TICS-1358; No.
of Pages 9
Review
Disruptions in autobiographical
memory processing in depression and
the emergence of memory
therapeutics
Tim Dalgleish and Aliza Werner-Seidler
Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK
Depression is characterized by distinct profiles of distur-
bance in ways autobiographical memories are repre-
sented, recalled, and maintained. We review four core
domains of difficulty: systematic biases in favor of negative
material; impoverished access and responses to positive
memories; reduced access to the specific details of the
personal past; and dysfunctional processes of rumination
and avoidance around personal autobiographical material.
These difficulties drive the onset and maintenance of de-
pression; consequently, interventions targeted at these
maladaptive processes have clinical potential. Memory
therapeutics is the development of novel clinical techni-
ques, translated from basic research, that target memory
difficulties in those with emotional disorders. We discuss
prototypical examples from this clinical domain including
MEmory Specificity Training, positive memory elabora-
tion, memory rescripting, and the method-of-loci (MoL).
Recollecting and reflecting upon our autobiographical past
defines human mental life. Personal memories are the
currency of social discourse, they mold and shape our
emotions, help us plan our future, and provide candidate
solutions for the problems that we face. Our library of
autobiographical memories defines who we are, scaffolding
our sense of self across time [1]. Systematic difficulties in
the recollection of these past experiences, especially of
emotionally evocative events, are a cardinal feature of
affective disorders, and range from intrusive flashbacks
of trauma in post-traumatic stress disorder (PTSD) to
ruminations upon overgeneral negative personal themes
in depression. These patterns not only define the mental
lives of many patients but also drive the onset and main-
tenance of disorder [2,3]. Consequently, emerging clinical
interventions that target and reverse these disrupted
memory processes have enormous potential. In this review
we discuss the often toxic problems faced by individuals
with clinical depression (a description of depression is
Corresponding author: Dalgleish, T. (tim.dalgleish@mrc-cbu.cam.ac.uk).
Keywords: autobiographical memory; depression; overgeneral memory bias; suppres-
sion; method-of-loci.
1364-6613/
ß 2014 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.tics.2014.06.010
given in Box 1) in the way that they process the autobio-
graphical past and outline recent advances in the transla-
tional science of memory therapeutics that seek to address
these difficulties.
The four mnemonic horsemen of depression
Sufferers of depression remember the past differently to
their never-depressed peers. Their autobiographical mem-
ory processing is compromised in at least four distinct but
interrelated ways that combine and interact to help main-
tain depressive episodes once they have begun, and to
confer vulnerability to new episodes when sufferers are
in remission (Figure 1).
Biased recollection of negative memories
The most striking feature when engaging with individuals
in the grip of depression is the pervasively negative tone
that sounds throughout their discourse about the past.
Depression appears to be characterized by a systematic
autobiographical recollection bias that favors negative
experiences [4,5], with faster access to negative personal
memories when prompted and a greater tendency to gen-
erate negative memories when recall is unconstrained [6].
Unbidden intrusive memories of negative, often traumatic,
past experiences also characterize the disorder [7]. This
facilitated negative retrieval is likely to be complemented
by biases at encoding as a function of selective attention to
negative personal experiences [4] and skewed interpreta-
tion of ambiguous personal scenarios in favor of negative
resolutions [8]. Such pervasive preferential access to neg-
ative personal memories in depression contributes to the
felt sense of a profoundly negative self, world, and future
that depressed individuals describe [9].
Impoverished positive memories
The day-to-day recollection of self-affirming positive
experiences has been identified as a core adaptive emotion
regulation strategy to counteract downturns in negative
affect [10,11]. The biased recollection of negative memories
in depression, described above, is also accompanied by
impoverished access to such positive autobiographical past
events [4]. Even when positive memories are successfully
brought to mind, their recollection appears to have little
Trends in Cognitive Sciences xx (2014) 1–9 1
TICS-1358; No. of Pages 9
Review
Box 1. The nature of depression and cognitive theories of the disorder
What is depression?
In psychiatric terms, depression (defined as presence of a major
depressive episode; MDE) is defined by the Diagnostic and Statistical
Manual of Mental Disorders (DSM-V) [70] as the presence of at least
five symptoms from a set of nine, one of which must be consistent
depressed mood or anhedonia. Additional symptoms may include
changes in appetite or sleeping pattern, restlessness, fatigue, feelings
of guilt or worthlessness, impaired concentration, and suicidal
ideation. To fulfill criteria for an MDE the constellation of symptoms
must be present for most of the day, nearly every day for a 2 week
period or longer, and represent a change from previous levels of
functioning. Symptoms must also interfere with functioning in social,
occupational, or other important domains, or cause considerable
distress to the individual.
Epidemiological studies have established depression as a major
public health concern that tends to run a chronic course [71]. The
lifetime prevalence rate is approximately 16% [72], with more than
80% of individuals experiencing multiple episodes [71]. Each
recurring episode predicts a higher risk of future recurrence [73],
even after successful treatment of the current episode [74,75].
Depression currently costs the UK exchequer more than £9 billion
annually [76] and is predicted by the World Health Organisation (see
http://www.who.int/whosis/whostat/2008/en/index.html) to be the
second leading cause of disability worldwide by 2020 [77]. Depression
is a growing problem at both individual and societal levels, under-
scoring the need for more effective interventions not only to target the
acute phase of disorder but also to reduce the likelihood of relapse/
recurrence.
beneficial impact on mood for those with a history of
depression [12,13], and may even be detrimental [13]. This
failure to improve mood may reflect the quality of recol-
lected positive memories. For example, there is evidence
that, when in a sad mood, individuals with a history of
depression recall positive memories that are markedly less
vivid [14] and less emotionally intense [15] than those
retrieved by never-depressed peers. The lack of salient
phenomenological memory features may very well make
it more challenging for positive memory recall to confer
emotional benefits (although whether this is also the case
in currently depressed groups awaits confirmation). An-
other possibility is that reflecting on a past happier time,
and making comparisons to current low mood, draws
Biased recollecon Impoverished
of negave memories posive memories
Depression
Altered relaonship
Overgeneral memory to emoonal
memories
TRENDS in Cognitive Sciences
Figure 1. The four mnemonic horsemen of depression. These four processes,
characteristic of depression, interact and combine in ways that maintain
depression and elevate the risk of recurrence even after remission.
2
Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x
Cognitive models of depression
Cognitive approaches to depression provide a framework for under-
standing the psychological mechanisms involved in the onset, main-
tenance, and recurrence of the disorder. Perhaps the most influential
cognitive model was provided by Beck who proposed that depression
results from the activation of underlying dysfunctional schemas* that
represent negative mental constructions about the self, the world, and
the future (‘the negative cognitive triad’ [62]). Schemas are claimed to
drive negative thinking and other cognitive biases and distortions
(including biases in autobiographical memory processing) that serve to
maintain schema integrity and thereby support and consolidate the
cognitive foundations that drive the disorder [62]. Beck’s cognitive
model and other related approaches [63] provide an overarching
framework in which biases and distortions in a cognitive process such
as memory are conceptualized as ‘rational’ and adaptive processes that
are servicing maladaptive and dysfunctional underlying schemas.
Cognitive behavior therapy (CBT), the intervention paradigm derived
from such cognitive formulations of depression, seeks to identify and
modify biases in thinking and cognitive processing and to reorganize
and shift underlying schema to make them more adaptive and
functional. The nascent memory therapeutics discussed here fall under
the umbrella of this broad CBT approach.
*
Schemas are proposed to be cognitive structures which provide an internal repre-
sentation of aspects of the self, the world, and of others, that derive from a lifetime of
experience in encountering relevant exemplars from these categories and that shape
the encoding, organization, and retrieval of information [62].
attention to the discrepancy between these states, thus
spawning rumination that itself contributes to worsening
mood [13]. There is some evidence supporting this account,
with data showing that preventing rumination by instruct-
ing depressed and formerly depressed individuals to focus
on the concrete and specific details of the memory leads to
improved mood following memory recall [16].
Categorical memory
A third striking feature of autobiographical recollection in
depression is the focus on ‘categorical’ aspects of the past.
In contrast to individual autobiographical episodes, these
categorical recollections comprise general, often negative-
ly-valent, themes that capture repetitions and regularities
across many personal experiences. There is now good
evidence that such categorical processing tends to override
access to detailed memories of specific individual events in
depression [3]. For example, on the widely-used autobio-
graphical memory test (AMT) [17] – where specific, de-
tailed memories are prompted by cue words – a depressed
responder would be more likely to generate a categorical
memory to a cue such as ‘party’ (e.g., ‘Every birthday party
I’ve ever hosted has been a disaster!’) as opposed to the
requisite recollection of a specific festive occasion.
One likely reason why categorical autobiographical rec-
ollection is so potent in depression is the highly consoli-
dated nature of negative categorical themes that underpin
the disorder – an idea that lies at the heart of cognitive
theories of depression with their emphasis on the role of
negative schemas (Box 1). We used a novel ‘life chapters’
task to elucidate these emotionally salient categorical
autobiographical themes in depression [18]. Participants
constructed autobiographical timelines, dividing their
life into discrete chapters (e.g., ‘student days’; ‘intimate
TICS-1358; No. of Pages 9

Review Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x

relationships’), and subjectively allocated positive and
negative descriptive information to each chapter. Those
with depression showed increased coherence and repeti-
tion of negative information across chapters, and reduced
coherence and repetition of positive information, whereas
their never-depressed peers showed the opposite pattern.
Greater depression entrenchment, indexed by number of
prior episodes, was associated uniquely with lack of posi-
tive coherence, suggesting that a paucity of positive auto-
biographical themes is a cognitive marker of depression
recurrence.
There is now substantive evidence that the relative
difficulty encountered by depressed individuals in acces-
sing specific autobiographical memories, and their procliv-
ity for dwelling on these categorical aspects of the personal
past, is related to poorer prognosis [19]. One reason for this
is that overgeneral recall can spur ruminative processes
focused on the categorical themes that have been accessed.
Rumination then consolidates these themes, further en-
hancing the tendency towards overgeneral memory (e.g.,
[20]). Another reason is that fluent processing of specific
autobiographical memories is a core aspect of successful
daily cognitive functioning involved in planning, problem-
solving, and social discourse (Table 1). Consequently, im-
pairment across these diverse cognitive operations has
adverse downstream consequences concerning the course
of depressive disorder [3].
Alterations in the mental relationship to emotional
autobiographical memories
The recollection of emotional past events can sometimes be
painful, particularly for those struggling with mental
health difficulties. Explicit and implicit efforts to avoid
or suppress distressing personal memories and/or the
emotions associated with them, perhaps unsurprisingly,
have been shown to be more prevalent in depression
[21,22]. However, such efforts are also more likely to be
counterproductive, with greater intrusion of the unwanted
memories following attempted suppression in individuals
high in depressive affect relative to their less-depressed
peers [23]. As well as being counterproductive, suppression
focused on a given target upsetting personal memory
appears to enhance subsequent access to other upsetting
memories in depressed individuals, suggesting that sup-
pression is a particularly toxic way of relating to the
personal past when depressed [23].
Subtler forms of mental avoidance also appear to be at
play in the way that those with depression relate to mem-
ories that have been recollected, especially when those
memories are recalled in the form of mental images as
opposed to verbal narratives [24]. With image-based mem-
ories, depressed individuals have a greater tendency to
adopt an observer perspective [25,26] – seeing themselves
in the situation, but from the point-of-view of an outsider.
This has been found to be the case for both negative and
positive personal memories, and adopting an observer
perspective generally reduces the affect associated with
the memory in the short-term [27,28]. For distressing
memories, it seems that adopting an observer perspective
per se may be counterproductive in the longer-term be-
cause it mitigates successful emotional processing of the
memory [24,29]. Similarly, in the case of positive memo-
ries, simply adopting an observer perspective may be
unhelpful because it reduces the affective impact associat-
ed with the memory [27,28]. One strong motivating factor
for such attempted (if unsuccessful) avoidance of the recol-
lection of distressing aspects of the past is the fact that,
when autobiographical memories do come to mind in de-
pression, they have a greater tendency to spawn rumina-
tive processes. These are either focused on the memories
themselves or on relating those memories to the wider
depressogenic categorical themes running through the
individual’s autobiography, referred to in the preceding
section [18,30].
The CaR-FA-X model of autobiographical memory
processing in depression
The CaR-FA-X model [3] (Figure 2) operationalizes the core
disruptions in autobiographical memory processing asso-
ciated with depression that we have outlined above. Within
the model, difficulties accessing specific episodes from the
past are characterized as resulting from the capture (Ca) of
memory search efforts by highly consolidated categorical
depressogenic themes, which then form the focus of mal-
adaptive cycles of rumination (R). The likelihood of such
capture is exacerbated by ingrained functional avoidance
(FA) of specific details of past upsetting autobiographical
events that itself diverts processing to the categorical level
of autobiographical representation. The ability to override
these dysfunctional processing imperatives is compro-
mised as a function of the relatively impoverished execu-
tive (X) control that characterizes those suffering from
depression [4,31].
Memory therapeutics and depression
These advances in our understanding of the key roles
that maladaptive aspects of autobiographical memory pro-
cessing play in depression, and the CaR-FA-X framework
that integrates them together, have prompted practition-
er-researchers to explore new avenues of therapeutic

Table 1. Putative functions of specific memories and examples of impairment in affective contexts
Function of specific memories
Problem solving
Planning
Emotional processing
Reducing rumination
Examples of impairment in depression
Reduced specificity is associated with impaired problem-solving in depression [78,79] and moderates
the effect of a negative mood disturbance on problem-solving performance in previously suicidal
patients [80].
Reduced specificity is associated with difficulty in imagining specific future events [81] with implications
for effective future day to day planning [82].
Reduced specificity is associated with high scores on emotional avoidance measures [83,84] and predicts
affective reaction to failure [85,86].
Reduced memory specificity is causally related to greater ruminative processing [87,88]

3
TICS-1358; No. of Pages 9
Review
Capture and
ruminaon
Funconal
Non-specific Consequences
avoidance autobiographical
E.g., impaired
memory problem-solving
Execuve
capacity
and control
TRENDS in Cognitive Sciences
Figure 2. The CaR-FA-X model of autobiographical memory processing in
depression. Three processes contributing to overgeneral memory – capture and
rumination (CaR), functional avoidance (FA), and impaired executive capacity and
control (X) – can each have effects on cognition and behavior (e.g., problem-
solving), either independently or through their individual or combined effect on
autobiographical memory. Reproduced from [3], with permission, copyright ß
(2007) American Psychological Association.
intervention which focus on changing patients’ processing
of, and relationship to, their personal past. These emerging
interventions sit against a broader backdrop of cognitive
approaches to the treatment of depression and other emo-
tional disorders which have historically focused on patient
autobiographies as a rich source of therapeutic material
(Box 1). We discuss here novel memory-based techniques
addressing the four highlighted core domains of autobio-
graphical memory disturbance in depression.
Changing negative memory biases
Cognitive bias modification (CBM) refers to a new range of
interventions that seek to shift the pervasive maladaptive
cognitive biases associated with clinical disorders through
systematic, computerized training to recalibrate underly-
ing processes in favor of positive or benign material, rather
than negative information [32]. To date, CBM has been
applied most effectively in anxiety [33]. However, recently
the focus has shifted to evolving and evaluating CBM
procedures in depression [34]. CBM for depression that
has targeted initial attention to [35,36], and interpretation
of [37–40], emotional events has produced mixed results
[34]. However, CBM procedures that have directly targeted
memory biases [41] by training depressed individuals to
process mildly upsetting events in a specific and concrete
way potentially show more promise, with the CBM parti-
cipants experiencing decreased depressive symptoms rel-
ative to a control group [42].
Explicit rescripting of negative autobiographical mem-
ories to reduce their distressing impact, an approach with a
history of successful application in anxiety syndromes [43],
also shows potential as a clinical tool in depression. Wheat-
ley et al. [44], in a clinical case series, reported benefits of
rescripting in the form of reduced symptoms of depression
and a decreased frequency of intrusive recollections of the
rescripted events.
Enhancing the recollection of positive autobiographical
memories
The affective impact of recalled positive and self-affirming
memories can be enhanced through elaboration processes
targeted at enriching the memories with affective, visual,
4
Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x
and sensory detail. For example, Werner-Seidler and
Moulds [16] showed that, for individuals with depression,
focusing on these detailed aspects of their memories (the
moment-to-moment experience of the memories), instead
of processing memories in an abstract way (reflecting on
the causes, meanings, and consequences), enhanced the
positive emotional impact of the memories. Commensurate
with these findings is work from the imagery domain
showing that, when positive material is elaborated using
imagery, the impact on emotion is amplified [45,46]. These
studies provide proof-of-principle that those with depres-
sion can derive affective benefits from suitably elaborated
positive material.
An entirely different challenge, however, is to facilitate
day-to-day access to such elaborated memories when they
are most needed (e.g., in the service of emotion regulation).
One candidate solution is the MoL technique – a mnemonic
device that relies on spatial relationships between familiar
locations or routes to scaffold recollection of previously
identified and stored information (Box 2). In the first study
investigating the utility of the MoL in depression [47] we
asked participants to generate and then elaborate a set of
positive and self-affirming memories before practicing
recalling the memories. Participants were divided into
two practice conditions, using either a chunking-and-re-
hearsal technique or the MoL, and completed a week of
retrieval training with their allocated method until they
could recall all their identified memories without error. On
the crucial surprise recall test after a further week (during
which no further practice took place), recollection
remained at ceiling only in the MoL group. These initial
data suggest that the MoL has promise as a technique to
allow easy access to sufficiently elaborated positive and
self-affirming memories in depression.
MEmory Specificity Training (MEST)
The wealth of basic research suggesting a relative difficulty
in accessing specific autobiographical memories in depres-
sion [3] suggests an elegantly simple intervention – train-
ing patients to become more specific in their emotional
recollection (Box 3). To this end, Raes and colleagues [48]
evaluated the effect of a group-based MEST program with
depressed inpatients in an uncontrolled trial. The retrieval
style of participants became significantly more specific
(Figure I in Box 3), and improvements in specificity were
significantly associated with reported improvements in
processes important in day-to-day cognition (Table 1) in-
cluding rumination, cognitive avoidance, and problem-
solving skills.
Building on this platform, we conducted the first random-
ized controlled trial (RCT) of MEST (versus a no-interven-
tion control) with a sample of bereaved, depressed Afghan
adolescent refugees living in Iran; importantly, this RCT
also included a 2 month follow-up [49] (Figure I in Box 3).
MEST successfully enhanced memory specificity, and spec-
ificity gains mediated subsequent improvements in depres-
sive symptoms for adolescents in the MEST group, which
were reduced into the non-clinical range. There is similar
promising evidence for MEST as an intervention for suf-
ferers of PTSD [50]. These early-stage trials suggest that,
despite its simplicity, MEST is an efficacious intervention
TICS-1358; No. of Pages 9
Review
Box 2. The method-of-loci (MoL)
The MoL is an ancient mnemonic device that relies on memorized
spatial relationships between loci (e.g., locations on a familiar route
such as the journey to work) that are used to arrange and recollect
memorial content. The basic method uses visual imagery to mentally
associate each to-be-remembered piece of information with one of
the loci along the route (e.g., a particular building). By this means,
material can be recollected simply by mentally retracing the route and
using the loci and associated imagery on this imagined journey as
prompts to cue the information from memory.
The MoL was first described in Roman rhetorical treatises (e.g.,
[89]). It remains the favored strategy adopted by contemporary
memory champions to store exceptionally large amounts of informa-
tion, such as recalling the value of P to thousands of decimal places
[90].
The MoL can be easily acquired by non-experts, and dramatically
improves memory performance in naı̈ve participants [91–93]. The
Elaborate
Idenfy memories to
memories to Idenfy a
include rich
be familiar route
and specific
remembered details
The birth of my I was overcome The daily
first son with emoon – I commute to work
remember his
skin was so so
as I held him for
the first me
Figure I. Using the method-of-loci (MoL) to enhance recollection of positive autobiographical memories in depression [47].
that can alleviate depression (and other disorders), consis-
tent with other novel depression interventions that focusing
on enhancing concrete processing of personal material [42].
Changing relationships to memories
Cognitive behavioral therapy (CBT) interventions for emo-
tional disorders, including depression, that seek to change
the way recipients relate to aspects of their mental life,
such as their memories of the past, instead of trying to
modify or challenge mental content itself, have been
deemed the ‘third wave’ of behavior therapy [51]. Such
treatments include acceptance and commitment therapy
[52], dialectic behavior therapy [53], and, of most relevance
to depression, rumination-focused cognitive behavioral
therapy (RF-CBT [54]) and mindfulness-based cognitive
therapy (MBCT [55]).
RF-CBT is an adapted form of CBT designed to reduce
residual symptoms of depression by directly targeting
ruminative processes that we know are intimately linked
to disruptions in autobiographical memory. There is pre-
liminary support for this intervention, with RF-CBT prov-
ing efficacious in reducing symptoms relative to treatment-
as-usual, although these effects need to be replicated in
trials involving an active control group [54].
MBCT is a group intervention targeted at preventing
relapse in currently well patients with recurrent
Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x
features of the images used to combine the loci with the material to
be remembered are crucially important – the more salient, vivid, and
bizarre the imagery, the easier the material is to recollect [94].
The MoL is versatile; it can be readily used for the temporary
storage of information (e.g., a shopping list), but also lends itself to
the construction of more permanent mental repositories supporting
access to the target material on repeated future occasions. Such
repositories are commonly known as ‘memory palaces’ [95,96]
because they often comprise elaborate and beautiful fictitious
locations that the recollector has imagined solely for the purposes
of information storage. Memory palaces of this kind have a long
pedigree dating back to medieval times [97].
Our study utilizing the MoL to improve access to positive and self-
affirming memories in depression [47] extends the technique to
clinical application; a worked example of this approach is illustrated in
Figure I.
Combine loci Retrieve
Idenfy loci with memories by
along the memories mentally
route using vivid navigang
imagery along route
The telephone Instead of the By simply
box at the end telephone imagining my
of the street booth, I see that cycle to work, I
my infant son is pass the
holding the telephone booth
phone receiver and see my son
chang away gossiping away
into the
receiver...
TRENDS in Cognitive Sciences
depression and has a strong database of supportive outcome
data [56]. Although not targeted at memories per se, MBCT
seeks to enhance affective executive control over mental life,
including memory for the past, through the cultivation of
mindfulness skills that promote the ability to psychological-
ly ‘step back’ from distressing mental content.
MBCT is a complex and intensive intervention requir-
ing highly trained therapist input. More recently,
researchers have endeavored to distil core cognitive ele-
ments of MBCT into simpler cognitive training protocols.
Kross and colleagues investigated the benefits of self-dis-
tancing (SD) – the process of intentionally stepping back
from an experience to reflect on it and reappraise it from
the perspective of a distanced observer. It is important to
note how this more reflective process is distinct from
simply automatically adopting an observer perspective
upon personal memories – something that by itself appears
to be counterproductive (as discussed above [24,29]). Kross
and colleagues have shown in a novel series of studies that
analyzing the meaning of memories and experiences (e.g.,
thinking about why they may have occurred) from a self-
distanced perspective can reap mental health benefits in
individuals with depression [57]. Similar work in our own
laboratory has examined perspective broadening (PB) –
the capacity to frame experiences within wider contexts.
Preclinical work across four studies showed that a single
5
TICS-1358; No. of Pages 9

Review Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x

Box 3. MEmory Specificity Training (MEST)

MEST is designed to enhance the specificity with which depressed
participants retrieve personal events from autobiographical memory 1
with the aim of counteracting the difficulties associated with the
disorder in accessing specific personal information [48,49]. MEST is
0.9 Key:

Memory specificity
delivered in small groups led by trained therapists and comprises the 0.8
following five-session structure: MEST (Raes pilot)
Session 1: psychoeducation about memory difficulties common in 0.7
MEST (Neshat-Doost trial)
depression is presented and discussed, and impairment in retrieving
0.6
specific memories is provided as the rationale for MEST. As a group,
Control (Neshat-Doost
participants practice recalling specific memories in response to 0.5 trial)
positive and neutral cues, with demonstrations and support from
therapists. For homework, participants identify specific memories in 0.4
response to 10 cue words, and identify an additional specific event 0.3
that has happened to them each day to bring to the subsequent Pre Post
session.
Session 2: the second session commences with a brief summary of
session 1 followed by a homework review. The remainder of the 40
session follows the same format as session 1, focusing on memory

Depressive symptoms
retrieval for positive and neutral words. Additionally, participants are 35 Key:
encouraged and assisted in retrieving multiple distinct memories in
response to the same cue. For homework, participants identify 30 MEST - BDI-II scores
(Raes Pilot)
specific memories in response to 10 cue words and identify two
additional specific events each day. 25 MEST - MFQ scores
Session 3: in the third session, negative cues are introduced and (Neshat-Doost trial)
participants practice retrieving specific memories in response to 20
Control - MFQ scores
negative and positive cue words. As in session 2, participants retrieve (Neshat-Doost trial)
multiple memories of a different nature in response to the same cue. 15
Homework is identical to that of session 2 with the inclusion of
negative cue words. 10
Pre Post Follow-up
Sessions 4–5: the fourth session involves further practice of
memory retrieval in response to neutral words, and the fifth and TRENDS in Cognitive Sciences
final session involves retrieval to a variety of cues (e.g., positive,
Figure I. The top panel shows mean of level specificity as measured by the
negative, and neutral), concluding with a summary and review of the autobiographical memory test (AMT) [17] at pre-training and post-training.
program. Bottom panel shows mean depression scores as measured by the Beck
The impact of MEST on memory specificity and depressive Depression Inventory (BDI-II) for the single-group, uncontrolled pilot trial in the
symptoms in the two published studies in depression is illustrated Raes et al. study (personal communication) and by the Mood and Feelings
in Figure I. Questionnaire (MFQ) in the Neshat-Doost et al. controlled trial [49].

session of PB training reduced negative affect and psycho-
physiological responses to distressing film clips and upset-
ting personal memories and reduced subsequent memory
intrusions [58].
Affective executive training
Central to the CaR-FA-X framework is the idea that a core
barrier faced by sufferers of depression when using auto-
biographical memory techniques in the clinic is a lack of
executive capacity to work in complex ways with memories
that are often emotive and resource-demanding [31]. To try
to address this we developed an affective variant of an
established working memory (WM) training protocol [59]
that aimed to augment executive control in such affective
contexts, and we used it to train affective WM over 20 days
in healthy participants. We found that those exposed to
training, unlike placebo-trained controls, showed en-
hanced performance on a measure of affective attention
– the emotional Stroop task [60] – as well as on a quintes-
sential index of affective executive control – the ability to
downregulate negative affect in response to viewing dis-
tressing film clips [61]. Regulatory gains were associated
with greater activity in the frontoparietal brain network as
well as in other neural regions implicated in affective
control, notably the subgenual anterior cingulate cortex
6
[61]. These initial studies suggest that affective executive
training has potential to accrue transferable benefits to
skills relevant to patients with affective disorders.
Concluding remarks and future perspectives
Cognitive theories of depression [62,63] emphasize the key
role played by biases and perturbations across core cogni-
tive faculties in the onset and maintenance of the disorder.
Central to these is maladaptive processing of the emotional
autobiographical past. We have reviewed four domains of
such autobiographical memory dysfunctionality: system-
atic biases in favor of negative material, impoverished
access and responses to positive memories, reduced access
to the specific details of the personal past (overgeneral
memory), and dysfunctional processes of rumination and
avoidance around emotive personal autobiographical
themes. These difficulties drive the onset and maintenance
of depression; consequently, interventions targeted at
these maladaptive processes have considerable clinical
potential. Memory therapeutics is the development of
novel intervention techniques, translated from basic re-
search to autobiographical memory, that target memory
difficulties in those with emotional disorders. We have
presented prototypical examples from this clinical domain
including MEST, positive memory elaboration, memory
TICS-1358; No. of Pages 9
Review
rescripting, and the MoL, that have promise either as
stand-alone low-intensity interventions for patients with
milder forms of depression or as adjuncts to existing evi-
dence-based interventions.
In terms of the trajectory of intervention development
[64], these techniques in autobiographical memory thera-
peutics are at an early stage. Although data from explor-
atory trials (e.g., MEST [48–50]) are encouraging, there
is now a mandate for later-stage trials to provide defini-
tive evidence of the clinical utility, feasibility, and cost-
effectiveness of these nascent approaches. There is also a
need to build on emergent techniques that are still at the
preclinical stage to explore their therapeutic utility in
patients (e.g., [65]).
Disturbances in autobiographical memory processing
are of course not limited to depression, and there is good
basic research evidence for the transdiagnostic relevance
[66] of the major domains of difficulty reviewed here; for
example, sufferers of PTSD also struggle to access specific
details of the personal past [67] and there is encouraging
evidence that memory specificity training delivers thera-
peutic benefits in this population [50]. Similarly, individuals
with social anxiety disorder show impoverished recollection
of positive personal experiences [68], and there is scope here
to apply techniques to assist the elaboration and retention
of memories for positive past events.
This focus on working clinically to target underlying
transdiagnostic processing difficulties that cut across
traditional nosological divisions, rather than clusters of
surface signs and symptoms, reflects a broader paradig-
matic shift in our approaches to understanding mental
health problems. Exemplified most clearly in the Nation-
al Institute of Mental Health research domain criteria
[69], this sea-change in the way that we seek to classify
psychopathology provides an excellent context for the
translation of novel process-focused interventions from
basic research.
References
1 Conway, M.A. and Pleydell-Pearce, C.W. (2000) The construction of
autobiographical memories in the self-memory system. Psychol. Rev.
107, 261–288
2 Dalgleish, T. (2004) Cognitive approaches to posttraumatic stress
disorder (PTSD): the evolution of multi-representational theorizing.
Psychol. Bull. 130, 228–260
3 Williams, J.M.G. et al. (2007) Autobiographical memory specificity and
emotional disorder. Psychol. Bull. 133, 122–148
4 Gotlib, I.H. and Joormann, J. (2010) Cognition and depression: current
status and future directions. Annu. Rev. Clin. Psychol. 6, 285
5 Watts, F.N. et al. (1990) Memory deficit in clinical depression:
processing resources and the structure of materials. Psychol. Med.
20, 345–349
6 Lloyd, G.G. and Lishman, W.A. (1975) Effect of depression on the speed
of recall of pleasant and unpleasant experiences. Psychol. Med. 5, 173–
180
7 Patel, T. et al. (2007) Intrusive images and memories in major
depression. Behav. Res. Ther. 45, 2573–2580
8 Dearing, K.F. and Gotlib, I.H. (2009) Interpretation of ambiguous
information in girls at risk for depression. J. Abnorm. Child
Psychol. 37, 79–91
9 Beck, A.T. (1976) Cognitive Therapy and the Emotional Disorders,
Meridian
10 Erber, R. and Erber, M. (1994) Beyond mood and social judgment:
mood incongruent recall and mood regulation. Eur. J. Soc. Psychol. 24,
79–88
Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x
11 Rusting, C.L. and DeHart, T. (2000) Retrieving positive memories to
regulate negative mood: consequences for mood-congruent memory. J.
Pers. Soc. Psychol. 78, 737–752
12 Joormann, J. and Siemer, M. (2004) Memory accessibility, mood
regulation, and dysphoria: difficulties in repairing sad mood with
happy memories? J. Abnorm. Psychol. 113, 179–188
13 Joormann, J. et al. (2007) Mood regulation in depression: differential
effects of distraction and recall of happy memories on sad mood. J.
Abnorm. Psychol. 116, 484–490
14 Werner-Seidler, A. and Moulds, M.L. (2011) Autobiographical memory
characteristics in depression vulnerability: Formerly depressed
individuals recall less vivid positive memories. Cogn. Emot. 25,
1087–1103
15 Werner-Seidler, A. and Moulds, M.L. (2012) Characteristics of self-
defining memory in depression vulnerability. Memory 20, 935–948
16 Werner-Seidler, A. and Moulds, M.L. (2012) Mood repair and
processing mode in depression. Emotion 12, 470–478
17 Williams, J.M.G. and Broadbent, K. (1986) Autobiographical memory
in suicide attempters. J. Abnorm. Psychol. 95, 144–149
18 Dalgleish, T. et al. (2011) The structure of past and future lives in
depression. J. Abnorm. Psychol. 120, 1–15
19 Kleim, B. and Ehlers, A. (2008) Reduced autobiographical memory
specificity predicts depression and posttraumatic stress disorder after
recent trauma. J. Consult. Clin. Psychol. 76, 231–242
20 Watkins, E.R. and Teasdale, J.D. (2001) Rumination and overgeneral
memory in depression: Effects of self-focus and analytic thinking.
J. Abnorm. Psychol. 110, 353–357
21 Beblo, T. et al. (2012) Increased suppression of negative and positive
emotions in major depression. J. Affect. Disord. 141, 474–479
22 Sumner, J.A. (2012) The mechanisms underlying overgeneral
autobiographical memory: an evaluative review of evidence for the
CaR-FA-X model. Clin. Psychol. Rev. 32, 34–48
23 Dalgleish, T. and Yiend, J. (2006) The effects of suppressing a negative
autobiographical memory on concurrent intrusions and subsequent
autobiographical recall in dysphoria. J. Abnorm. Psychol. 115, 467–473
24 Holmes, E.A. and Mathews, A. (2010) Mental imagery in emotion and
emotional disorders. Clin. Psychol. Rev. 30, 349–362
25 Bergouignan, L. et al. (2008) Field perspective deficit for positive
memories characterizes autobiographical memory in euthymic
depressed patients. Behav. Res. Ther. 46, 322–333
26 Lemogne, C. et al. (2006) Episodic autobiographical memory in
depression: Specificity, autonoetic consciousness, and self-
perspective. Conscious. Cogn. 15, 258–268
27 Nigro, G. and Neisser, U. (1983) Point of view in personal memories.
Cogn. Psychol. 15, 467–482
28 McIsaac, H.K. and Eich, E. (2002) Vantage point in episodic memory.
Psychon. Bull. Rev. 9, 146–150
29 Kuyken, W. and Moulds, M.L. (2009) Remembering as an observer:
how is autobiographical memory retrieval vantage perspective linked
to depression? Memory 17, 624–634
30 Watkins, E.R. (2008) Constructive and unconstructive repetitive
thought. Psychol. Bull. 134, 163–206
31 Dalgleish, T. et al. (2007) Reduced specificity of autobiographical
memory and depression: the role of executive control. J. Exp.
Psychol. Gen. 136, 23–42
32 MacLeod, C. et al. (2009) Whither cognitive bias modification research?
Commentary on the special section articles. J. Abnorm. Psychol. 118,
89–99
33 Hallion, L.S. and Ruscio, A.M. (2011) A meta-analysis of the effect of
cognitive bias modification on anxiety and depression. Psychol. Bull.
137, 940–958
34 Browning, M. et al. (2013) The use of cognitive bias modification and
imagery in the understanding and treatment of depression. Curr. Top.
Behav. Neurosci. 14, 243–260
35 Baert, S. et al. (2010) Attentional bias training in depression:
therapeutic effects depend on depression severity. J. Behav. Ther.
Exp. Psychiatry 41, 265–274
36 Wells, T.T. and Beevers, C.G. (2010) Biased attention and dysphoria:
manipulating attention reduces subsequent depressive symptoms.
Cogn. Emot. 24, 719–728
37 Yiend, J. et al. (2013) Modifying interpretation in a clinically depressed
sample using cognitive bias modification errors: a double blind
randomised controlled trial. Cogn. Ther. Res. 2, 1–14
7
TICS-1358; No. of Pages 9
Review
38 Lang, T.J. et al. (2012) Cognitive bias modification using mental imagery
for depression: developing a novel computerized intervention to change
negative thinking styles. Eur. J. Pers. 26, 145–157
39 Williams, A.D. et al. (2013) Combining imagination and reason in the
treatment of depression: A randomized controlled trial of internet-
based cognitive bias modification and internet-CBT for depression. J.
Consult. Clin. Psychol. 8, 793–799
40 Micco, J.A. et al. (2013) Efficacy of interpretation bias modification
in depressed adolescents and young adults. Cogn. Ther. Res. 37,
1–14
41 Watkins, E.R. et al. (2009) Concreteness training reduces dysphoria:
proof-of-principle for repeated cognitive bias modification in
depression. J. Abnorm. Psychol. 118, 55–64
42 Watkins, E.R. (2012) Guided self-help concreteness training as an
intervention for major depression in primary care: a Phase II
randomised controlled trial. Psychol. Med. 42, 1359–1371
43 Holmes, E. et al. (2007) Imagery rescripting in cognitive behaviour
therapy: images, treatment techniques and outcomes. J. Behav. Ther.
Exp. Psychiatry 38, 297–305
44 Wheatley, J. et al. (2007) ’I’ll believe it when I can see it’: imagery
rescripting of intrusive sensory memories in depression. J. Behav.
Ther. Exp. Psychiatry 38, 371–385
45 Holmes, E.A. et al. (2009) Developing interpretation bias modification
as a ‘cognitive vaccine’ for depressed mood: imagining positive events
makes you feel better than thinking about them verbally. J. Abnorm.
Psychol. 118, 76–88
46 Holmes, E.A. et al. (2006) Positive interpretation training: effects of
mental imagery versus verbal training on positive mood. Behav. Ther.
37, 237–247
47 Dalgleish, T. et al. (2013) Method-of-Loci as a mnemonic device to
facilitate access to self-affirming personal memories for individuals
with depression. Clin. Psychol. Sci. 1, 156–162
48 Raes, F. et al. (2009) Reducing cognitive vulnerability to depression: a
preliminary investigation of MEmory Specificity Training (MEST) in
inpatients with depressive symptomatology. J. Behav. Ther. Exp.
Psychiatry 40, 24–38
49 Neshat-Doost, H.T. et al. (2013) Enhancing autobiographical memory
specificity through cognitive training: an intervention for depression
translated from basic science. Clin. Psychol. Sci. 1, 84–92
50 Moradi, A. et al. (2014) A pilot randomized control trial investigating
the efficacy of MEmory Specificity Training in improving
symptoms of posttraumatic stress disorder. Behav. Res. Ther. 56,
68–74
51 Hofmann, S.G. et al. (2010) The empirical status of the ‘new wave’
of cognitive behavioral therapy. Psychiatr. Clin. North Am. 33,
701–710
52 Hayes, S.C. et al. (2006) Acceptance and commitment therapy: model,
processes and outcomes. Behav. Res. Ther. 44, 1–25
53 Linehan, M.M. (1993) Cognitive behavioural therapy of borderline
personality disorder, Guilford Press
54 Watkins, E.R. et al. (2011) Rumination-focused cognitive-behavioural
therapy for residual depression: Phase II randomised controlled trial.
Br. J. Psychiatry 199, 317–322
55 Kuyken, W. et al. (2012) Does mindfulness-based cognitive therapy
prevent depressive relapse in routine practice settings? Br. Med. J.
345, e7194
56 Piet, J. and Hougaard, E. (2011) The effect of mindfulness-based
cognitive therapy for prevention of relapse in recurrent major
depressive disorder: a systematic review and analysis. Clin. Psychol.
Rev. 31, 1032–1040
57 Kross, E. et al. (2012) ‘Asking why’ from a distance: its cognitive and
emotional consequences for people with depression. J. Abnorm.
Psychol. 121, 559–569
58 Schartau, P. et al. (2009) Seeing the bigger picture: Training in perspective
broadening reduces self-reported affect and psychophysiological response
to distressing films and autobiographical memories. J. Abnorm. Psychol.
118, 15–27
59 Jaeggi, S.M. et al. (2008) Improving fluid intelligence with training on
working memory. PNAS 105, 6829–6833
60 Schweizer, S. et al. (2011) Extending brain-training to the affective
domain: increasing cognitive and affective executive control through
emotional working memory training. PLoS ONE 6, e0024372
8
Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x
61 Schweizer, S. et al. (2013) Training the emotional brain: improving
affective control through emotional working memory training. J.
Neurosci. 33, 5301–5311
62 Beck, A.T. (1972) Depression: Causes and Treatment, University of
Pennsylvania Press
63 Power, M.J. and Dalgleish, T. (2008) Cognition and Emotion: From
Order to Disorder. (2nd edn), Taylor Francis
64 Craig, P. et al. (2008) Developing and evaluating complex
interventions: the new Medical Research Council guidance. BMJ
337, 979–983
65 Küpper, C. et al. (2014) Direct suppression as a mechanism for
controlling unpleasant memories in daily life. J. Exp. Psychol. Gen.
http://dx.doi.org/10.1037/a0036518
66 Watkins, E. et al. (2004) Cognitive Behavioural Processes Across
Psychological Disorders, Oxford University Press
67 Moore, S.A. and Zoellner, L.A. (2007) Overgeneral autobiographical
memory and traumatic events: an evaluative review. Psychol. Bull.
133, 419–437
68 Kashdan, T.B. et al. (2011) Whether, how, and when social anxiety
shapes positive experiences and events: a self-regulatory framework
and treatment implications. Clin. Psychol. Rev. 31, 786–799
69 Sanislow, C.A. et al. (2010) Developing constructs for psychopathology
research: research domain criteria. J. Abnorm. Psychol. 119,
631–639
70 American Psychiatric Association (2012) Diagnostic and Statistical
Manual of Mental Disorders. (5th edn), American Psychiatric
Publishing
71 Judd, L.L. (1997) The clinical course of unipolar major depressive
disorders. Arch. Gen. Psychiatry 54, 989–991
72 Kessler, R.C. et al. (1994) Lifetime and 12-month prevalence of DSM-
III-R psychiatric disorders in the United States. Results from the
National Comorbidity Survey. Arch. Gen. Psychiatry 51, 8–19
73 Solomon, D.A. et al. (2000) Multiple recurrences of major depressive
disorder. Am. J. Psychiatry 157, 229–233
74 Frank, E. et al. (1990) 3-year outcomes for maintenance therapies in
recurrent depression. Arch. Gen. Psychiatry 47, 1093–1099
75 Kupfer, D.J. et al. (1992) 5-year outcome for maintenance therapies in
recurrent depression. Arch. Gen. Psychiatry 49, 469–477
76 The Kings Fund (2008) Paying the Price: The Cost of Mental Health
Care in England to 2026, The Kings Fund
77 Murray, C.J.L. and Lopez, A.D. (1997) Alternative projections
of mortality and disability by cause 1990-2020. Lancet 349, 1498–
1504
78 Raes, F. et al. (2005) Reduced specificity of autobiographical memories:
a mediator between rumination and ineffective problem solving in
major depression? J. Affect. Disord. 87, 331–335
79 Goddard, L. et al. (2001) The effects of specific retrieval instruction
on social problem-solving in depression. Br. J. Clin. Psychol. 40,
297–308
80 Williams, J.M.G. et al. (2005) Problem solving deteriorates following
mood challenge in formerly depressed patients with a history of
suicidal ideation. J. Abnorm. Psychol. 114, 421–431
81 Williams, J.M.G. et al. (1996) The specificity of autobiographical
memory and imageability of the future. Mem. Cognit. 24, 116–125
82 Ajzen, I. (1998) Attitudes, Personality and Behaviour, Dorsey Press
83 Hermans, D. et al. (2005) Reduced autobiographical memory specificity
as an avoidant coping style. Br. J. Clin. Psychol. 44, 583–589
84 Kuyken, W. and Brewin, C.R. (1995) Autobiographical memory
functioning in depression and reports of early abuse. J. Abnorm.
Psychol. 104, 585–591
85 Raes, F. et al. (2003) Autobiographical memory specificity and affect
regulation: an experimental approach. Emotion 3, 201–206
86 Raes, F. et al. (2006) Reduced autobiographical memory specificity and
affect regulation. Cogn. Emot. 20, 402–429
87 Crane, C. et al. (2007) The effects of analytical and experiential
rumination on autobiographical memory specificity in individuals
with a history of major depression. Behav. Res. Ther. 45, 3077–3087
88 Raes, F. et al. (2008) Non-ruminative processing reduces overgeneral
autobiographical memory retrieval in students. Behav. Res. Ther. 46,
748–756
89 Cicero, M.T. (2009). In (55 BCE/2001) Cicero on the Ideal Orator (De
Oratore) (May, J.M. and Wisse, K., eds), Oxford University Press
TICS-1358; No. of Pages 9
Review
90 Raz, A. et al. (2009) A slice of P: an exploratory neuroimaging study
of digit encoding and retrieval in a superior memorist. Neurocase 15,
361–372
91 Bellezza, F.S. and Reddy, B.G. (1978) Mnemonic devices and natural
memory. Bull. Psychon. Soc. 11, 277–280
92 Groninger, L.D. (1971) Mnemonic imagery and forgetting. Psychon.
Sci. 23, 161–163
93 Ross, J. and Lawrence, K.A. (1968) Some observations on memory
artifice. Psychon. Sci. 13, 107–108
Trends in Cognitive Sciences xxx xxxx, Vol. xxx, No. x
94 von Restorff, H. (1933) Uber die Wirkung von Bereichsbildungen im
Spurenfeld [The effects of field formation in the trace field].
Psychologische Forschung 18, 299–342 (in German)
95 Spence, J.D. (1984) The Memory Palace of Matteo Ricci, Penguin
96 Yates, F.A. (1966) The Art of Memory, Routledge and Kegan Paul
97 Carruthers, M.J. and Ziolkowski, J. (2002) The Medieval Craft of
Memory: An Anthology of Texts and Pictures, University of
Pennsylvania Press