Effectiveness of Memory Specificity Training on Emotion Regulation and Adherence in Cancer Patients

Document Type : Original Article


1 PhD student in psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran

2 Professor, Department of Clinical Psychology, Khwarazmi University, Higher Education Institute of Cognitive Sciences, Tehran, Iran

3 Assistant Professor, Department of Psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran

4 Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran


Introduction: Cancer is one of the most  challenging diseases in the current age. Therefore it is important to choose and use an intervention aimed at improving the quality of life, mental health, and adaptation to the disease in cancer patients. This research is carried out to determine the effectiveness of Memory Specificity Training, as a short-term training intervention, on emotion regulation and adherence in cancer patients.
Method: This survey is applied research using a semi-experiment design that applies repeated measures (pre-test/post-test/follow-up) control group. The study population consisted of all outpatients in Tehran hospitals and medical care centers, who are diagnosed with Cancer in 2021. 60 patients were recruited by convenience sampling method. They were randomly categorized into experimental and control groups. Participants in the experimental group received Memory Specificity Training in 90 minutes sessions for 6 weeks. Patients were interviewed by a semi-structured clinical interview and filled out Cognitive Emotion Regulation Questionnaire (CERQ) and Adherence Questionnaire. Data were analyzed by mixed variance analysis and SPSS-24.
Results: Significant higher and lower scores were found respectively for adaptive emotion regulation strategies and maladaptive strategies in the Memory Specificity Training group compared to the control group.  A significant difference was also observed in adherence scores. Significant indices of Group Main Effect (F=13.85, p<0.01, Ƞ2=0.251), Time Main Effect (F=274.22, p<0.01, Ƞ2=0.825), and Interaction Main Effect (F=283.21, p<0.01, Ƞ2=0.830) were found.
Conclusion: Memory Specificity Training leads to improving emotion regulation strategies and increasing adherence in cancer patients.


  1. منابع

    1. American Cancer Society. Cancer Facts and Figures. Atlanta, Ga: American Cancer Society, 2019; Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures.
    2. Copeland, B., Green, G., & Firth, D. Cancer in North America: 2011-2015. Volume Two: Registry-specific Cancer Incidence in the United States and Canada. Springfield, IL: North American Association of Central Cancer Registries; 2018.
    3. Sanatani, M., Schreier, G., & Stitt, L. Level and direction of hope in cancer patients: An exploratory longitudinal study. Support. Care Cancer. 2008; 16: 493–499.
    4. Strong, V., Waters, R., Hibberd, C., Rush, R., Cargill, A., Storey, D., Sharpe, M. Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study. Br J Cancer. 2007; 96(6): 868–874.
    5. Myhren, H., Tøien, K., Ekeberg, O., Karlsson, S., Sandvik, L., & Stokland, O. Patients' memory and psychological distress after ICU stay compared with expectations of the relatives. Intensive Care Med. 2009; 35(12): 2078-86.
    6. Sears, S. R., Stanton, A. L., & Danoff-Burg, S. The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol. 2003; 22: 487–497.
    7. Adler, N. E., & Page, A. E. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington DC- USA: National Academies Press; 2008.
    8. Andersen, B. L., Rowland, J. H., & Somerfield, M. R. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: An American Society of Clinical Oncology guideline adaptation. J. Clin. Oncol. 2015; 11: 133–134.
    9. Ness, S., Kokal, J., Fee-Schroeder, K., Novotny, P., Satele, & D., Barton, D. Concerns across the survivorship trajectory: Results from a survey of cancer survivors. Oncol. Nurs. Forum. 2013; 40: 35–42.
    10. Conley, C. C., Bishop, B. T. & Andersen, B. L. Emotions and Emotion Regulation in Breast Cancer Survivorship. Healthcare (Basel). 2016; 4(3): 56.
    11. Moradi, A., Jabari, H., Miraghayi, A. M., Parhoon, H., Forooghi M. & Moradmand-Badiee, B. Autobiographical memory performance among people with AIDS/HIV. Res Psychol Health. 2010; 3(4): 17-26.
    12. Greer, J. A., Pirl, W. F., Park, E. R., Lynch, T. J., & Temel, J. S. Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer. J. Psychosom. Res. 2008; 65: 549–552.
    13. Satin, J. R., Linden, W., & Phillips, M. J. Depression as a predictor of disease progression and mortality in cancer patients: A meta-analysis. Cancer. 2009; 115: 5349–5361.
    14. Bultz, B. D., & Carlson, L. E. Emotional distress: The sixth vital sign in cancer care. J. Clin. Oncol. 2005; 23: 6440–6441.
    15. Curry, S., & Fitzgibbon, M. Theories of Prevention. In S. A. Schumaker, J. K., Ockene, & K. A. Riekert (Eds.) The handbook of health behavior change. New York, NY: Springer Publishing Co. 2009.
    16. WHO. Adherence to long-term therapies: evidence for action. 2003; Available from: https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=D455EAAEA65CC0846AA956585F441F75?sequence=1.
    17. Rand, C. S. Measuring adherence with therapy for chronic diseases: Implications for the treatment of heterozygous familial hypercholesterolemia. American Journal of Cardiology. 1993; 72(10): 68D–74D.
    18. Haynes, R. B. Determinants of compliance: The disease and the mechanics of treatment. In Haynes, R. B. (Ed.): Compliance in healthcare. Baltimore, MD: Johns Hopkins University Press; 1979.
    19. Levin, J. B., Krivenko, A., Bukach, A., Tatsuoka, C., Cassidy, K. A., Sajatovic, M. A. Reexamination of Nonpsychiatric Medication Adherence in Individuals With Bipolar Disorder & Medical Comorbidities. J Nerv Ment Dis. 2017; 205(3):182-7.
    20. Rosenstock, I. M. Enhancing patient compliance with health recommendations. Journal of Pediatric Health Care. 1988; 2(2): 67–72.
    21. Feachem, R. G., Sekhri, N. K., & White, K. L. Getting more for their dollar: A comparison of the NHS with California’s Kaiser Permanente. British Medical Journal. 2002; 324(7330): 135–141.
    22. McWilliam, C. L. Patients, persons or partners? Involving those with chronic disease in their care. Chronic Illness. 2009; 5(4): 277–292.
    23. Dunbar-Jacob, J., & Schlenk, E. Patient adherence to treatment regimen. In A. Baum & T. Revenson (Eds.), Handbook of health psychology Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2001.
    24. McDonald, H. P., Garg, A. X., & Haynes, R. B. Interventions to enhance patient adherence to medication prescriptions: Scientific review. The Journal of the American Medical Association. 2002; 288(22): 2868–2879.
    25. Berg, J., Evangelista, L. S., Carruthers, D., & Dunbar-Jacob, J. M. Adherence. In Larsen, P. D., Lubkin, I. M. (Ed.), Chronic Illness: Impact And Intervention. Burlington, MA: Jones & Bartlett Learning; 2013.
    26. De la Torre-Luque, A., Gambara, H., López, E., & Cruzado, J. A. Psychological treatments to improve quality of life in cancer contexts: A meta-analysis. International Journal of Clinical and Health Psychology. 2016; 16(2): 211-219.
    27. National Institute of Health and Care Excellence. Depression in adults: Recognition and management [clinical guide]. 2017; Available from www.nice.org.uk/guidance/cg90/chapter/1-Guidance.
    28. Docherty, M., & Thornicroft, G. Specialist mental health services in England in 2014: Overview of funding, access and levels of care. International Journal of Mental Health Systems. 2015; 9. 34.
    29. Farahimanesh, S., Moradi, A., Sadeghi, M. Impacts of Competitive Memory Training Program on Interpretation-bias in Cancer Patients with Post-traumatic Stress Disorder. Journal of Clinical Psychology, 2020; 12(1): 37-48.
    30. Barry, T., Hallford, D., Hitchcock, C., Takano, K., & Raes, F. The current state of Memory Specificity Training (MeST) for emotional disorders. Current Opinion in Psychology. 2021; 41(5).
    31. Serrano, J. P., Latorre, J. M., Gatz, M., & Montanes, J. Life review therapy using autobiographical retrieval practice for older adults with depressive symptomatology. Psychol Aging. 2004; 19: 270-277.
    32. Erten, M. N., & Brown, A. D. Memory Specificity Training for Depression and Posttraumatic Stress Disorder: A Promising Therapeutic Intervention. Frontiers in psychology. 2018; 9: 419.
    33. Santos Alves Peixoto, L., Guedes Gondim, S. M., & Pereira, C. R. Emotion Regulation, Stress, and Well-Being in Academic Education: Analyzing the Effect of Mindfulness-Based Intervention. Trends in Psychology. 2022; 30(1), 33–57.
    34. Ahola, A. J., Forsblom, C., Harjutsalo, V., & Groop, P. H. Perceived Stress and Adherence to the Dietary Recommendations and Blood Glucose Levels in Type 1 Diabetes. Journal of diabetes research. 2020; 3548520.
    35. Colombo, D., Serino, S., Suso-Ribera, C., Fernández-Álvarez, J., Cipresso, P., García-Palacios, A., Riva, G., & Botella, C. The Moderating Role of Emotion Regulation in the Recall of Negative utobiographical Memories. Int. J. Environ. Res. Public Health. 2021; 18: 7122.
    36. Quenstedt, S. R., Sucher, J. N., Pfeffer, K. A., Hart, R. & Brown, A. D. Autobiographical Memory and Future Thinking Specificity and Content in Chronic Pain. Front. Psychol. 2021; 11: 624187.
    37. Raes, F., Hermans, D., de Decker, A., Eelen, P., & Williams, J. M. G. Autobiographical memory specificity and affect regulation: An experimental approach. Emotion. 2003; 3(2): 201–206.
    38. Hallford, D. J., Austin, D.W., Takano. K., Fuller-Tyszkiewicz, M., Raes, F. Computerized Memory Specificity Training (c-MeST) for major depression: A randomised controlled trial. Behav Res Ther. 2021; 136: 103783.
    39. Neshat-Doost, H. T., Dalgleish, T., Yule, W., Kalantari, M., Ahmadi, S. J., & Dyregrov, A. Enhancing Autobiographical Memory Specificity Through Cognitive Training: An Intervention for Depression Translated From Basic Science. Clin Psychol Sci. 2012; 1-9.
    40. Moradi, A.R., Moshirpanahi, S., Parhon, H., Dalgleish, Ti, & Jobson, L. A pilot randomized controlled trial investigating the efficacy of MEmory Specificity Training in improving symptoms of posttraumatic stress disorder. Journal of Behaviour Research & Therapy. 2014; 56: 68-74.
    41. Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., & Johansen, C. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011; 12: 160-174.
    42. Farahimanesh, S. Moradi, A.R., Sadeghi, M., & Jobson, L. Comparing the Efficacy of Competitive Memory Training (COMET) and MEmory Specificity Training (MEST) on Posttraumatic Stress Disorder Among Newly Diagnosed Cancer Patients. Cognitive Therapy and Research. 2020; 45(5): 918–928.
    43. Hallford, D. J., Carmichael, A., Austin, D., Takano, K., Raes, F., Fuller-Tyszkiewicz, M. A study protocol for a randomised trial of adjunct computerised memory specificity training (c-MeST) for major depression in youth: targeting cognitive mechanisms to enhance usual care outcomes in mental health settings. Trials. 2020; 21(85).
    44. Sumner, J. A., Griffith, J. W., & Mineka, S. Overgeneral autobiographical memory as a predictor of the course of depression: A meta-analysis. Behaviour Research and Therapy. 2010; 48(7): 614–625.
    45. Garnefski, N., Kraaij, V., & Spinhoven, P. H. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences. 2001; 30: 1327-1311.
    46. Hasani, J. The Psychometric Properties of the Cognitive Emotion Regulation Questionnaire (CERQ). Journal of Clinical Psychology, 2010; 2(3): 73-84.
    47. Seyed Fatemi N, Rafii F, Hajizadeh E, Modanloo M. Psychometric properties of the adherence questionnaire in patients with chronic disease: A mix method study. Koomesh. 2018; 20 (2):179-191.
    48. Iyadurai, L., Visser, R. M., Lau-Zhu, A., Porcheret, K., Horsch, A., Holmes, E. A., & James, E. L. (2019). Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application. Clinical psychology review, 69, 67–82.
    49. Adenauer, H., Catani, C., Gola, H., Keil, J., Ruf, M., Schauer, M., & Neuner, F. Narrative Exposure Therapy for PTSD increases top-down processing of aversive stimuli – evidence from a randomized controlled treatment trial. BMC Neuroscience. 2011; 12 (1): 1-13.
    50. Conway, M. A. Sensory-perceptual episodic memory and its context: autobiographical memory. Philosophical transactions of the Royal Society of London. 2001; 356(1413): 1375-84.
    51. Smyth, J. M. Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology. 1998; 66(1): 174–184.
    52. Stenmark, H., Catani, C., Neuner, F., Elbert, T., & Holen, A. Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study. Behaviour Research and Therapy. 2013; 51(10): 641–647.
    53. Piltan, M., Moradi, A., Choobin, M., Azadfallah, P., Eskandari, S., & Hitchcock, C. Impaired Autobiographical Memory Flexibility in Iranian Trauma Survivors With Posttraumatic Stress Disorder. Clinical Psychological Science. 2021; 9 (2): 294-301.
    54. Williams, J. M. G., Barnhofer, T., Crane, C., Herman, D., Raes, F., Watkins, E. R., & Dalgleish, T. Autobiographical memory specificity and emotional disorder. Psychological Bulletin. 2007; 133(1): 122–148.
    55. Starr, L. R., & Davila, J. Responding to anxiety with rumination and hopelessness: Mechanism of anxiety-depression symptom co-occurrence? Cognitive Therapy and Research. 2012; 36, 321-337.
    56. Colombo, D., Serino, S., Suso-Ribera, C., Fernández-Álvarez, J., Cipresso, P., García-Palacios, A., Riva, G., & Botella, C. The Moderating Role of Emotion Regulation in the Recall of Negative utobiographical Memories. Int. J. Environ. Res. Public Health. 2021; 18, 7122.
    57. Quenstedt, S. R., Sucher, J. N., Pfeffer, K. A., Hart, R. & Brown, A. D. Autobiographical Memory and Future Thinking Specificity and Content in Chronic Pain. Front. Psychol. 2021; 11, 624187.
    58. Wegner, D. M., & Bargh, J. A. Control and automaticity in social life. In D. T. Gilbert, S. T. Fiske, & G. Lindzey (Eds.), The handbook of social psychology(pp. 446–496). McGraw-Hill; 1998.
    59. Nolen-Hoeksema, S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000; 109(3): 504-11.
    60. Gross, J. J., & Barrett, L. F. Emotion generation and emotion regulation: One or two depends on your point of view. Emot. Rev. 2011; 3: 8–16.
    61. Hargis, M. B., & Castel, A. D. Improving Medication Understanding and Adherence Using Principles of Memory and Metacognition. Behavioral and Brain Sciences. 2018; 5(2): 147–154
    62. Peterson, A. M., Takiya, L., Finley, R. Meta-analysis of trials of interventions to improve medication adherence. American Journal of Health-system Pharmacy. 2003; 60: 657-665.
    63. Conway, M. A., & Pleydell-Pearce, C. W. (2000). The construction of autobiographical memories in the self-memory system. Psychol Rev, 107(2): 261-88.
    64. Fernandez-Lazaro, C. I., García-González, J. M., Adams, D. P., Fernandez-Lazaro, D., Mielgo-Ayuso, J., Caballero-Garcia, A., Moreno Racionero, F., Córdova, A., & Miron-Canelo, J. A. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC family practice. 2019; 20(1), 132.
    65. Ogden, J. Health Psychology: A Textbook. 5th Edition, New York: McGraw-Hill; 2012.
    66. Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P., Yao, X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews. 2008; 2: 1-161.
    67. Roohafza, H., Kabir, A., Sadeghi, M., Shokouh, P., Ahmadzad-Asl, M., Khadem-Maboudi, A. A., & Sarrafzadegan, N. Stress as a risk factor for noncompliance with treatment regimens in patients with diabetes and hypertension. ARYA atherosclerosis. 2016; 12(4), 166–171.
    68. Hekler, E., Lambert, J., Leventhal, E., Leventhal, H., Jahn, E., & Contrada, R. Commonsense illness beliefs, adherence behaviors and hypertension control among African Americans. Journal of Behavioral Medicine. 2008; 31: 391–400.