol-related stimuli, the mnesic
accessibility of alcohol-related concepts, inhibition abilities, or mnesic performance (F.
Ryan, 2002; F. Stetter, K. Ackerman, A. Bizer, E. R. Straube, & D. Mann, 1995). The
author investigated (a) cognitive inhibition abilities of alcohol-dependent individuals, particularly for alcohol-related words, and (b) the relationship between anxiety and cognitive
activation of alcohol-related concepts in alcohol-dependent individuals by using the
directed-forgetting paradigm item-by-item and list procedures. The author used a 2 (Alcohol Consumption: alcohol-dependent individuals vs. social drinkers) × 2 (Word Type: neutral vs. alcohol-related) design. Alcohol-dependent individuals had significantly more difficulty than did social drinkers in voluntarily inhibiting alcohol-related verbal stimuli.
This effect seems to be general and nonspecific in alcoholism. In alcohol-dependent individuals, a high level of state anxiety was associated with significant difficulties in inhibiting alcohol-related verbal stimuli. Results suggest that anxiety is a key feature in alcoholism, facilitating the activation of alcohol-related concepts in semantic memory.
Keywords: alcohol dependence, cognitive inhibition, directed forgetting, memory

THE IMPORTANCE OF MEMORY CONTENTS AND PROCESSES in the etiology of alcoholism has been widely demonstrated in various theoretical accounts
(Stetter, Ackerman, Bizer, Straube, & Mann, 1995; Verheul, van den Brink, &
Geerlings, 1999). Activation in memory of clinically relevant concepts or activation of the associative networks involving situational, cognitive, and affective factors play a significant role in craving or alcohol consumption in alcohol-dependent
individuals (Baker, Morse, & Sherman, 1987) predict relapse in abstinent alcoholdependent individuals (Marlatt & Gordon, 1980). According to classical conditioning models of alcoholism, over a long history of drinking, stimuli and events
repeatedly paired with alcohol consumption become conditioned stimuli that can
Address correspondence to Ioana Todor, University of Alba Iulia, Nicolae Iorga Street, no.
13, 510009, Alba Iulia, Romania; ioanatodor@hotmail.com (e-mail).
229

modified skin conductance. Results of experimental studies support the hypothesis that alcohol-dependent individuals and healthy social drinkers differ in the mnesic accessibility of diseaserelated concepts and the presence in semantic memory of particular structures involving these concepts. Because alcoholrelated words should have more emotional valence for alcohol-dependent individuals.. Verheul et al.g. 1998). Morse. attributions. In recent cognitive perspectives on alcohol dependence. EAST scores have also been shown to predict relapse (Johnsen et al. 2002). and it measures the cognitive interference induced by the cognitive processing of alcohol-related words. desire to drink. Through brain-imaging research. wine.g. Behavioral and cognitive–behavioral theories emphasize the role of expectations. Toneatto. 1995. reflecting increased allocation of neural resources to these cues. The score of the test is calculated as the difference between the delays in naming the colors for the two categories of words. The hypothesis has been supported by the results of most studies. Laberg. a glass of vodka). 2002).). 1999). Juliano & Brandon. 1999a. Zack. which are an expression of the automatic information processing sequences intrinsic to the dependence (e. 1990). (1985) identified heightened activity in the amygdala during exposure to alcohol-related stimuli.g. Laberg. Stetter et al. Thayer. consumption behavior (Ludwig & Wikler. This cue reactivity was observed in the laboratory presentation of physical (e. 1974). To evaluate these attentional or perceptual processing biases in alcoholism. expected reinforcing effects of drinking. & Gaupp. 1991. Litt..) and to correlate positively with the duration of alcohol abuse or dependence and negatively with .). (1994) designed a particular Stroop task. Researchers have found several forms of reactivity: (a) physiological responses. 1997. There is solid empirical evidence that alcohol-related stimuli are important sources of cognitive distortions in alcohol-dependent individuals (e.g.. Various researchers demonstrated a selective attentional orientation toward substance-related stimuli in alcohol dependence (Johnsen. and self-efficacy in performing or controlling drinking behavior (Marlatt & Gordon. blackout)—written with different colors. drunkenness. consequently. Rohsenow et al.. Tiffany. their EAST scores likely will be considerably higher than those of social drinkers. Bauer.. 1994.. 1995. but not to neutral cues. & Hugdahl. McCusker & Brown. Zack. 1997). Cox. social learning. Vaksdal. salivation. researchers have focused on the information-processing involved in the maintenance of drinking behavior and identified specific cognitive distortions (Verheul et al.g.g. Cooney. & MacLeod. Alcohol-dependent individuals are characterized by a significant reactivity to alcohol consumption-related stimuli. Toneatto. Stetter et al. verbal (alcohol-related words). and visual stimuli (images or short filmed scenarios). cognitive distortion.. and cocaine dependence (Rosse et al. beer. 1994. & MacLeod. Kaplan et al. nicotine dependence (Johnsen..229-240 Todor May 07 230 4/28/07 10:40 AM Page 230 The Journal of Psychology induce cravings and. (b) subjective responses (e. 1997. Johnsen et al. & Asbjornsen. 1985)... The Emotional Alcohol Stroop Test (EAST) consists of two categories of words—neutral and alcohol-related (e. Sayette & Hufford. and (c) cognitive responses (e.

. In contrast. 1998. and (b) the list procedure. 1999a. The effects in the item method of directed forgetting. In another study.. Derogatis. in which the instruction to forget or remember follows each item presented. expectations. Comparative researchers (Ryan. (1999a. in participants who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV. and beliefs. 395). The effects in the list method. They found that negative-affect words prime lexical decisions to alcohol-related words in alcohol-dependent individuals who have high anxiety levels. Anxiety seems to play a central role in these effects. Toneatto. Stetter et al. Ryan (2002) found a significant correlation between EAST scores and anxiety levels in alcohol-dependent individuals. or lexical decision tasks and found an increased mnesic accessibility of alcohol-related concepts in alcohol-dependent individuals. Weingardt. Zack et al. This effect correlates positively with the level of psychiatric distress (assessed with the Symptom Checklist-90.. and no such effect was observed in nonanxious alcohol-dependent individuals (Zack et al. (2002) found strong memory associations between alcohol concepts and negative affective cues in alcoholdependent individuals with high anxiety levels.” and “it has the potential to elicit processing biases . . Directed-forgetting studies use two basic procedures of delivering the instruction to forget: (a) the item procedure. 2002). negativemood induction by presentation of words denoting negative affective states facilitates the implicit activation of alcohol-related concepts assessed by a lexical decision task. Stetter et al. semantic priming. in social drinkers. and it decreases significantly after the administration of benzodiazepines (Zack. in which one cue to forget is usually inserted in the middle of the list. observed on both recall and recognition tests. 2002. Zack et al. & MacLeod. 1994) diagnostic criteria for alcohol dependence.) used dichotic listening. p. are interpreted in terms of differential processing of remembered and forgotten items during the study. researchers found support for the idea of the existence of complex memory networks in alcoholdependent individuals in which alcohol-related concepts are associated with emotions. 1999b). 2002) found that negative emotional states may activate alcohol-related concepts in implicit and explicit memory in alcohol-dependent individuals. the activation of alcohol-related concepts is facilitated by positive emotional states. . American Psychiatric Association. 1975). On the basis of the associative network theories of semantic memory. and Leigh (1996) found that. 2002) have identified significant differences in semantic memory between alcoholdependent individuals and social drinkers (differences concerning the activation level of alcohol-consumption related concepts and their organization in complex memory networks).229-240 Todor May 07 4/28/07 10:40 AM Page 231 Todor 231 the abstinence period (Stetter et al. This effect was present in anxious alcoholdependent individuals irrespective of whether they used implicit or explicit priming. Several researchers (e. 1995. Stacy. Directed forgetting is a useful experimental paradigm for studying the “balance of remembering and forgetting that occurs in healthy individuals. Zack et al. (1999a) found that. . specific to clinical disorders” (Cloitre.).g. Zack et al.

MacLeod.229-240 Todor May 07 232 4/28/07 10:40 AM Page 232 The Journal of Psychology observed only on recall tests. All participants had abstained from alcohol from between 11 days and 4 weeks. I explored the relationship between anxiety and cognitive activation of alcohol-related concepts in alcohol-dependent individuals. Method Participants For the experimental group. Each of the two sets of words consists of five neutral words selected from the Rey Memory Test (Rey. Regarding the history of alcohol misuse. The control group included 41 male participants 27–65 years of age. 1993. I investigated the supplementary activation of alcohol-related concepts by using the item and list methods of the directed-forgetting paradigm. will have significant difficulty voluntarily inhibiting alcohol-related verbal stimuli. I did not classify any of them as alcohol-dependent individuals. Severe withdrawal symptoms. All participants were men 34–67 years of age. use of psychoactive drugs. and 2 people reported alcohol misuse for less than 2 years. The 10 alcohol-related words I selected by this method had scores higher than 8. 1994). I selected the set of alcohol-related words from a longer list that I complied on the basis of short interviews with alcohol-dependent individuals about the history of their dependence. 1964) and five alcohol-related words.46 on this scale. 19 between 2 and 5 years. Badsen. or presence of psychosis were grounds for exclusion. On the basis of self-reports. half of them (10) with a forget instruction and the other half (10) with a remember instruction. on a scale ranging from 0 (completely irrelevant) to 10 (extremely relevant). 14 participants reported a previous duration of alcohol abuse or dependence between 5 and 10 years. I formed two hypotheses (H): H1: Alcohol-dependent individuals. the relevance of each word to alcohol dependence. & Gargano. 1999). Stimuli I used a set of 20 verbal stimuli (words). In this study. they met the DSM-IV criteria for alcohol dependence (American Psychiatric Association. a high level of anxiety will be associated with significant difficulties inhibiting alcohol-related verbal stimuli. but not social drinkers. . are interpreted in terms of retrieval inhibition (Badsen. According to their medical records. H2: In alcohol-dependent individuals. I recruited 35 abstinent alcohol-dependent individuals for voluntary participation from the consecutive outpatients of a detoxification program conducted in a psychiatric clinic. Then I presented this list to a group of 15 alcohol-dependent individuals and asked them to estimate.

p < . and for the alcohol-related words. In the item-by-item procedure.006 (see Table 2). with participants being asked to remember all the words presented.002. t(40) = 3.22. The results were similar for the list procedure: The directed-forgetting effect was significant for the words from the neutral. I instructed the participants to memorize only the words followed by the instruction remember. Results I calculated the directed-forgetting effect as the difference between the number of words the participant remembered that were associated with the remember instruction and the number of words associated with the forget instruction. p > .33. Spielberger. participants recalled the studied words. and (c) the State–Trait Anxiety Inventory (STAI. t(34) = 1.229-240 Todor May 07 4/28/07 10:40 AM Page 233 Todor 233 Procedure and Design I conducted this experiment in three phases: (a) the directed-forgetting task–item procedure. I read the words and their instructions at a reading speed of approximately 4 s/word. p < . t(40) = 3. Last. I provided participants with the words from both lists. 1970). including those they had been instructed to forget. Gorsuch. making the same calculation for the item and list procedures. p < . the directed-forgetting effect in the item-by-item procedure was significant for the neutral words. I provided participants with the first list of words to memorize. I estimated the magnitude of the directed-forgetting effect by using the difference between the actualized words from the remember and forget categories. t(40) = 4. I estimated statistical significance by conducting a t test for paired samples (see Table 2). Then I presented the second list of words and the instructed the participants to remember the list of words. social drinkers). Then I gave them a mid-list instruction to forget these words (with the explanation that the words had been given only for practice).59. and each word as associated with an explicit instruction: remember or forget. regardless of the associated instruction.002. and alcohol-related. p < . the directed-forgetting effect in the item-by-item procedure was not statistically significant for both categories of words: neutral. I analyzed the data with SPSS for Windows. categories.10. & Lushene.. For social drinkers. (b) the directed-forgetting task–list procedure. In the list version. t(40) = 2.30.001.e.. and alcohol- . I also measured the directed-forgetting effect in a freerecall task and estimated its magnitude by using the difference between the actualized words from the two lists. The experimental procedure was the same for the experimental and control groups.e. For alcohol-dependent individuals. I analyzed the significance of the directed-forgetting effect for each group (experimental and control) and for each word category (alcohol-related and neutral). The evaluation phase consisted of a free-recall task. alcohol-dependent individuals) and control groups (i. Table 1 presents means and standard deviations for these scores in the experimental (i.92.

97 2.34 1.92 3. t(34) = 1.229-240 Todor May 07 234 4/28/07 10:40 AM Page 234 The Journal of Psychology TABLE 1. Means and Standard Deviations of Social Drinkers’ and AlcoholDependent Individuals’ Memory Scores RAW Procedure M FAW SD M RNW SD FNW M SD M SD 2.59 .19 0.30 .59 0.94 1. word type (alcohol-related or neutral).10.97 1. F(1) = 7.774 . I conducted an analysis of variance (ANOVA) to test the significance of differences or interactions among the directed-forgetting effects.15 2.60 1.257. t(34) = 0.83 Note. F(1) = 4. p < . the directed-forgetting effect was not statistically significant for neutral words. the .22 1.49 1.002 . t(34) = 0.90 0.21 . RAW = remember alcohol-related words.21 3.15 0.51 0.29.66 0. p > .80 1.30 .002 . see Table 2.257 . p > .827.99 2.89 2.000 . Paired-Samples t-Test Results Estimating the Directed-Forgetting Effect in Social Drinkers and Alcohol-Dependent Individuals Social drinkers Procedure and word type Item-by-item Alcohol-related Neutral List Alcohol-related Neutral Alcohol-dependent individuals t(34) p SEM t(34) p SEM 2.54 0.99 0. as an independent variable.827 .77.006 . RNW = remember neutral words.15. in both experimental modalities: item-by-item.12 0. For the second independent variable. or alcohol-related words.006.26 .25 related. p > . I found main effects for alcohol consumption. FAW = forget alcohol-related words.34 1.20 0. list.58.01 Social drinkers Item-by-item List 2.06 1.94 Alcohol-dependent individuals Item-by-item List 1.89 1.034.74 0. For the list procedure.61 2.97 0.29 1.20 . TABLE 2. Possible scores ranged from 0 to 5.94 1.00 1.00 1.00 1.33 4.15 .230 .08 0.22.22 . p < . FNW = forget neutral words.

28. For social drinkers. I found significant correlations between the directed-forgetting effect for alcohol-related words and state anxiety (item-by-item procedure: r = − . p < .34–.01.19. I used both modalities to study intentional forgetting in alcohol-dependent individuals to identify the presence of cognitive distortion at the memory levels of encoding and retrieval. p < . t(74) = 2.89. Golding & MacLeod. In this group. For the list procedure. in both experimental procedures we used. The reduction in statistical significance of the directed-forgetting effect for the item-by-item procedure in alcohol-dependent individuals (see Table 2) suggests that they have difficulty voluntarily inhibiting both alcohol-related and neutral verbal stimuli.32.049.66. Discussion The two experimental procedures I used to study intentional forgetting— item-by-item and list—differ in the cognitive mechanisms they require participants to use.15–. 1998). The reduction in significance of the directed-forgetting effect in both the item-by-item .049. The list procedure reflects the inhibition processes activated during remembering (MacLeod. I compared the directed-forgetting effect in the social drinker and alcohol-dependent individual groups for the list procedure and found a significant difference for neutral words. The experimental data support H1. p < .062.97.18. I calculated Pearson correlations between (a) the directed-forgetting effect for each category of words and for each experimental procedure and (b) state anxiety as measured with the STAI. the mean score on the STAI was 37. but not social drinkers. which also suggests that alcohol-dependent individuals have difficulty inhibiting verbal stimuli from both categories. effect size (ES) = . that alcohol-dependent individuals. I found a significant directed-forgetting effect in the control group in the item-by-item procedure for both categories of words (see Table 2).336. list.61). As I predicted. The item-by-item procedure is particularly sensitive to the cognitive processes and mechanisms operating during encoding. The effect of word type on the directed-forgetting task was statistically insignificant for both social and alcohol-dependent individuals (ps range from .g.. The directed-forgetting effect for unrelated words in an average population has considerable empirical support (e. I found the same pattern of results (see Table 2). p < .08.01. the mean score on the STAI was 41. p < .8 with a range of 14–64. have difficulty inhibiting alcohol-related verbal stimuli.66).229-240 Todor May 07 4/28/07 10:40 AM Page 235 Todor 235 ANOVA did not reveal significant effects: item-by-item. list procedure: r = −. No correlations for the control group were statistically significant (ps range from .005). with a range of 14–66. F(1) = 1. such as differential encoding and selective rehearsal. and for alcohol-related words. For alcohol-dependent individuals.30. p < . F(1) = .466. list. 1999). F(1) = . The interaction between alcohol consumption and word type was also insignificant in both experimental modalities: item-by-item. F(1) = 1. ES = .33. p < .5. p < . t(74) = 1.

In addition to a general reduction of the mnesic performance (see Table 1). Zack et al. the chronic use of alcohol leads to cognitive deficits in the executive and control functions coordinated by the prefrontal cortex: inhibition. Anxiety and the personality dimension of trait anxiety were strongly correlated (Gershuny & Sher. researchers conducting intentional-forgetting studies have found significant cognitive inhibition difficulties only for particular stimuli (those with an increased emotional valence for the patients. In alcohol-dependent individuals who are abstaining from alcohol. I did not find significant correlations in alcohol-dependent individuals between state anxiety and the directed-forgetting effect for neutral words. 1991. such as obsessive-compulsive disorder. words denoting physical sensations specific to panic attacks. verbal autoregulation. in alcohol-dependent individuals. Anxiety is a relatively common symptom of alcohol dependence and tends to persist long after the cessation of consumption..g. Several researchers have demonstrated significant positive correlations between state anxiety and subjective reactivity in alcohol-dependent individuals exposed to alcohol cues (McCusker & Brown. task planning. In alcohol-dependent individuals in this study. (2002) hypothesized that trait anxiety mediates this effect. people in this group had significant difficulty voluntarily regulating and controling their memory.229-240 Todor May 07 236 4/28/07 10:40 AM Page 236 The Journal of Psychology and list methods suggests a reduction of inhibitory ability in alcohol-dependent individuals. posttraumatic stress disorder. Anxious alcohol-dependent individuals consequently have increased difficulty voluntarily inhibiting alcohol-related words (as demonstrated by the reduction of the directed-forgetting effect). motor control. The directed-forgetting experimental paradigm was a useful instrument for revealing the increased activation of alcohol-related concepts in semantic memory of alcohol-dependent individuals with high anxiety.. metacognitive abilities. In alcohol-dependent individuals. verbal stimuli can be explained through the neurotoxic effects of alcohol. Cloitre. 1999b). not only alcohol-related. words related to obsessions or trauma. and trait anxiety predicted increased subjective reactivity to alcohol-related stimuli during cue exposure (McCusker & Brown). These results suggest that. 2000). I did not find a significant influence of word type on directed forgetting. situational anxiety correlated with the magnitude of directed forgetting for alcohol concepts. internal control. In social drinkers. In most cases. 1988). which indicates a general effect of reduction of inhibitory capacity for verbal stimuli in alcohol-dependent individuals. anxiety has been a valid predictor of relapse (Zack et al. and lower anxiety was associated with increased directed forgetting. working memory. both in encoding and in recollection. 1998).. and emotional and motivational regulation (Tabakoff & Petersen. anxiety is associated with increased activation of alcohol-related concepts. Szegedi et al. or anxiety disorder with panic attacks. e. 1998). the nonspecific reduction of inhibitory ability for all. . the correlations between anxiety and directed forgetting were not significant for either word category. Using ANOVAs. For people with other disorders.

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