Received: 22 October 2017 Revised: 18 January 2018 Accepted: 23 January 2018

DOI: 10.1002/jclp.22597

RESEARCH ARTICLE

The effect of positive and negative memory bias

on anxiety and depression symptoms among
adolescents
Samuel M.Y. Ho1 Joseph Cheng1 Darren Wai Tong Dai2
Titian Tam1 Otilia Hui1

1 Psychology Laboratory, Department of Applied

Social Sciences, City University of Hong Kong, Abstract

Hong Kong
2 Tsung Tsin Mission of Hong Kong
Correspondence
Samuel M.Y. Ho, Department of Applied Social
Sciences, City University of Hong Kong, Hong
Kong.
Email: munyinho@cityu.edu.hk
Objective To examine the interaction effect of anxiety and depres-
sion on the intentional forgetting of positive and negative valence
words.
Methods One hundred fifty-five grade 7 to grade 10 students partic-
ipated in the study. The item-method directed forgetting paradigm
was used to examine the intentional forgetting of positive-valence,
negative-valence, and neutral-valence words.

Results Negative-valence words were recognized better than either

positive-valence or neutral-valence words. The results revealed an
anxiety main effect (p = .01, LLCI = −.09, and ULCI = −.01) and a
depression main effect (p = .04, LLCI = .00, and ULCI = .24). The
anxiety score was negative, whereas the depression score was pos-
itively related to the directed forgetting of negative-valence words.
Regression-based moderation analysis revealed a significant anxi-
ety × depression interaction effect on the directed forgetting of
positive-valence words (p = .02, LLCI = .00, and ULCI = .01). Greater
anxiety was associated with more directed forgetting of positive-
valance words only among participants with high depression scores.
With negative-valence words, the anxiety × depression interaction
effect was not significant (p = .15, LLCI = − .00, and ULCI = .01).

Conclusion Therapeutic strategies to increase positive memory bias

may reduce anxiety symptoms only among those with high depres-
sion scores. Interventions to reduce negative memory bias may
reduce anxiety symptoms irrespective of levels of depression.

KEYWORDS
anxiety, Chinese language, depression, directed forgetting,
emotional words, intentional forgetting, memory bias

J. Clin. Psychol. 2018;74:1509–1525. wileyonlinelibrary.com/journal/jclp 

c 2018 Wiley Periodicals, Inc. 1509
1510 HO ET AL.

1 INTRODUCTION

There is a high comorbidity between anxiety and depression disorders in both adults (Lamers et al., 2011; Watson,
2005) and young people (Cummings, Caporino, & Kendall, 2014; Wolk et al., 2016). Among adolescents, it has been
reported that 10%–15% of youths in the United States have concurrent anxiety and depressive disorders (Garber &
Weersing, 2010). Several models have been proposed to delineate the common and specific factors related to the eti-
ology and maintenance of anxiety and depression (McLaughlin & Nolen-Hoeksema, 2011; Watson, 2005). For instance,
the tripartite model of Watson and colleagues (Watson, 2005; Watson et al., 1995) suggested that anxiety and depres-
sion disorders could be collapsed into an overarching class of emotion disorders with negative affect. This model
applies to both anxiety and depression disorders, while physiological hyperarousal and (low) positive affect are more
specific to anxiety and depression, respectively. There is evidence to support the generalizability of the tripartite model
to youths and adolescents (Chin, Ebesutani, & Young, 2013; Jacques & Mash, 2004).

1.1 Memory biases, anxiety, and depression

The cognitive model posits that schema-congruent biases towards danger and vulnerability or loss and failure in the
processing of emotional information play a vital role in the onset and maintenance of both anxiety and depression
(Beck, 1976; Lotterman & Bonanno, 2014; Mathews & MacLeod, 2005; Watkins, 2002). Accordingly, the high comor-
bidity of anxiety and depression disorders may be due to cognitive processing errors that are shared between them
(Garber & Weersing, 2010). Memory bias is one of the schema-congruent biases related the etiology and maintenance
of anxiety and depression in both adults and youths (Lau & Waters, 2016). Regarding anxiety, it is postulated that
an overdeveloped threat-detection system may cause people to become hypervigilant and clinically anxious (Clark &
Beck, 2011; Mathews & Mackintosh, 1998; Mathews, Mackintosh, & Fulcher, 1997). Thus, anxious individuals exhibit
a stronger tendency than nonanxious individuals to selectively recall events in ways that are consistent with their
anxiety-prone cognitive schema (Eysenck & Derakshan, 2011; Gómez-Ariza et al., 2013). Furthermore, anxiety may
reduce an individual's executive control capacity in the cognitive processing of information (Bishop, 2009; Pacheco-
Unguetti, Acosta, Lupiáñez, Román, & Derakshan, 2012), particularly the ability to control the retrieval of relevant and
irrelevant materials from long-term memory (Eysenck, Derakshan, Santos, & Calvo, 2007). Thus, anxious individuals
may exhibit oversensitivity to threat-related information and exhibit less ability to forget such information, leading to
the phenomenon of negative memory bias (Mathews & MacLeod, 2005). Similarly, depressed individuals may also tend
to encode and retrieve information that is congruent with their mood (Watkins, 2002). Due to their negative mood
state, depressed individuals are more prone to remembering negative information, leading to a negative memory bias
(Lotterman & Bonanno, 2014). Furthermore, the ruminative self-focus tendency among depressed individuals, i.e., the
tendency to think negatively about oneself and one's symptoms, and a focus on the discrepancies between current
and wanted outcomes may increase the recall of negative experience (Lo, Ho, & Hollon, 2008; Lo, Ho, Yu, & Siu, 2014;
Teasdale, 1999).
Mood-congruent memory bias is thus a common feature of both anxiety and depression and may explain the high
comorbidity between the two disorders, although the exact processes may differ somewhat between anxiety and
depression (Rinck & Becker, 2005). In accord with the prediction of mood-congruent memory (Watkins, 2002), empir-
ical studies have found a negative memory bias among adults (White, Ratcliff, & Vasey, 2015; Yang et al., 2016) and
adolescents (Goldstein, Hayden, & Klein, 2015; Gomez-Ariza et al., 2013) with anxiety disorders and depression. How-
ever, inconsistent results have been reported by other studies (Lau & Waters, 2016; Mitte, 2008). For instance, Mitte
(2008) concluded after a meta-analysis that no support was found for an association between anxiety and implicit
memory bias. Other studies reported negative memory bias in depression but not in anxiety disorders (Bradley, Mogg,
& Williams, 1995; Rinck & Becker, 2005), while the reverse has been reported in other studies (Wingenfeld, Terfehr,
Meyer, Lowe, & Spitzer, 2013).
The above-mentioned literature review identifies several research gaps in the current investigation of the roles of
memory bias in anxiety and depression. First, as pointed out by Lau and Waters (2016), the role of memory bias on
HO ET AL. 1511

anxiety is under-researched when compared with studies on depression. Second, more studies have been conducted
on adults than on youths. Third, many studies have compared memory bias in patients with depression and patients
with anxiety disorders, and fewer studies have measured both anxiety and depression within a single subject (Brown,
Meiser-Stedman, Woods, & Lester, 2016). As a result, little is known about the shared and specific cognitive factors
related to anxiety and depression among youths (Brown et al., 2014). Finally, studies have paid more attention to the
role of negative memory bias on anxiety and depression than on the role of positive memory bias on the disorders.
Liang, Hsu, Hung, Wang, and Lin (2011) reported that anxious university students tended to forget positive-valence
words more readily than did nonanxious individuals, especially when instructed to do so. It has also been proposed
that positive memory (i.e., mood-incongruent memory) may help to repair a negative mood (Rusting & DeHart, 2000).
In a recent study, Lotterman and Bonanno (2014) further proposed that the actual experience and recall of positive
events per se did not predict depression and distress, while a discrepancy between the two (i.e., the positive memory-
frequency bias) predicted the severity of the psychopathology.

1.2 The directed forgetting paradigm

Intentional forgetting, the voluntary forgetting of materials after they have been encoded (Payne & Corrigan, 2007),
has been used to assess memory bias. The directed forgetting (DF) paradigm is commonly used in the laboratory to
investigate intentional forgetting (MacLeod, 1999). Two DF procedures have been developed; in both, participants are
presented with words and are instructed to either remember or forget the words. In the item method, the participants
are given cues to remember or to forget after the presentation of each item. In the list method, the participants are
given a single mid-list instruction to forget the first half of the list. In both methods, an explicit memory test (e.g., recall
or recognition) of all of the words—both those with “remember” labels and those with “forget” labels—is then adminis-
tered in a later task. The DF effect is characterized by poorer memory performance with to-be-forgotten (TBF) words
than with to-be-remembered (TBR) words (Bjork, Bjork, & Anderson, 1998). Importantly, the DF effect cannot be
explained by demand characteristics. The DF effect has been commonly attributed to selective rehearsal and retrieval
inhibition, but the procedure used is likely to favor one process over the other. Basden, Basden, and Gargano (1993)
proposed that the item method promoted the selective rehearsal of TBR words, whereas the list method promoted the
retrieval inhibition of TBF words. Recently, it has been argued that inhibitory control over the episodic encoding of the
TBF words may play a more significant role in the item method than previously acknowledged (Anderson & Hanslmayr,
2014).

1.3 The present study

As mentioned above, the role of memory bias on anxiety is under-researched when compared with studies on depres-
sion (Lau & Waters, 2016). The present study, therefore aimed to focus on the potential DF effect of both positive-
valence words and negative-valence words on anxiety symptoms among adolescents. It has been well established that
there is a high comorbidity between anxiety and depression among adolescents (Cummings et al., 2014; Wolk et al.,
2016). Accordingly, depression was included as a moderator in the current study. Both positive and negative memory
biases were included to allow the comparison of their effects on psychopathology.
Based on the mood-congruent memory bias model (Watkins, 2002), we anticipated that anxiety and depression
levels would be negatively associated with the DF of negative words and positively with the DF of positive words in
an experiment (Goldstein et al., 2015; Gomez-Ariza et al., 2013). The mood-congruent memory bias model (Watkins,
2002) may imply that individuals with comorbid anxiety and depression symptoms should exhibit more memory biases
when compared with individuals with neither or only one of the disorders. We hypothesized an anxiety and depression
interaction effect on memory biases. In particular, we planned to examine whether depression would act as a mod-
erator on the relationship between anxiety and memory bias. No a priori hypothesis was made due to a lack of prior
research findings on this moderation relationship.
In sum, this study aimed to contribute to our understanding of the relationship between memory bias and psy-
chopathology by investigating both positive and negative memory biases in anxiety among adolescents. Specifically,
1512 HO ET AL.

it explored the potential moderation effect of depression on the relationship between anxiety and DF of positive and
negative words.

2 METHOD

2.1 Participants
One hundred fifty-five adolescents, 80 girls (51.6%) and 75 boys (48.4%), were recruited from a high school in Hong
Kong. The participants were enrolled in grades 7 to 10 (mean age = 14.21 years, SD = 1.23 years): 44 were in grade 7
(28.4%), 45 in grade 8 (29.0%), 27 in grade 9 (17.4%), and 39 in grade 10 (25.2%).

2.2 Measures

2.2.1 Chinese version of the Revised Child Anxiety and Depression Scale
The Revised Child Anxiety and Depression Scale (RCADS) (Chorpita, Yim, Moffitt, & Umemoto, 2000) is a revision
and extension of the Spence Children's Anxiety Scale (Spence, 1998). It has 47 items that assess symptoms of anxi-
ety disorder and depression in children aged 8 to 18 years. The RCADS has five subscales related to anxiety, including
separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disor-
der, and one subscale on major depressive disorder. The Chinese version was obtained from the website of the scale
(https://www.childfirst.ucla.edu/Resources.html). The participants were required to rate on a 4-point Likert scale (from
1 = never to 4 = always) how often each item applied to them; a higher score indicated greater severity of symptoms.
Because the focus of the current study was on the interaction effect of anxiety and depression on memory bias, the anx-
iety subscale scores of the RCADS were not included in the current investigation (Brown et al., 2015). Each participant's
depression score was computed by summing the scores for the 10 items on the Major Depressive Disorder subscale,
and his or her anxiety score was obtained by summing the scores for the other 37 items, which all relate to anxiety. The
Cronbach alphas of the participants’ depression scores and anxiety scores were .839 and .923, respectively.

2.2.2 Demographic questionnaire

A demographic questionnaire we developed was administered to obtain information on each participant's age, gender,
handedness, place of birth, visual acuity, and first language.

2.3 Procedure
Ethics approval was obtained from the Human Subjects Ethics Sub-Committee of the City University of Hong Kong.
Each experiment session was conducted in a computer laboratory at the participating school, with 40 desktop comput-
ers. Written informed consent was first obtained from the parents of the students, through the participating school.
Eight experiment sessions were conducted, on different days, between March 10 and March 18, 2016. There were two
experiment sessions for each of the four grades (7–10) represented. The number of participants in each experiment
session ranged from 12 to 30, with an average of around 20 participants per session. Before the participants began
the tasks, a research assistant with an academic background in psychology explained the purpose of the study and
the procedures. The participants were reminded that participation was voluntary and that they could withdraw from
the study at any time with no negative consequences. Written consent was obtained from the participants before the
commencement of the DF task and completion of the questionnaire.

2.4 The DF task

2.4.1 Words
The word set was composed of 144 adjectives, with 48 positive, 48 neutral, and 48 negative words selected from the
Chinese Affective Word System (CAWS) (Wang, Zhou, & Luo, 2008). The first two authors (SH and JC) first selected
HO ET AL. 1513

the words and grouped them into positive, negative, or neutral categories according to the valence scores of the
CAWS. The third author (DD), who is an educational psychologist at the participating high school, reviewed all of
the words to ensure that they were suitable for the reading level of the students. Appendix 1 contains these 144
adjectives in both English and Chinese. All of the words were matched in terms of arousal (F(2,141) = .441, p = .66)
and word frequency score (F(2,141) = .653, p = .52) on the CAWS, and they differed in terms of valence score only
(F(2,141) = 751.22, p < .001). The arrangement of materials for the DF task was similar to that described in McNally,
Metzger, Lasko, Clancy, and Pitman (1998). All of the experimental words were randomized into four sets (A, B, C,
and D) of 36 words (12 positive, 12 neutral, and 12 negative). There were no significant mean differences between
the four word sets in terms of word valence (for the positive words, F(3,44) = .99, p = .40; for the neutral words,
F(3,44) = .10, p = .96; for the negative words, F(3,44) = .20, p = .92); or in terms of arousal (for the positive words,
F(3,44) = .95, p = .43; for the neutral words, F(3,44) = .10, p = .96; for the negative words, F(3,44) = .50, p = .69); or
in terms of frequency (for the positive words, F(3,44) = .77, p = .52; for the neutral words, F(3,44) = 1.48, p = .23;
for the negative words, F(3,44) = .85, p = .48). In the encoding phase, half of the participants (the AB group) first
received sets A and B; the other half (the CD group) first received sets C and D. The order of instructional assign-
ment (TBR or TBF) was counterbalanced, and the participants received the two remaining sets (e.g., for the AB group,
the remaining sets were C and D) as distractors. The order of presentation in the encoding and recognition phases was
randomized.

2.4.2 Apparatus
The stimuli were presented using the PsychoPy library written in Python (Peirce, 2007) on IBM-compatible PCs with
17-inch LCD monitors (with an aspect ratio of 4:3). Each participant was seated 60 cm away from the monitor. All of the
encoding- and test-word stimuli were presented at the center of the screen and against a white background. The words
in the encoding phase and the testing phase of the recognition condition were in black and subtended 5.7◦ × 2.9◦ of the
visual angle. The cues presented during the encoding phase were either red or green and subtended 8.6◦ × 2.9◦ of the
visual angle. The black fixation cross presented in the testing phase of the recognition condition subtended 3.5◦ × 3.5◦
of the visual angle, with a line width that subtended 0.11◦ of the visual angle. The responses were recorded using a
standard USB keypad. A blue and an orange label were put on the “4” and “6” keys on the number pad, respectively, to
facilitate the participants’ responses.

2.4.3 The experiment

The experiment had four phases. First, the participants were told to read the instructions on the computer screen; the
research assistant then repeated the instructions aloud to ensure that all of the participants understood the instruc-
tions. The DF task then commenced.

1. Encoding Phase. In this phase of the experiment, the words were presented for 2000 ms; then a blank screen was
shown for 250 ms. The cue of red XXXXX (indicating a TBF instruction) or the cue of green VVVVV (indicating a
TBR instruction) then appeared for 500 ms. Next, a blank screen was shown for 250 ms before the presentation
of the next word (see Figure 1). A previous study showed that postcue durations of 300, 600, and 900 ms yielded
no significant differences in the magnitude of the DF effect (Bancroft, Hockley, & Farquhar, 2013); this provides
support for the choice of a postcue duration of 750 ms in the present study. There were six neutral-word buffer
trials, three at the beginning and three at the end of the encoding phase, to minimize primacy and recency effects.
All six were followed by a TBF cue, but were not tested in the test phase.
2. Filler Task. A dummy Latin passage (“Lorem Ipsum”) printed on A4 paper was used for this filler task, which was
based on that in the study by Gómez-Ariza et al. (2013). The purpose of this filler task was to prevent the par-
ticipants from rehearsing the words before the commencement of the test phase. The participants were asked to
search for and circle (using a pencil) the two letters “in” wherever they occurred in the Latin passage; the task lasted
for 3 min.
1514 HO ET AL.

F I G U R E 1 Encoding phase of the directed forgetting task

Note. dd is the Chinese for “Skilled” in English.
dd is the Chinese for “Daily” in English.

F I G U R E 2 Test phase of the directed forgetting task

Note. dd is the Chinese for “Skilled” in English.
dd is the Chinese for “Daily” in English.

3. Test Phase. The participants first read the instructions on the computer screen, with the instructor repeating the
instructions aloud afterwards. Before the experiment began, each participant was instructed to place the index
finger of his or her dominant hand on the “5″ key, which was between the “4″ and “6″ keys on the number pad. In
the test phase, the participants were told to press the blue (“4″ ) key or the orange (“6″ ) key to indicate that they
had seen the words, irrespective of whether they were instructed to remember or to forget the words. Each word
remained on the screen until a participant gave his or her response, and a fixation cross was shown for 500 ms
before the presentation of the next word. There was no time limit for this task, but most of the participants were
able to complete it within 5 minutes. Finally, each participant was instructed to place his or her index finger back on
the “5″ key after each trial (see Figure 2).

2.5 Questionnaires and screening items

The participants were asked to complete the RCADS and the demographic questionnaire immediately after the
experiment. Because there were eight experiment sessions conducted on different dates, it was possible that the
HO ET AL. 1515

performance of a participant could affected by having heard about the nature of the tasks from a participant in an
earlier experiment. The following two items were included to monitor this possibility.

1. Checking item 1 was “I knew the experimental procedures before I arrived today” (1 = disagree; 2 = neither agree nor
disagree; 3 = agree).
2. Checking item 2 was “I knew the detailed content of the experiment before I arrived today” (1 = disagree; 2 = neither
agree nor disagree; 3 = agree).

Participants who scored 3 (i.e., who chose agree) on either of the above-mentioned two items were excluded from
the analyses. There was no time limit for the completion of the questionnaire. Upon completion of the experiment, a
certificate and a university souvenir pen worth about US$1 (HK$8) were given to each participant as a small token of
appreciation for their participation. Before they left the computer laboratory, the participants were told not to disclose
any details of the experiment to other participants.

2.6 Data analysis

Participants with a positive response to either of the two checking items were excluded. Chi-square analysis and one-
way analysis of variance/t-tests were conducted to examine if there were significant differences between the selected
and nonselected participants with regard to their performance. We calculated the DF indexes by subtracting the num-
ber of correctly recognized TBF words from the number of correctly recognized TBR words (which had been pre-
sented in the encoding phase), irrespective of the instruction (Liang et al., 2011; Müller et al., 2005). Three indexes
were obtained: (1) DF Positive = Positive TBR words − Positive TBF words; (2) DF Negative = Negative TBR words −
Negative TBF words; and (3) DF Neutral = Neutral TBR words − Neutral TBF words. A higher score indicated a stronger
intentional forgetting effect; that is, it indicated that the participant more readily forgot words after being instructed
to forget them. Descriptive statistics of the DF indexes and RCADS scores were compiled next, and analyses were
conducted to examine whether any of the demographic variables should be controlled for as covariates in subsequent
analyses. We first conducted a 2 (instructions—TBR vs. TBF) × 3 (word types—positive vs. negative vs. neutral) mixed
design ANOVA with repeated measures on instructions and word types. We particularly wanted to examine whether
the TBR words had been recognized better than the TBF words, to ensure that the DF effect had occurred in the exper-
iment. We also anticipated a word types main effect, with negative words being recognized better (i.e., being harder
to forget) than positive words (Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001; Rozin & Royzman, 2001). Next,
we used regression-based moderation analysis (Hayes, 2013) to examine whether Depression moderated the rela-
tionships between Anxiety and the DF indexes of the positive, negative and neutral words separately. Linearity, equal
variance and normality assumptions were checked by a normal P–P plot of regression standardized residuals and his-
togram. The tolerance figure was calculated to examine potential multicollinearity between the anxiety and depression
scores. The regression-based moderation analysis was conducted using the SPSS macro developed by Hayes (2013).
The Johnson–Neyman technique (Johnson & Neyman, 1936) was used to probe significant interactions (Bauer & Cur-
ran, 2005; Hayes, 2013).

3 RESULTS

3.1 Screening of participants

Thirteen participants (8.4%) mentioned that they had either heard about the procedures or known about the details of
the experiment before they attended the session; 11 of these 13 participants gave a positive response to both screening
items (i.e., they had heard about the procedures and knew the details). Because prior knowledge of the DF procedures
defeats the purpose of the TBR and TBF instructions, these 13 participants were excluded from subsequent analyses.
1516 HO ET AL.

TA B L E 1 Mean and standard deviation of psychological variables by grade of study

Grade 7 Grade 8 Grade 9 Grade 10 Total

(n = 41) (n = 39) (n = 23) (n = 39) (n = 142)

Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) F value
Anxiety 29.49 33.46 40.74 38.1 34.77 3.13*
(16.59) (17.02) (17.03) (14.33) (16.56)
Depression 6.88 8.20 9.72 10.00 8.57 3.29*
(5.06) (4.78) (5.64) (4.33) (5.01)
DF Positive .66 .72 .13 1.08 .70 .77
(2.33) (2.22) (2.05) (2.73) (2.37)
DF Negative 1.71 .85 1.17 1.46 1.32 .89
(2.72) (2.22) (2.42) (2.45) (2.47)
DF Neutral − .12 .95 .96 .87 .62 2.14ª
(2.16) (2.08) (2.64) (2.19) (2.26)

*p < .05, ªp = .098.

Note. Anxiety: Chinese version of the Revised Child Anxiety and Depression Scale Anxiety Score; Depression: Chinese version
of the Revised Child Anxiety and Depression Scale Depression Score; DF Positive: Directed Forgetting Index - Positive Words;
DF Negative: Direct Forgetting Index - Negative Word; DF Neutral: Directed Forgetting Index – Neutral Words.

Chi-square analyses showed that the selected and nonselected participants were not significantly different in terms of
their gender (𝜒 2 (1) = .03, p = .87) or grade (𝜒 2 (3) = 6.60, p = .09). Independent sample t-tests showed that there were
no significant differences between these two groups in terms of their psychological symptoms: anxiety, t(153) = −.98,
p = .33; depression, t(153) = −.82, p = .41; and RCADS total, t(153) = −.99, p = .32.
The final sample consisted of 142 participants: 73 girls (51.4%) and 69 boys (48.6%). The grade distribution was
as follows: 41 were in grade 7 (28.9%), 39 in grade 8 (27.5%), 23 in grade 9 (16.2%), and 39 in grade 10 (27.5%). The
mean age of the participants was 14.23 years (SD = 1.25 years); the range was 12.25–17.70 years. Chi-square analysis
showed that gender was distributed evenly across all of these grades (𝜒 2 (3) = .355, p = .95). Most of the participants
(n = 149, 96.1%) were right-handed and spoke Cantonese as a first language (n = 132, 93.0%).

3.2 Descriptive statistics

Table 1 shows the mean scores of the psychological measures, by the participants’ grades. The mean scores of the
RCADS anxiety and depression subscales were converted into T scores according to the user's guide of the RCADS
(Chorpita, Ebesutani, & Spence, 2015). All T scores were below 65, the borderline clinical threshold for both anxiety
and depression.
One-way ANOVA revealed significant differences between the RCADS scores of the participants in different grades.
Scheffé post-hoc tests revealed that grade 10 participants reported marginally more depression symptoms than grade
7 participants (with mean scores of 10.00 and 6.88, respectively; p = .05). Furthermore, grade 9 participants had
marginally a higher anxiety score than those in grade 7 (with mean scores of 40.74 and 29.49 respectively, p = .07).
No other significant differences were revealed by the Scheffé tests. Further, there were no significant differences cor-
relating any of the psychological variables to gender. Grade was the only demographic variable to be controlled for as
a covariate in the subsequent analyses.

3.3 Partial correlation analyses

Because significant differences between the RCADS scores of the participants in different grades were obtained (see
Table 1), partial correlation analyses were conducted with grade as a covariate. Age did not correlate with any of the
HO ET AL. 1517

TA B L E 2 Partial correlation with grade of study as a covariate (n = 142)

1 2 3 4 5 6
1. Age 1 − .01 .12 − .15 .04 .04
2. Anxiety 1 .72** .03 − .12 .14
3. Depression 1 .01 .04 .20*
4. DF Positive 1 .13 .03
5. DF Negative 1 .10
6. DF Neutral 1

**p < .01, *p < .05.

Note. Anxiety: Chinese version of the Revised Child Anxiety and Depression Scale Anxiety Score; Depression: Chinese version
of the Revised Child Anxiety and Depression Scale Depression Score; DF Positive: Directed Forgetting Index – Positive Words;
DF Negative: Direct Forgetting Index – Negative Word; DF Neutral: Directed Forgetting Index – Neutral Words.

psychological variables. Depression was significantly and positively correlated with DF Neutral (r = .204, p = .02), sug-
gesting that the participants with more severe depressive symptoms tended to forget neutral-valence words better,
especially when they were instructed to do so. No other significant results were obtained. (Table 2)

3.4 Analysis of variance to examine the DF effect

A 2 (instruction: TBR vs. TBF) × 3 (word type: positive vs. negative vs. neutral) ANOVA with repeated measures on
instruction and word type was conducted first. No covariate was included because grade, gender, first language, place
of birth, and visual acuity had no significant effect on variables in the analysis.
The instruction main effect was significant, with a large effect size (F(1, 141) = 50.14, p < .01, partial 𝜂 2 = .26). Sub-
sequent paired-sample t-tests showed that the participants correctly recognized more TBR words than TBF words,
irrespective of word type and RCADS category (t(141) = 7.08, p < .01). A significant word type main effect was also
obtained, with a medium effect size (F(2,140) = 8.34, p < .01, 𝜂 2 = .11). Paired sample t-tests showed that negative-
valence words were recognized better than either positive-valence words (t(141) = 3.27, p = .001) or neutral-valence
words (t(141) = 3.85, p < .01). There was no significant difference between the recognition of positive-valence words
and that of neutral-valence words (t(141) = .62, p = .54). A significant instruction × word type interaction effect
was obtained, with a small effect size (F(2, 140) = 3.829, p = .02, partial 𝜂 2 = .06). Subsequent paired-sample t-tests
showed that under the TBR condition, negative-valence words were recognized better than the positive-valence words
(t(141) = −3.893, p < .001) or the neutral-valence words (t(141) = −4.758, p < .001). No significant differences related
to word type were obtained under the TBF condition.

3.5 Moderation analysis

Separate anxiety × depression interaction analyses, with DF Positive, DF Negative, and DF Neutral as the dependent
variables, were conducted, using the SPSS macro developed by Hayes (2013). The tolerance figure between anxiety
and depression was .46, demonstrating that multicollinearity was not an issue. Linearity, equal variance and normality
assumptions were met. The results are set out in Table 3 below.
For DF Positive, neither the anxiety main effect (p = .84, LLCI = −.03, and ULCI = .04) nor the depression main effect
(p = .66, LLCI = −.14, and ULCI = .09) was significant. A significant anxiety × depression interaction effect was obtained
(p = .02, LLCI = .00, and ULCI = .01). Figure 3 depicts the interaction relationship. The Johnson–Neyman technique
revealed that for participants with a depression score above 13.34, the anxiety score was positively associated with
the DF index for the positive-valence words. No significant relationship between the anxiety score and the DF index
for positive-valence words was obtained for participants with medium or low depression scores.
With regard to the negative-valence words, both the anxiety main effect (p = .01, LLCI = −.09, and ULCI = −.01) and
the depression main effect were significant (p = .04, LLCI = .00, and ULCI = .24). A higher anxiety score was related to a
1518 HO ET AL.

TA B L E 3 Model coefficients, standard errors, and model summary information for moderation of depression and
anxiety on directed forgetting indexes of positive, negative, and neutral words

Unstandardized coefficient
B SE p 95% CI
DF Positive
Anxiety .00 .02 .84 [− .03, .04]
Depression − .03 .06 .66 [− .14, .09]
Anxiety × Depression .00 .00 .02* [.00, .01]
R2 = .04, F(1, 138) = 1.82, p = .15
DF Negative
Anxiety − .05 .02 .01* [− .09, − .01]
*
Depression .12 .06 .04 [.00, .24]
Anxiety × Depression .00 .00 .15 [− .00, .01]
R2 = .06, F(3, 138) = 3.10, p = .03
DF Neutral
Anxiety − .00 .02 .93 [− .03, .03]
Depression .11 .06 .05* [.00, .22]
Anxiety × Depression − . 00 .00 .85 [− .00, .00]
R2 = .06, F(3, 138) = 2.68, p = .05

Note. B: unstandardized coefficient; SE: standard error; CI: confident interval; Anxiety: Chinese version of the Revised Child
Anxiety and Depression Scale Anxiety Score; Depression: Chinese version of the Revised Child Anxiety and Depression Scale
Depression Score; DF Positive: Directed Forgetting Index – Positive Words; DF Negative: Direct Forgetting Index – Negative
Word; DF Neutral: Directed Forgetting Index – Neutral Words.

lower DF index for the negative-valence words (t-value = −2.76); in contrast, a higher depression score was associated
with a higher DF index for the negative-valence words (t-value = 2.04). The anxiety × depression interaction effect was
not significant (p = .15, LLCI = .00, and ULCI = .01).
Only one other marginal main effect was obtained: the participants with a higher depression score tended to have a
higher DF index for the neutral-valence words (p = .05, LLCI = .00, and ULCI = .22).

4 DISCUSSION

The major objective of this study was to examine both positive and negative memory biases in anxiety among ado-
lescents with depression being controlled as a moderator. When anxiety and depression were treated as dimensional
variables in a regression-based approach, a significant anxiety × depression interaction effect was obtained, and the
Johnson–Neyman technique showed that only among individuals with high levels of depression did levels of anxiety
show a positive relationship with the DF of positive-valence words. In other words, individuals with higher anxiety,
when compared with those with lower anxiety, were more prone to forgetting the positive-valence words. It is possi-
ble that the retrieval of positive memories could predispose depressed individuals to compare their past experience
to their current depressed state, leading to a sense of deterioration over time, which could increase their anxiety
levels (Joormann & Siemer, 2004; Lotterman & Bonanno, 2014). For participants with low levels of depression, anx-
iety seemed to have no significant relationship with the intentional forgetting of positive-valence words. The avoid-
ance behavior commonly found in depressive individuals (Ottenbreit & Dobson, 2004) might interfere with the selec-
tive rehearsal of TBR positive-valence words, which was an important cognitive process in the item method used in
the present study (Basden et al., 1993). A recent study also showed that anxiety interacts with attentional control
on positive attentional bias among adolescents (Ho, Yeung, & Mak, 2016). Given the high comorbidity of anxiety and
HO ET AL. 1519

F I G U R E 3 Interaction effect of RCADS-Anxiety and RCADS-Depression on directed forgetting of positive words

Note. Among participants with high level of depression, higher level of anxiety was related to higher tendency of
directed forgetting of positive words. The relationship between level of anxiety and directed forgetting of positive
words was not significant for participants with medium and low level of depression.

depression among young people (Anderson & Hope, 2008), other potential moderators should be investigated further
in future studies (Mitte, 2008).
TBR words were recognized significantly better than TBF words, according to the analysis of variance and the sub-
sequent t-test findings (t(141) = 7.082, p < .01). This result shows that the DF instruction was effective in the current
study. Paired-sample t-tests revealed that negative-valence words were recognized better than either positive-valence
words or neutral-valence words. An analysis of variance also showed a significant instruction (TBR, TBF) × word type
(positive, negative, neutral) effect, with negative words being better recognized than either positive or negative words
under the TBR condition but not under the TBF condition. Our results showed that individuals tended to remember
negative materials better than they did positive and neutral materials, especially when they were asked to remem-
ber them. Updating memory content may require an inhibitory executive control mechanism to make nonrelevant
memories less accessible (Anderson, 2005; Bjork et al., 1998). Because emotions enhance mood-congruent mem-
ory, emotional materials should be harder to forget than neutral materials (Minnema & Knowlton, 2008; Reisberg &
Hertel, 2004). Negative-valence materials, which are more salient than positive-valence materials, appear to com-
mand more attention (Baumeister et al., 2001; Rozin & Royzman, 2001) and are remembered more accurately than
positive-valence materials in some contexts, such as an emotionally charged public event (Kensinger & Schacter, 2006).
Our results are consistent with the suggestion made by other researchers that negative information should command
more attention and should be more difficult to forget (Baumeister et al., 2001; Kensinger & Schacter, 2006; Rozin &
Royzman, 2001). Overall, we found a DF effect in our Chinese-speaking sample (using Chinese words as stimuli) similar
to that found in English-speaking samples (using English words as stimuli) by Western researchers.
Consistent with our hypothesis, an anxiety main effect was obtained for negative-valence words. We found that, in
line with some previous findings (Airaksinen, Larsson, & Forsell, 2005; Pacheco-Unguetti, Acosta, Callejas, & Lupiáñez,
2010; Wilhelm, McNally, Baer, & Florin, 1996), higher levels of anxiety were associated with less DF of negative-valence
1520 HO ET AL.

words. In other words, according to our findings, anxious individuals exhibited an impaired ability to forget negative
memories. According to the cognitive model of anxiety, anxious individuals tend to allocate more attention to threaten-
ing/negative information (Aikins & Craske, 2001; Craske et al., 2009), leading to better recognition of negative-valence
words. It should be noted that earlier studies have reported that memory bias among anxious individuals towards
negative-valence words applied only to implicit memory tasks, not to explicit memory tasks (MacLeod & McLaughlin,
1995). The recognition task used in the present study may be considered an explicit memory task, so our results sug-
gested that anxious individuals exhibited a memory bias towards negative-valence words in explicit memory tasks as
well.
In contrast to our hypothesis and to the prediction of the mood-congruent memory bias proposition (Watkins, 2002)
that more severe depression should be associated with more negative memory bias, it was found that depression was
positively correlated with the DF of negative words among the adolescents in our sample. In other words, adolescents
with more depression tended to forget negative materials better, especially when they were instructed to do so. The
avoidance tendency of depressive individuals (Ottenbreit & Dobson, 2004) may explain the smaller DF of negative-
valence words among individuals with higher levels of depression. However, other studies have shown that the DF
effect among depressed individuals was moderated by the kind of instructions given to them (TBR vs. TBF) (Claudio,
Noronha, & Balola, 2014; Minnema & Knowlton, 2008). This possibility is beyond the scope of the present study and
should be investigated further.
Both the univariate correlation analysis (see Table 2) and the regression-based analysis (see Table 3) showed a sig-
nificant depression main effect on the DF of neutral-valence words: individuals with more severe depressive symp-
toms tended to show a stronger DF effect with neutral words. This finding could be explained by the cognitive bias of
depressive individuals: they may interpret neutral stimuli as negative stimuli (Lawson & MacLeod, 1999; Lo et al., 2008).
Recently, it has been shown that interpretation bias has an effect on memory performance among depressed individ-
uals (Everaert, Tierens, Uzieblo, & Koster, 2013). Furthermore, because the valence rating of words may vary across
populations (Ho et al., 2015), it is possible that some of our participants might have appraised the neutral words used
in our experiments as negative-valence words, leading to our finding that the positive relationship between depressive
symptoms and negative-valence words also applied to neutral words. A previous study used complex pictures in a DF
experiment (Hauswald & Kissler, 2008), and positive and negative pictures are commonly used (e.g., in the visual dot-
probe experimental paradigm) to investigate attentional bias (Chan, Ho, Tedeschi, & Leung, 2011; MacLeod & Mathews,
1991; MacLeod, Mathews, & Tata, 1986). Picture stimuli, in addition to or instead of words, should be considered for
future studies. Finally, Liang et al. (2011) failed to find any DF effect in their recognition task and mentioned that it is
unclear how to explain their findings. Our experiment used a recognition task and found DF effects with both positive-
and negative-valence words among anxious individuals. It should be noted that Liang et al.’s (2011) study was con-
ducted among socially anxious university students, whose characteristics are different from those of the sample used
in the present study. In addition, the results may be attributed to the statistical analysis strategies used in the present
study or may be explained by other, unknown reasons.
The present study has several limitations. As already mentioned, the use of emotional words may be subject to dif-
ferent interpretation biases when participants come from different cultures. For this study, words were selected from
the CAWS (Wang et al., 2008) to reduce interpretation variation. However, in future studies, researchers should con-
sider using pictures as stimuli to facilitate crosscultural comparison of the findings. Furthermore, the words in each
valence group (positive, negative, neutral) did not share the same emotional overtones in this study. For examples, the
negative valence group contained words related to threat, sadness and harm. Given that anxiety has been related to
bias towards threat in particular, future study may examine whether a different result is obtained when threatening
words alone are used. Our community sample may mean that the results cannot be generalized to individuals with
clinical anxiety disorders. It would be interesting to see whether the current findings can be replicated in independent
clinical samples. Furthermore, only a DF item-method recognition task was used in the current study; in the future,
other experimental methods—such as the free recall and list methods—should be used.
Our findings have several clinical implications. First, the finding of a more prominent negative memory bias among
anxious and depressed individuals supports conventional approaches to reducing negative cognitive processing bias
HO ET AL. 1521

among anxious individuals (Clark & Beck, 2011; Kendall & Chansky, 1991). For instance, the cognitive approach to
changing the distorted interpretation of an event can reduce negative memory bias. Cognitive bias modification pro-
grams (Amir, Beard, Burns, & Bomyea, 2009; Amir, Beard, Taylor, et al., 2009) to reduce negative attention may help
to reduce negative memory. Other methods to increase positive memory sensitivity may be useful for reducing anxi-
ety among those with high levels of depression. Positive psychology interventions (Seligman, Steen, Park, & Peterson,
2005) such as gratitude training to increase sensitivity to positive events may be relevant to reducing anxiety and
depression in adolescents (Linley & Joseph, 2004). Cognitive bias modification programs to enhance positive atten-
tional bias among children (Waters et al., 2015) may also help to increase positive memory bias.
In conclusion, the results of the present study revealed that negative memory bias is a cognitive processing error
shared by both anxiety and depression. However, anxious individuals tended to exhibit more negative memory bias,
whereas depressive individuals tended to show less memory bias. The effect of positive memory bias on anxiety was
moderated by levels of depressive symptoms: only individuals with high levels of depressive symptoms showed a nega-
tive relationship between anxiety level and positive memory bias. Conventional intervention to reduce negative cogni-
tive bias may be effective in reducing anxiety symptoms irrespective of the depression level. Interventions to increase
positive memory sensitivity may be effective in reducing anxiety symptoms only among those with concurrent high
depression levels.

ACKNOWLEDGMENTS
We would like to express our sincere gratitude to the teachers and students of The ELCHK Yuen Long Lutheran
Secondary School for their participation in this study. This work was supported by the General Research Fund of the
University Grant Committee (Project number: 11606715).

ORCID
Samuel M.Y. Ho http://orcid.org/0000-0001-7803-1657

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How to cite this article: Ho SMY, Cheng J, Tong DW, Tam T, Hui O. The effect of positive and neg-
ative memory bias on anxiety and depression symptoms among adolescents. J Clin Psychol. 2018;74:
1509–1525. https://doi.org/10.1002/jclp.22597