Neuropsychologia 41 (2003) 1230–1240

An investigation of errorless learning in memory-impaired patients:

improving the technique and clarifying theory
Rebecca Tailby a , Catherine Haslam b,∗
a The Australian National University, Canberra, Australia
b School of Psychology, University of Exeter, Exeter EX4 4QG, UK
Received 12 June 2001; received in revised form 7 January 2003; accepted 7 January 2003

Abstract
In rehabilitating individuals who demonstrate severe memory impairment, errorless learning techniques have proven particularly effective.
Prevention of errors during acquisition of information leads to better memory than does learning under errorful conditions. This paper
presents results of a study investigating errorless learning in three patient groups: those demonstrating mild, moderate, and severe memory
impairments. The first goal of the study was to trial a new version of errorless learning, one encouraging more active participation in
learning by patients via the use of elaboration and self-generation. This technique led to significantly better memory performance than
seen under standard errorless conditions. This finding highlights the value of encouraging active and meaningful involvement by patients
in errorless learning, to build upon the benefits flowing from error prevention. A second goal of the study was to clarify the mechanisms
underlying errorless learning. Memory performance under errorless and errorful conditions was compared within and across each group of
patients, to facilitate theoretical insight into the memory processes underlying performance. The pattern of results observed was equivocal.
The data most strongly supported the hypothesis that the benefits seen under errorless learning reflect the operation of residual explicit
memory processes, however a concurrent role for implicit memory processes was not ruled out.
© 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Errorless learning; Memory impairment

1. Introduction tiveness of the technique is to be enhanced, there are two

One of the more successful techniques used in rehabili-
tating people with memory disorders, especially those with
more severe forms of impairment, is errorless (EL) learning.
The EL learning technique involves learning or encoding
new information without error. To achieve this, individu-
als are given the correct information during each learning
episode. In a typical experiment, this involves the examiner
providing the same new information to the patient over
multiple learning trials, with the patient repeating or writing
down the information. This can be contrasted with errorful
(EF) learning, where individuals are encouraged to guess
and thus are more likely to produce errors during learning
[1,2]. Despite some successes, the EL learning technique
is not without limitations. For patients with severe memory
impairment, acquisition is effortful and requires the thera-
pist or examiner to direct learning. There also appears to be
little generalisability across learning situations. If the effec-
∗ Corresponding author.
E-mail address: c.haslam@exeter.ac.uk (C. Haslam).
issues that need to be addressed. The first is the reliance
on the examiner to generate responses. If individuals can
generate their own responses, this in turn may strengthen
memory traces and perhaps facilitate the process. Secondly,
theoretical implications need to be clarified. Presently, ques-
tions remain about the processes responsible for improved
memory under EL learning conditions. If the mechanisms
that support such learning are clearly identified, we will
be in a better position to improve the effectiveness of
the technique. Both issues are addressed in the present
research.
EL learning originated in behavioural psychology re-
search in the 1960s. Terrace [3,4] and Sidman and Stoddard
[5] used a similar technique to teach visual discrimination
to pigeons and to children with intellectual disabilities. Al-
though new learning was poor in both groups, it was found
that training under errorless conditions facilitated learning
in these populations. However, the general technique was
not applied to the treatment of memory disorders until
the 1990s. The focus of this work was both practical and
theoretical. Researchers investigated both the effectiveness

0028-3932/03/$ – see front matter © 2003 Elsevier Science Ltd. All rights reserved.
doi:10.1016/S0028-3932(03)00036-8
 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
of the technique and the mechanisms or processes that
supported learning when applying the technique.
EL learning was first applied to the treatment of memory
disorders by Wilson et al. [1]. These researchers investigated
list-learning performance in severely memory-impaired (i.e.
amnesic) patients and two non-impaired control groups (a
young group and an elderly group). They found that patients
made significantly more correct responses on a cued recall
test following EL learning than they did following EF learn-
ing. Furthermore, the amnesic group received greater benefit
from the EL condition than did either control group. Bad-
deley and Wilson [2] argued subsequently that EL learning
both enhanced learning and reduced forgetting rates in am-
nesic patients.
Many researchers have replicated this finding of supe-
rior performance under EL learning conditions both in
immediate and delayed memory tests. The EL technique
has been shown to be effective when learning remotely
linked word pairs and unrelated word pairs [6], as well
as learning extended word lists [7]. It has also been use-
ful in the acquisition of more practical information. In a
series of case studies, amnesic patients showed superior
learning of object names, names of people, word lists, ori-
entation items (time, place, age) and general knowledge, as
well as electronic diary programming [1]. A recent study
found a limited advantage of EL over EF methods on a
face-name learning task [8]. EL learning has also been
applied to the restoration of premorbid knowledge [9] and
the development of procedural skills in a work setting [10].
Although most studies have focused on amnesic patients,
the EL learning technique has also been shown to be rea-
sonably successful in facilitating performance in patients
suffering from a moderate degree of memory impairment
[7].
Despite these benefits, there are limitations to the useful-
ness of the EL technique. First, not all studies have found
the benefits of EL learning to be maintained over time delay
(e.g. [6]). Furthermore, there is some evidence to suggest
that EL learning may not be the best method in all cases,
particularly when acquiring more complex information. For
instance, tasks involving multiple steps or requiring the ac-
quisition of more detailed information have been difficult for
amnesic patients even when learning under EL conditions.
Evans et al. [8] found only a limited advantage of EL over
EF methods on a face-name learning task, and no advantage
on other complex tasks, namely, programming an electronic
organiser and route-finding.
A further limitation of the EL learning technique is that
it remains quite directive. Participants need only listen to
correct answers, follow written instruction, or on occasion
write the answer, over a series of learning trials. Wilson and
her colleagues have suggested that this may not be sufficient
to ensure adequate learning [1]. This raises an interesting
question—could the effectiveness of the EL learning tech-
nique be improved if patients were somehow able to gener-
ate their own correct responses during learning?
1231
1.1. Improving the technique
There is existing evidence to suggest the EL learning
technique can be improved. Although Evans et al. [8] found
a limited advantage when learning face-name associations
using standard EL conditions, memory performance was
best when the EL learning task was extended to include ac-
tive processing of associations via use of a visual imagery
strategy. Further evidence is provided by Squires et al. [6],
who found that the benefits of EL over EF methods were
greater on a novel association task when compared with
remotely linked word pairs. These researchers argued the
added cognitive effort required during learning of novel
associations, involving the creation of an extrinsic link
between the target words, resulted in a stronger memory
representation and better performance at test.
Additional evidence from the cognitive literature is rel-
evant to this point. Much of the evidence concerning the
benefits of active participation in learning comes from re-
search investigating levels of processing (LOP) theory. In
LOP theory it is argued that the strength or durability of
a memory representation is dependent on the manner in
which the information is processed during encoding [11,12].
Memories are strengthened by elaboration, or by processing
information on the basis of its meaning. Current EL learning
techniques are akin to rote learning, as they involve repeated
exposure to correct information. According to LOP theory,
retention of information acquired during EL learning should
be improved by increasing the level of active involvement
or processing engaged by participants during encoding. Re-
searchers have shown memory performance is best when in-
formation is learned in a meaningful or semantic context—
for instance, when processed conceptually or elaboratively
rather than on the basis of superficial or lexical characteris-
tics. This finding has emerged in both clinical (e.g. [13–15])
and non-clinical (e.g. [11]) populations. This evidence high-
lights the value of exploiting semantic memory, which is
preserved in many people with acquired memory deficits.
The present research draws upon this notion, and seeks to
determine whether EL learning can be improved by encour-
aging participants to engage in elaborative processing during
learning.
1.2. Theory
There is considerable evidence supporting the case that
EL learning is an effective technique for the rehabilitation
of patients with memory impairment. Yet the cognitive pro-
cesses responsible for improved retention of information
learned under EL conditions are the subject of some debate.
Two theories have been proposed, and both focus on the
distinction between implicit and explicit memory. The first
theory proposes that the benefits seen under EL conditions
are supported by implicit memory. The second theory pro-
poses that these benefits are supported by residual explicit
memory.
1232 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
1.2.1. Implicit memory theory
The implicit memory theory was first proposed by Badde-
ley and Wilson [2] to account for the facilitation in memory
performance observed in amnesic patients who were sub-
jected to the EL learning technique. This theoretical account
is not surprising given evidence of preserved implicit mem-
ory in these patients [16,17]. Specifically, Baddeley and
Wilson found that under EF conditions, amnesic patients
tended to repeat the same errors across learning trials. It
was suggested this occurred because EF learning relies on
explicit memory processes, which amnesic patients cannot
apply. Explicit processes enable the conscious monitoring
and elimination of errors. Without this capacity, one cannot
modify and update responses during learning. Hence, under
EF conditions any error generated by memory-impaired
patients may be repeated, resulting in reinforcement of an
incorrect response. In contrast, implicit memory, attuned to
eliciting production of the strongest response, is reported to
be intact in amnesic patients (e.g. [16,17]. Implicit learning
is well served under EL conditions, as by eliminating errors
during learning the strongest response will be the correct
response and this would be the only one reinforced. On the
strength of these arguments and their findings, Baddeley
and Wilson concluded that the advantages seen under the
EL technique reflected the operation of implicit memory.
Further, albeit limited, support for the implicit theory was
provided by Evans et al. [8]. These authors concluded that
EL learning may only be beneficial in tests of implicit mem-
ory, and may be ineffective when explicit recall of infor-
mation is required. They report mixed results in their study,
and argued that EL learning was only useful in tasks or sit-
uations facilitating retrieval of implicit memory for learned
material.
Critical analysis of the above studies exposes some short-
comings. For instance, although Baddeley and Wilson [2]
proposed that EL learning must be supported by implicit
memory, this conclusion was based on the assumption that
implicit memory was preserved in patients with amnesia. Al-
though numerous researchers have found that implicit mem-
ory and learning is relatively preserved in amnesia [16,17],
other researchers have argued that implicit memory is not
preserved in all tasks performed by amnesic patients [18].
This highlights the need to demonstrate preservation of im-
plicit memory with the task being used, rather than simply
accepting an assumption that may be false. The reasoning
behind Evans et al.’s [8] explanation is also open to ques-
tion. These authors concluded that EL learning may only be
beneficial in implicit memory tests. Yet in their study (as in
most others) EL learning was beneficial in cued recall tasks,
and in one free recall task. Both cued and free recall are
measures commonly employed to tap explicit memory.
1.2.2. Residual explicit memory theory
A subsequent line of empirical research provided support
for an alternative theory—namely, that the benefits observed
during EL learning are supported by residual explicit mem-
ory. This was first suggested by Hunkin et al. [7]. These
researchers used the same learning procedure as Baddeley
and Wilson [2], but tested memory in two ways—using an
implicit test (fragment completion) followed by an explicit
test (cued recall). They found no correlation between items
produced in the implicit and explicit memory tests, which
is contrary to expectations if performance in cued recall re-
flects implicit memory. Based on these findings, Hunkin and
colleagues argued that the benefits associated with EL learn-
ing must therefore reflect the operation of residual explicit
memory. This conclusion was strengthened by their findings
of EL learning advantages in free recall—a task that is ar-
guably explicit. They thus joined other researchers who ar-
gue that any learning observed in amnesia is only possible
via the use of residual explicit memory (e.g. [19]).
Evidence supporting this second theory is also open to
qualification. In the Hunkin et al. [7] study, the accuracy ob-
served in performance in the fragment completion task was
quite low. Performance at such low rates of accuracy might
be considered to reflect residual explicit memory, which is
expected to be poor in groups with severe memory impair-
ment. Yet this conclusion poses some difficulties, given the
lack of correlation with performance on cued recall (their
test of explicit memory). The authors note their failure to
find a correlation between implicit and explicit test perfor-
mance may be an artefact resulting from the use of different
stimulus materials in their tasks. Performance in fragment
completion (i.e. implicit test) was compared with that on
word-stem completion (i.e. explicit test) and the processes
involved in completing these tasks may differ.
1.2.3. Summary
In sum, error prevention during learning has been found
in many cases to be advantageous over techniques that allow
errors to be made in the study period. The benefits of EL
learning have been shown in a number of learning tasks using
a variety of materials and information. To date, two theories
have been proposed to explain the mechanisms underlying
this observed advantage. However the evidence provided to
date in support of each theory remains open to challenge.
The present research re-examines both theories and attempts
to establish which best fits the data.
2. The present investigation
In the present research the two main issues arising from
the literature are addressed. The first concerns the reliance on
an examiner-directed approach to EL learning and whether
the method can be improved by providing semantic cues
during learning so as to enable participants to generate re-
sponses themselves without error. The second concerns clar-
ification of the process underlying EL learning.
Analysis of the literature from both clinical and non-
clinical domains highlights the value of exploiting seman-
tic memory and encouraging deeper or more “meaningful”
 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
processing. In the present study this principle was applied
to the EL learning paradigm. A method was developed
via which participants could generate their own answers
without error (i.e. “self-generated” method) in response to
semantically rich descriptions of the target words. It was
hypothesised that encoding information without error in a
meaningful and active manner would strengthen the mem-
ory representation relative to that formed under the standard
EL (i.e. examiner-generated) condition, thus leading to
better performance at test. Hence, increased accuracy and
retention were predicted in the self-generated EL condition.
The present research also investigated whether EL learn-
ing is supported by implicit memory or residual explicit
memory. This question was addressed by comparing EL and
EF learning in patients suffering from a range of memory
deficits—that is, mild or no memory impairment, moder-
ate memory impairment, and severe memory impairment.
Severity of memory impairment was used as the basis from
which to predict performance according to the two theoreti-
cal explanations—that is, whether EL learning is supported
by (a) implicit memory, or (b) residual explicit memory.
Severity was classified on the basis of performance on a stan-
dardised memory test. A measure of implicit memory was
also taken rather than simply accepting it would be equal
across groups. This was important given our theoretical ex-
ploration required proof of this assumption.
If EL learning is primarily supported by implicit memory
processes, then EF performance should decrease as the level
of memory impairment increases, as assignment to groups is
based on level of explicit memory function. By contrast, if
learning in the EL condition reflects the operation of implicit
memory processes then EL performance should be equiva-
lent, and relatively strong, across all participant groups. The
advantage of EL over EF learning would accordingly be ex-
pected to increase as the severity of memory impairment
increases.
If EL learning is supported by residual explicit memory,
performance under EL conditions would be expected to dif-
fer between groups in line with group differences in the level
of explicit memory impairment, as is predicted for the EF
condition. However, EL performance would still be supe-
rior to EF performance, due to encoding differences. In the
EF condition, an incorrect response is introduced during ac-
quisition. This should produce interference, making perfor-
mance poorer on a subsequent explicit memory task than in
the EL condition, where no such interference is generated
during acquisition. Resolving such interference requires the
use of explicit memory, thus the interference effect would
be expected to be greatest for participants with the most se-
vere memory impairment, with the size of the interference
decreasing as the level of memory impairment decreases.
Statistical predictions relevant to each theory can also be
generated. The one finding that would discriminate between
these theories is a simple effect for severity in the EL con-
dition, which is only predicted by the residual explicit the-
ory. For the implicit theory to be supported a main effect for
1233
method (i.e. where EL is greater than EF), a simple effect
for severity in the EF condition and a method by severity
interaction is required. The same pattern of results would be
predicted by the residual explicit theory with an additional
simple effect for severity in the EL condition.
3. Method
3.1. Subjects
Twenty-four participants took part in the study. Although
they differed in pathology (head injury: n = 12, CVA:
n = 6, hypoxia: n = 3, dementia: n = 1, herpes simplex
encephalitis: n = 1, Parkinsons: n = 1), most had acquired
deficits in explicit memory. A small number of participants
in the mild/no impairment group displayed non-impaired
explicit memory (although all had suffered some neurolog-
ical incident). Participants were divided into three groups,
with eight in each, on the basis of their performance on
the Verbal Memory Index (VMI) on the Wechsler Memory
Scale-III [20]. The VMI was selected as an appropriate
tool for assignment to groups as the experimental tasks in
the present research were auditory-verbal in nature. A VMI
score falling between 0 and 69 was classified as severe
(this score range is achieved by less than 2% of the general
population and is typical of that achieved by patients suf-
fering from amnesia). Moderate impairment was defined as
obtaining a score between 70 and 89 (indicative of perfor-
mance between the second and twenty-third percentiles),
and a classification of mild or no impairment was assigned
to participants scoring at or above 90. Participants were
matched as closely as possible across groups in terms of
age, gender, premorbid and current intellectual function-
ing. Participants were excluded if deemed to suffer from
depression, which was determined by responses to items
in the Beck Depression Inventory-II where a cut-off score
of 12 was used. Summary demographic information and
screening statistics for participants appear in Table 1.
3.2. Materials
The materials comprised 96 words of five to six letters
in length: 48 target words and 48 substitute words (see
Appendix A for a list of these words). Twenty-four of the
target (and substitute) words contained five letters, and
the remaining twenty-four target (and substitute) words
contained six-letters. Word length varied to allow for a
sufficient number of target and substitute words. All target
words were concrete nouns with high imageability. No two
target words began with the same two-letter stem, and target
words were selected so that the two-letter stem provided for
each had at least four possible stem completions for the ap-
propriate word length (i.e. five or six letters). For each of the
48 target words, a semantically-rich description was created
for use in the self-generated EL condition. Pilot testing of
1234 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
Table 1
Demographic information and results of screening tests as a function of severity of memory impairment
Memory impairment group Age Males:females ratio
Severe 43; S.D. = 17.2 1:1
Moderate 43.8; S.D. = 13.1 3:1
Mild/no 37.5; S.D. = 15.7 7:1
a Premorbid IQ estimated using NART-R.
b Current IQ estimated using WAIS-R short form.
the semantic descriptions was conducted on 10 individuals
to ensure the semantic information was sufficient to enable
error-free identification of the word by all those tested. Defi-
nitions for 46 of the words met this criterion. The remaining
two definitions were then revised and piloted on another
eight people. The new definitions successfully met the cri-
terion. Finally, each target word had a matched “substitute”
word, with the same two-letter stem, length and frequency.
These words were used (if required) in the errorful learning
condition only—if participants correctly guessed the target
word on their first attempt, they were told they were in-
correct and the substitute item then became the new target
word.
The 48 target words were assigned to one of four lists (lists
A, B, C and D). Each list of 12 target words was balanced on
average word frequency (40), and contained an equal number
of five and six-letter words. Where there were multiple target
words from the same category (e.g. “animals”, “fruit”), these
items were evenly distributed between the lists.
A fifth list, list E, consisted of twelve 2-letter word stems
to be used as distractors in the implicit test, which was a
stem completion task. This type of implicit memory test was
chosen as it was equivalent to the tasks employed in the rest
of the experimental procedure (i.e. the same test materials
and procedures—cueing with word stems—were used in the
explicit and implicit tasks). Half of the list E distracter stems
comprised five letters (e.g. SL . . . ), and the remaining half
comprised six letters (e.g. YE . . . ). All twelve stems had at
least one possible completion.
3.3. Procedure
All participants underwent preliminary neuropsycholog-
ical screening to facilitate subject matching across groups.
Premorbid and current intellectual functioning were assessed
using the National Adult Reading Test-Revised (NART-R:
[21]), and a short form (comprising vocabulary and block
design subtests: [22]) of the Wechsler Adult Intelligence
Scale-Revised (WAIS-R: [23]) respectively. As mentioned
previously, allocation to the three experimental groups was
on the basis of performance on the VMI.
All participants were tested in each of the three learn-
ing conditions—errorful, standard (examiner-generated) er-
rorless (EL(E)), and self-generated errorless (EL(S)). Each
participant also completed the stem completion (SC) test
condition. A different target list was used in each condition,
NART-R Estimated premorbid IQa Estimated current IQb
27.6; S.D. = 9.9 97.8; S.D. = 10.4 99.9; S.D. = 18.8
29.5; S.D. = 10.8 99.8; S.D. = 11.3 106.5; S.D. = 11.3
33; S.D. = 8.1 103.5; S.D. = 8.5 103.4; S.D. = 6.8
with appropriate counterbalancing of lists to condition across
participants within each group as well as counterbalancing
of the order of methods studied. Each participant was seen
over two sessions. Two conditions were presented in each
session, with a break of 20 min between conditions. There
was at least 1 week separating sessions 1 and 2. There were
two phases to the experimental procedure—a study phase
and a test phase.
3.4. Study phase
At the commencement of the experimental procedure par-
ticipants were told they would be asked to learn some word
lists, and that each list would be presented a total of three
times. Participants were also informed that after presenta-
tion of each item in the list they would be asked to write
down the word on a piece of paper. In all but the SC task,
participants were informed that their memory for the words
would be tested. These latter three conditions (EF, EL(E)
and EL(S)) will be referred to as the “explicit” conditions. In
the study phase participants were given the length (i.e. five
or six letters) and the first two letters of each target word
both verbally, and visually via a flashcard (e.g. BR . . . ).
Following this, instructions varied according to the specific
condition as follows.
3.4.1. Errorful learning
In this condition participants were asked to guess what the
word might be. For example, they were told: “I’m thinking
of a five-letter word beginning with “BR”. Can you guess
what the word is?” Participants were allowed up to three
guesses (or a maximum of 25 s) and were told whether they
were correct or incorrect after each guess. A failure to re-
spond was not accepted, and participants were encouraged
to make a guess. If they had not guessed correctly by the
end of the time limit, they were told the word (e.g. bread).
If participants provided the correct response on their first
guess, they were told that they were incorrect, and the tar-
get word was then replaced by the corresponding substitute
word (e.g. brush). This ensured that at least one error was
made for each stimulus item.
3.4.2. Errorless learning (examiner-generated)
and stem completion
In these conditions participants were provided with the
correct word. For example, “I’m thinking of a five-letter
 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
word beginning with “BR”, and the word is “BREAD”.
Please write that down”.
3.4.3. Errorless learning (self-generated)
In this condition participants were given a verbal descrip-
tion of the target item and asked to name the word (e.g. “I’m
thinking of a five-letter word beginning with “BR”, and this
word describes a food made of flour, liquid and yeast which
is baked and then sliced to make sandwiches. What do you
think the word might be?”). Participants were given 25 s to
respond. A failure to respond was not accepted and partici-
pants were strongly encouraged to provide a response.
Once the target word was identified, participants were
asked to write down the word on a small piece of paper.
These pieces of paper were removed after each word, to
control the amount of exposure to each item. This procedure
was carried out for each of the 12 words on the list, and
the whole procedure was repeated twice so that participants
studied each target word three times. Order of presentation
of the 12 words on successive trials was constant.
3.5. Test phase
Following completion of the three learning trials in each
condition, a 5 min distracter task was administered (a digit
span test). Memory was tested both immediately following
the distracter task (all conditions) and again after a 30 min
delay (“explicit” conditions only). Participants were pro-
vided with a break between immediate and delayed tests.
The testing procedure differed slightly depending on the
condition and details are provided below.
3.5.1. Explicit learning conditions (EF, EL(E) and EL(S))
Memory was tested using a cued recall task. Participants
were presented with the flashcards used in the study phase,
and were then asked to recall the target word corresponding
to the stem cue. These cards were presented in a random
order. Participants were encouraged to provide a response,
and if unsure, to guess. Only one response was allowed for
each word stem.
3.5.2. Implicit test (stem completion)
Participants were told that they were required to complete
a list of two-letter word stems of varying length and asked
to complete stems with the first word that came to mind.
It was explained that they had no more than 2 s for each
item, and that the examiner was timing how quickly they
completed the task. If they got stuck on any stem they were
instructed to leave it and focus on the next stem. Partici-
pants were not permitted to go back to missed items. Pre-
sentation of the word stems was via the flashcards used in
the original study phase, randomly interspersed with the 12
distracter stems from list E. The experimenter presented the
flashcards consecutively for 2 s each. A tape recorder and
microphone were used to record responses. On completion,
participants completed the Memory Strategies Questionnaire
1235
(see Appendix B) to identify strategies employed when per-
forming the stem completion task. As no participant indi-
cated they had deliberately tried to complete the stems with
study list words, it is likely they used implicit processes to
perform this task.
4. Results
Six “explicit” scores were calculated for each partici-
pant, comprising the number of items recalled correctly
(out of 12) in each explicit learning condition—EF, EL(E),
EL(S)—at both immediate and delayed test. Mean scores
and the percentage of accurate responses are provided in
Table 2. As initial testing revealed no effect of time, the
data were collapsed across time (immediate and delayed)
and all analyses conducted using collapsed data. The results
will be discussed in two parts: the first addressing the prac-
tical question of improving the technique, and the second
addressing the question concerning theory.
4.1. Improving the technique
To determine whether elaborative processing of informa-
tion enabling self-generation of responses during errorless
acquisition was more beneficial than the standard error-
less learning procedure, performance in self-generated and
examiner-generated (i.e. standard) EL learning conditions
was compared. A two-way mixed ANOVA was conducted,
comparing performance under EL(S) and EL(E) condi-
tions in the three memory-impaired groups (i.e. mild/no,
moderate, severe). As noted above, performance in each
condition was collapsed over time. A significant main ef-
fect of learning method was found, indicating that cued
recall performance following self-generated EL learning
was significantly better than that seen under standard EL
conditions (F(1, 21) = 18.74, P < 0.0001). A signifi-
cant main effect for group was found (F(2, 21) = 13.60,
P < 0.001), however no method by group interaction was
found (F(2, 21) = 1.15, ns). The above results indicate the
modified errorless learning method, which used semantic
cues to enable error-free generation of responses by par-
ticipants, produced the best memory performance and the
advantage of this method over the standard EL method was
maintained over time and across groups. It is worth noting
that in both EL conditions, very little information was lost
following delay (see mean values reported in Table 2).
4.2. Clarifying the mechanisms behind EL learning
To examine the question of theory, it was important to
determine first whether there was any difference in im-
plicit memory functioning (at least on a test equivalent to
those employed in the experimental conditions) between
groups. To achieve this, two scores were calculated for each
participant. First, the number of target stems on the stem
1236 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240

Table 3
Mean priming scores across participant groups
Memory impairment group Mean priming score

Severe 4.50
Moderate 4.25
Mild/no 5.75

completion test completed with items from the original

study list was calculated, giving a “target score”. Second,
the number of distractor stems completed with pre-allocated
baseline items (selected to match target items on word
frequency—see Appendix A for baseline items) was calcu-
lated, giving a “baseline score”. A priming score was then
calculated for each participant, being the difference between
his or her target and baseline scores. Mean priming scores
for each group are presented in Table 3.
A one-way between-groups ANOVA was then conducted
to compare levels of priming across the three participant
groups. Results indicated that the level of priming did
not differ significantly between groups (F(2, 21) = 1.48,
P > 0.05). As priming is considered to be an indicator of
implicit memory functioning, it was concluded that implicit
memory processing on this type of task was comparable
across all participant groups.
To address the question of theory, an analysis comparing
performance under EF and standard EL (i.e. EL(E)) con-
ditions was conducted. Mean performance scores for each
group under the two conditions are provided in Table 2.
The first analysis explored whether data from the present
study replicated earlier findings of an advantage of EL
over EF learning. A two-way mixed ANOVA was con-
ducted, comparing data from the EL(E) and EF conditions
across all participant groups. As expected, the group ef-
fect reached significance (F(2, 21) = 14.63, P < 0.001).
Furthermore, a significant main effect for learning condi-
tion was found, indicating that memory performance was
significantly better following learning under standard EL
conditions (F(1, 21) = 20.76, P < 0.0001). Thus the cur-
rent study provides further confirmation of the superiority
of learning methods incorporating error prevention.
In light of the significant difference that emerged in mem-
ory performance between the EL(E) and EF conditions,
the question remained whether this difference reflected the
operation of implicit memory processes or residual explicit
processes. Resolution of this query was possible by inves-
tigating whether there was a simple effect of severity (i.e.
in memory impairment) in each learning condition. Specif-
ically, the veracity of the implicit theory can be tested by
investigating whether there was a simple effect of severity
for the EL(E) condition. The implicit theory predicts that
all groups should perform equally if EL performance is
supported solely by implicit memory processes, as groups
have been found (via the stem completion test) to show
no difference in implicit processing on an equivalent task.
The implicit theory prediction was tested using a one-way
 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
ANOVA, with performance under standard EL conditions
as the dependent variable. A significant effect of sever-
ity was found (F(2, 21) = 9.90, P < 0.005) suggesting
that performance in standard EL conditions differed be-
tween the groups. Post hoc contrasts revealed the moderate
group performed significantly better than the severe group
(t(21) = 2.7, P < 0.05), as did the mild group (t(21) =
4.42, P < 0.001). Although there was a trend towards better
performance of the mild group compared to the moderate,
this was not significant (t(21) = 1.70, ns). Importantly, the
finding of an effect of severity in the standard EL condition
does not support the implicit theory, but it is consistent with
the residual explicit theory.
A second one-way ANOVA taking performance in the EF
condition as the dependent variable also revealed a signifi-
cant effect of severity (F(2, 21) = 15.17, P < 0.001). This
was as expected given participants were allocated to groups
based on their performance on a standard explicit memory
measure. Finally, the method by memory impairment sever-
ity interaction in the overall two-way ANOVA failed to reach
significance (F(2, 21) = 1.26, ns). Although this finding
was contrary to predictions made under both implicit and
residual explicit theories, it is important to note that a trend
in the predicted direction emerged. Closer inspection of the
data in Table 2 shows that the difference between perfor-
mance under the EL(E) and EF conditions was noticeably
greater for the severe group than for the moderate and mild
groups.
The results of statistical analyses, showing a main effect
for method and simple effects for severity in both the EL and
EF conditions, were used to evaluate the competing theories.
Although the present findings do not find an exact match
with either of the predicted profiles (as noted in the introduc-
tion), the closest match emerged with the residual explicit
theory. The implications of the data, including possible al-
ternate explanations for the pattern of results observed, are
discussed below.
5. Discussion
The present study sought to improve the practical use-
fulness of an already beneficial rehabilitation technique,
and to increase our theoretical understanding of the mecha-
nisms supporting errorless learning. The first issue involved
determining whether the technique could be improved by
encouraging more active, or elaborative, processing during
errorless acquisition of information. The present findings
indicate that the self-generation elaborative EL method
employed resulted in a superior memory performance com-
pared with the standard errorless technique. Performance
was also maintained over time. A second issue concerned
the question of theory and in particular, what process is
responsible for supporting errorless learning. Results were
more equivocal on this matter, with the most consistent
match emerging with the residual explicit theory.
1237
The answer to the first research question was unequi-
vocal—memory performance resulting from learning under
the new self-generated errorless technique was significantly
better than that under standard errorless conditions. The re-
sults comparing the standard and self-generated EL methods
indicate there is much to be gained from active as opposed
to passive participation during study. This benefit was seen
in all groups, and the advantage persisted over time. While
there was no loss of information over time with the standard
technique, the best result was obtained with the modified
technique which provided sufficient elaborative cues dur-
ing learning to enable self-generation of responses without
error.
Particular mention should be made of performance in the
severely memory-impaired group. These participants expe-
rienced the most difficulty in any test of memory. Despite
this, at immediate test the severe group recalled two-thirds
(68.8%) of the target items learned using the self-generated
EL method, with very little loss of information after delay.
This was substantially more than that recalled in the stan-
dard EL condition, where around half (52.1%) of the target
items were recalled, and in the EF condition where only
a third (33.3%) of target items were recalled. In practical
terms, this suggests that the self-generated elaborative EL
method has the same advantage over the standard EL condi-
tion as the latter has over the EF condition. Although there
is a marked advantage for standard EL conditions relative to
the trial-and-error method, the present research has shown
that a similar degree of improvement can be produced
over the standard EL technique simply by engaging par-
ticipants in active semantic processing and self-generation
of responses during study. While this advantage was most
dramatic in the severely memory-impaired group, similar
gains were seen in the other two groups. These findings,
while confirming previous reports of memory facilitation
using the EL learning method, also extend them by high-
lighting the value of tapping into the semantic system in
memory-impaired patients, and encouraging active engage-
ment during acquisition of new information to facilitate
stronger memory representations.
Aside from evidence of superiority in terms of the num-
ber of items recalled and the persistence of these benefits
over time in the self-generated condition, there were several
flow-on effects that emerged in the course of conducting
this experiment. In many cases participants spontaneously
reported that they found it much easier to recall list words
at test following learning under EL(S) conditions than un-
der the standard EL method (and of course the EF method).
In addition, the experimenter noted that responding at test
tended to be more rapid following EL(S) learning than the
other two explicit methods. In other words, responses to tar-
get items appeared more accessible. Greater confidence in
responding was also apparent in responding to these target
items. While these factors were not the primary focus of this
experiment, they provide additional evidence of the superi-
ority of the self-generated method.
1238 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
While the gains seen under the EL(S) technique are clear, a
question arises as to which component of the technique most
facilitated performance. That is, whether it was the elabora-
tive cues provided during target acquisition, the fact that re-
sponses were actively generated by participants themselves
rather than by the examiner, or a combination of the two. Our
findings cannot address this question, and further studies are
needed to clarify the relative importance of semantic cueing
during acquisition, and the act of response-generation itself,
in facilitating memory performance in patients demonstrat-
ing memory impairment.
In relation to theory, the findings appeared to discount
the implicit theory proposed by Baddeley and Wilson [2]
but provided some support for the residual explicit theory
proposed by Hunkin et al. [7]. Comparing the results seen
under EF and standard EL conditions (Table 2), the first
thing to note was the superior performance seen in the EL
condition in all memory-impaired groups (although only
a small advantage was seen for the moderate impairment
group). A significant overall advantage of EL learning was
found, in line with previous studies and as predicted by
both theories. The additional finding of a significant simple
effect of severity in the EL condition suggests that implicit
processes alone are not sufficient to explain performance.
No differences should have emerged between groups in the
EL condition were performance due solely to implicit pro-
cesses. This was not found—performance in the EL condi-
tion increased as severity of memory impairment decreased.
It might be argued then that there were differences between
groups’ implicit memory function. This can be discounted
given no difference was found between groups in an implicit
stem completion task which used equivalent test procedures
to those employed in the experimental conditions. As such,
the most reasonable explanation is that implicit memory
alone cannot explain the performance observed.
Having said this, it must also be noted that the results did
not fully support the residual explicit theory. Of the four sta-
tistical effects predicted by this theory, the only effect not
observed in this study was the prediction of a method by
severity interaction. Although not reaching statistical sig-
nificance, inspection of Table 2 revealed some differences
in the mean scores between EL and EF conditions in each
group, which is in line with the conceptual predictions of the
residual explicit theory. Specifically, in each group accuracy
in performance was found to be higher under EL conditions
than under EF and accuracy in the EL conditions increased
as severity of memory impairment decreased. The failure of
this trend to reach significance was unexpected, given that
both theoretical accounts predicted a significant interaction
between method and severity, but there are several possible
explanations for this finding.
First, it is possible that EL learning may be supported by
a combination of implicit and explicit memory processes. It
is surprising that the theoretical accounts proposed in the EL
learning literature to date have not considered the combined
contribution of both implicit and residual explicit memory
processes (although [24], did consider this possibility in a
study on a similar learning technique—the method of van-
ishing cues). Given the central predictions of both the “single
process” theories were not fully substantiated by the find-
ings of the present study, the combined influence of both
processes arises as an alternate explanation worthy of con-
sideration. Were a combination of implicit and explicit pro-
cesses responsible for improving EL performance, then the
predicted difference between EL and EF conditions as in-
dicated by the residual explicit theory would be reduced
further. All other predictions would be consistent with the
residual explicit theory. In this event, an interaction would
still be predicted but the effect more difficult to substantiate
statistically. Given the predicted patterns of performance un-
der the “residual” and “combined’ theories are so similar, it
is difficult to distinguish between these accounts using our
method.
A second and related possibility is that EL learning may
be supported by different processes in different individuals.
For instance, it is possible that EL learning relies primarily
on implicit processes in very severely impaired patients who
lack explicit memory abilities, but relies more on explicit
processes in those demonstrating only a mild impairment.
Finally, interpretation may have been complicated in the
present study by the ceiling effect observed in the errorless
conditions in the mild/no impairment group. Future studies
could avoid the possibility of ceiling effects by increasing
list length or having fewer repetitions during acquisition,
which might then reduce performance in the mildly impaired
group. This would enable a clearer assessment of the level
of benefit provided by EL learning across all groups, and
permit greater confidence in conclusions.
These considerations notwithstanding, the present study
has shown that an already beneficial memory rehabilitation
technique can be improved further with the use of active
or elaborative semantic processing and self-generation dur-
ing learning. While the concept itself is not new, it has not
been applied to EL learning previously. This research has
only explored one aspect of self-generated elaborative en-
coding. The options for further exploration of this principle
are numerous. There are many ways in which researchers or
therapists might facilitate elaborative processing by patients
whilst still preventing errors. Information could be taught in
the standard EL fashion (i.e. rote presentation of words) then
patients could be asked to use each word in a meaningful
sentence, create a story around that concept, or some similar
strategy—i.e. encouraging self-elaboration. Alternately, one
could provide the elaborative context for individuals (which
may be advantageous if they have deficits in self-directed
cognitive processing) by providing richly elaborated concep-
tual information to serve as a cue to the target information.
Further possibilities exist, and merely await discovery by
innovative therapists. For patients with acquired deficits in
semantic memory and/or processing, self-generation could
be encouraged in response to a highly constraining set of
non-semantic cues (e.g. letters of the word). The method of
 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240 1239

vanishing cues, a technique which draws upon this idea, has Appendix A (Continued )
shown promise with patients who demonstrate severe mem-
ory impairment (for an overview, see [25]). Substitute
The issue of which mechanism(s) support EL learning in (6)NE needle Nephew
memory-impaired patients remains a complex one. While (5)RU ruler Ruins
some support for the residual explicit theory emerged from (6)TU turtle Tunnel
the present findings, the data was equivocal. Single theory (5)WH wheel Wheat
explanations may in fact be insufficient to explain the facil- (6)WI window Winter
itation observed when learning information under EL con-
ditions. It is possible that different individuals capitalise on List D
different processes, or that a combination of processes, both (5)BR bread Brush
implicit and residual explicit, contribute to the facilitation (6)CA cannon Cancel
observed. Further research is required to clarify the relative (6)DO donkey Double
contributions of implicit and residual explicit memory pro- (6)FL flower Flames
cessing in EL learning. (5)GL glove Gland
(6)GU guitar Guards
(6)OR orange Organs
Appendix A. Stimulus words (5)PI piano Pilot
(6)SA saddle Savage
Substitute (5)TA table Taken
(5)TI tiger Timid
List A (5)WA watch Wagon
(5)AR arrow Array
(6)BU button Bucket List E (distracter stems and baseline completions)
(6)CH church Change (5)BE beard
(5)CL cloud Clock (5)DA dance
(6)LA ladder Lagoon (5)LO lolly
(6) MO monkey Modify (5)MA match
(5)PA pants Patch (5)NO north
(6)PE peanut Pepper (5)SL slate
(5)SN snail Sniff (6)EM empire
(5)SW swing Sweat (6)FR freeze
(5)TH thumb Thief (6)JU jumper
(6)TO tomato Toffee (6)PR prompt
(6)SI singer
List B (6)YE yellow
(6)AN anchor Antler
(5)AP apple Apron
(6)BO bottle Bottom Appendix B. The memory strategies questionnaire
(5)HE heart Heavy
(5)KN knife Knees This was a series of three questions designed to determine
(6)PO potato Polish whether participants had deliberately tried to complete stems
(6)RA rabbit Ration with words from the study list, or whether they had in fact
(5)SK skirt Skill responded as instructed with the first word coming to mind.
(6)SP spider Sprout
(5)ST stool Stack B.1. Memory strategies questionnaire
(5)TR truck Trust
(6)VI violin Violet 1. What was your general strategy when completing the
stems?
List C
2. Did you deliberately try to complete the stems with words
(6)BA basket Barrel
from the study list?
(5)CR crown Creek
3. Did you respond with the first word coming to mind (its
(5)DR dress Dream
OK if some of these were study list words, so long as
(6)HA hammer Hazard
you weren’t deliberately trying to recall list words)?
(5)HO horse Hotel
(6)JA jacket Jaguar If response to question 2 was “yes”, participants were
(5)LE lemon Lever judged to be using explicit memory to complete the task.
1240 R. Tailby, C. Haslam / Neuropsychologia 41 (2003) 1230–1240
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