Effectiveness, Dissemination & Implementation of Memory Specificity Training

A deficit in the ability to retrieve specific autobiographical memories, referred to as reduced autobiographical memory specificity (rAMS), is considered to be a transdiagnostic vulnerability factor. Since 2009 one intervention called Memory Specificity Training (MeST), has repeatedly been been shown to successfully remediate rAMS. In some examinations, concomitant effects of MeST on related psychological processes such as rumination and hopelessness, and on symptoms of depression and posttraumatic stress disorder, are found as well. More efficacy research is needed. However, interventions that work in research do not always translate to clinical practices and as such, there is also a need for research which examines how to implement MeST. In addition, in recent years the need for other methods of delivery and training clinicians became more prevalent in clinical psychology. The goal of this dissertation was to explore the fit of MeST in clinical practices and to train clinicians in MeST whilst keeping its core mechanism of increasing memory specificity intact. This dissertation also explored a new computerized individualized method of delivery called c-MeST.

The first chapter of this dissertation introduces key concepts such as autobiographical memory, rAMS and MeST. Second, relevant trends in clinical psychology that formed the context in which this dissertation occurred, are described. Chapters 2 and 3 focus on the transportability of MeST. In Chapter 2, results are presented showing that MeST was transportable to clinical settings, such that it was feasible for clinicians involved and MeST continued to be as effective in improving memory specificity as it is in research settings. Chapter 3 presents results on how MeST was implemented in clinical practices using a web-based self-directed training protocol. When using this protocol, trainers showed fidelity to the protocol, MeST kept its core mechanism intact, and attitudes of stakeholders (psychiatrists, psychologists, nurses and therapists) and users towards MeST were generally positive.

In Chapters 4, 5 and 6 three studies examining c-MeST are presented. The study designs varied: A multiple baseline across participants design with a follow-up of 3 months in 20 participants with a history of depression (Chapter 4); an observational before-after design with a follow-up of 1 month in 21 healthy older adults (Chapter 5); and, an experimental before-after case study with a follow-up of 1 month in 1 person with rapid cycling bipolar disorder type 1 (Chapter 6). In all three studies, memory specificity increased from pre-intervention to the follow-up assessment, showing that c-MeST can indeed improve memory specificity. However, no impact on secondary measures such as rumination, problem solving or depressive symptomatology was found, probably because of a floor effect in related processes and symptoms in Chapters 4 and 5 and the presence of a hypomanic phase at baseline in Chapter 6.

All results and limitations are summarized in Chapter 7. This dissertation is concluded with suggestions for future research for interventions derived from basic science in an era of process-based clinical psychology.