Open Journal of Medical Psychology, 2012, 1, 25-31 Published Online July 2012 (
Emotional Bias in Childhood-Event Interpretation by
Adults with Generalized Anxiety Disorder
Fanny Marteau1,2, Anne-Sophie Lassalle1,2, Bruno Vilette1,2,
Dominique Servant3, Stéphane Rusinek1,2
1Université Lille Nord de France, Lille, France
2UDL3, PSITEC, F-59653 Villeneuve d’Ascq, France
3Hopital Fontan, Lille, France
Email:, {anne-sophie.lassalle, bruno.vilette},,
Received March 21, 2012; revised April 27, 2012; accepted May 24, 2012
Objectives: It is often stressed that anxiety alters perceptions of the world by way of processes like the rapid detection
of threats and the exaggeration of risks. Given that these processes are active during all information processing, they are
thought to influence not only the interpretation of current events, but also the recall of past events. In patient’s anamne-
sis, we have often attempted to incorporate the events that patients recollect into our functional explanation of their dis-
order, forgetting that the meaning of what a patient relates may be intrinsically linked to his/her pathology and patho-
logical functioning. We are interested here in potential biases in the events remembered by anxious patients. Methods:
We contacted twenty-seven men aged 25 or older suffering from generalized anxiety disorder. They were asked to rec-
ollect childhood events from cue words and then rate each remembered event on its subjective emotional valence and
intensity, its frequency of recollection, and the vividness of the memory. The responses of the anxious subjects were
compared to those of control subjects without psychiatric disorders. Results: Findings seem to show that anxious pa-
tients’ memories of childhood events may be impaired by emotional interpretation biases. Indeed, anxious patients re-
member more negative events than participants in the control group. The emotional intensity of negative or positive
events remembered by anxious patients is also considered more important.
Keywords: Generalized Anxiety; Childhood Events; Emotional Interpretation Biases
1. Introduction
Many studies on cognitive biases showed that anxious
patients focus on threatening stimuli [1-5]. This bias has
also been identified in children [6-8]. Moreover, Eysenck
[9,10] demonstrated that the principal role of anxiety is
to facilitate the early detection and the process of threat-
ening signals coming from the environment. This role
was originally an undeniable adaptive value, but it can
also amplify threats. Thus, in this study we investigated
the recall process of past events by anxious patients.
We will consider here that memories are constantly
undergoing a redefinition process, as Bartlett [11] de-
scribed by saying, that for an individual or for a group,
the past is constantly being reworked, reconstructed, in
accordance with immediate interests. These processes,
which we “rewrite” our own history and the events that
took place during our childhood, must be regarded as
normal and healthy, for the reworking of the past permits
better adaptation to personal change. However, in anx-
ious patients, this process may lead to an over-focus or
over-concentration on negative past events.
Indeed the worry, which is one of the most important
processes of anxiety, leads to the reinterpretation of past
events in a negative way [12-15]. Similarly, the theory of
emotional disorders proposed by Beck [16-19], the pio-
neer of cognitive therapy, states not only that anxiety-
based thought patterns or anxiety schemas affect infor-
mation encoding, but also that the encoded information
in turn influences the structure of the schemas. It follows
that anxiety schemas are continuously being redefined, in
such a way that every experienced events are constantly
being reinterpreted in order to make them fit into the
dominant schema.
For twenty years, a significant amount of research
showed that emotional events are better recalled than
neutral events, whether they were events of everyday life
[20] or experimental material such as words [21]. How-
ever, there are individual differences concerning the
memory of emotional events either negative or positive
[22]. For some authors [23], the negative emotional
opyright © 2012 SciRes. OJMP
events lead mechanisms of repression in normal indi-
viduals. They estimated that the normal individual seeks
to protect himself from negative emotional memories that
disrupt his self-esteem and future goals. Similarly, the
emotional intensity is attenuated for negative events in
order not to destabilize the individual. As the memories
of past events influence the self-representation of the
person and his future, the person reconstructs the past in
order to be consistent with a positive self-image. In con-
trast, anxious people have a disturbance of the control
function for negative events [24,25]. They would re-
member more negative events than positive events and
the emotional events would be judged as more intense.
Several studies showed that people rethink more often
the intense emotional events than the weakly intense
ones. The frequent reactivation of memories related to
the mechanism of rumination among anxious individuals
will accordingly keep them permanently in memory [26].
It appears that the amygdale and stress hormones play a
vital role in increasing the storage of emotional events
[27]. From a clinical standpoint, the anxious person has
difficulty in maintaining a positive self-image and self-
confidence in the future due to the persistence of nega-
tive memories.
Studies concerning recall of negative events among
anxious patients are not homogeneous. In fact, other au-
thors suggested that anxious patients do not remember
more negative events [28,29]. They stated that anxiety is
characterized by selective attention to threatening events,
but that these negative events tend to be avoided after-
wards by the person. There would exist two adaptive
styles: repressive people and non-repressive ones. Rep-
ressors, who may be either anxious or not anxious, would
memorize less negative events and would allocate less
effort to retrieve negative information. Thus, repressors
would recall less negative memories than non-repressors,
either for the period of childhood or the recent past.
In the study reported below, we hypothesized that
anxiety have an impact on the recall of events stored in
memory. To study these biases, we asked adults who
suffer from generalized anxiety disorder, and adults with
no psychiatric disorders, to remember events from their
childhood. Our goal was to determine whether anxious
and non-anxious people differ in their emotional judge-
ments of past events (emotional valence and intensity),
and also whether the features and structure of the mem-
ory traces (recollection frequency and vividness of the
memory). Under the data of literature, we believe that
anxious patients will remember more negative events
than positive. They should also judge the emotional in-
tensity of the event that they reported, either it was nega-
tive or positive as more important? The anxious patients
should remember negative events more often and should
have a clearer image of negative events.
2. Method
2.1. Participants
The study was run on a group of 27 male patients, who
were of European origin, with generalized anxiety disor-
der without any co morbidity, with age ranging from 25
to 57 years (m = 36.17, sigma = 9.632). They were tested
during a consultation at the hospital. We only met pa-
tients with generalized anxiety disorder to study the ef-
fects of anxiety on recall of emotional events, because
we did not want them focus on a particular object. A
pre-test showed that people with other forms of patho-
logical anxiety tended to spontaneously seek to child-
hood events related to their pathology (e.g., events in-
volving physiological feelings for patients with panic
disorder or contamination events for patients with ob-
sesssive Compulsive Disorder). The diagnosis of gener-
alized anxiety was made on the basis of DSM-IV criteria
[30] assessed using the MINI Test for the French version
[31]. The anxious subjects were also given the French
Lifestyle Test [32]. The “French Lifestyle” consists of 66
items measuring the degree of anxiety, rated in a di-
chotomous fashion “true” or “false”, without the system-
atic sense of answers. The general anxiety score is be-
tween 0 (very weak anxiety) and 66 (very strong anxiety).
The calibration of the test showed that beyond 40, a pa-
tient could be regarded as suffering from pathological
anxiety, but that beyond 50, the anxiety is “very disab-
ling”. According to the authors [32], this test has a good
internal validity and a satisfactory fidelity test-retest.
This test was the anxiety test most used in this hospital,
where patients were tested. Patients whose lifestyle score
was below 50 out of 66 were considered ineligible for the
study. Among the patients seen in the first interview, four
were not included in the study because their anxiety was
too high. We selected only male patients to avoid that the
sex effects interfering with anxiety during the study.
Thus, there is a restriction on the generalization of the
results in the general population. All patients were tested
over a period of three month (June, July, August), in the
same specialized hospital in the management of anxiety
by the cognitive and behavioural therapy. It was their
first consultation and they had made an appointment on
their own initiative after visiting their family doctor. At
the time of testing, patients were not hospitalized. Their
medications were varied but not disabling. The study was
clearly explained to patients to obtain their consent. All
patients agreed to participate in the study.
The control group was strictly matched to the anxiety
patient group on age and socio-occupational category, so
this group also contained 27 men, who were of European
origin, between the ages of 25 and 57. There are no other
variables (IQ, sexual orientation) that could be consid-
ered in the matching of these two groups. Control sub-
Copyright © 2012 SciRes. OJMP
jects were interviewed first to ensure that they never had
a psychiatric disorder. They were tested on the French
Lifestyle Test [32] and the STAI [33] to make sure that
their trait-anxiety level wasn’t too high. The STAI test of
Spielberger [33] is a self-administered questionnaire
composed of two scales. The first scale used to measure
“state-anxiety” (transitory provision of the individual)
and the other measure “trait-anxiety” (corresponds to the
personality). Only the measurement of “trait-anxiety”
was used. The scores of “trait-anxiety” are between 0 and
80. A score of 50 is considered by the authors [33] as a
sign of a pathological anxiety. Subjects with a lifestyle
score above 40 out of 66 and a STAI score above 50
(state-scale and trait-scale) were excluded, as recom-
mended by the authors of these tests. For reasons having
to do with procedures in the hospital where they were
tested, the anxious subjects did not take the STAI. The
anxiety of the control participants was measured in order
to be sure that they had no pathological anxiety. None the
control group subjects were excluded following this
measure. The study was clearly explained to the subjects
to obtain their consent. All subjects agreed to participate
in this study.
2.2. Materials and Procedure
The experimental materials were designed specifically
for this study. They included a list of 15 words likely to
evoke childhood memories, along with various scales for
evaluating each event remembered.
The list of words used as event-recall cues was gener-
ated as follows. Nine psychology experts (four research-
ers at the University and five clinicians) examined re-
ports of interviews of 66 ordinary individuals. From the
reports, they selected 46 very general words pertaining to
childhood events mentioned by the 66 individuals. The
46 words were then tested on 106 other ordinary indi-
viduals, whose task was to say whether or not a child-
hood memory came spontaneously to mind when they
heard the words. The 15 nouns for which a memory came
to mind for 80% of the individuals were used as the items
for the experiment. The 15 words were vacation, friend,
love, birthday, animals, Christmas, sports, fight, family,
home, school, toy, candy, dream, and accident. The
words old and car, both of which elicited spontaneous
memories in 78% of the individuals, were added to the
top of the list to be used later for training. The results
obtained for these two words were not included in the
statistical processing. Given that these materials were
being used here for the first time, this study also served
as an initial validation of their use. The words were writ-
ten in black letters on white A5-size cards.
The subjects first saw the two training words, after
which the other words were presented in random order.
For each word, the subject was asked to find an event he
had experienced before he was 16 years old. A different
event was to be related for each cue. If the subject could
not think of an event within two minutes, the experi-
menter was supposed to go on to the next word, but this
in fact never happened. As soon as an event was recol-
lected, the subject had to answer four questions on a 10
cm analogical scale. Questions asked participants to rate
1) the valence of the emotion experienced during the
event (0 = Negative, 10 = Positive, with a mark labelled
“Neutral” in the middle of the scale); 2) the intensity of
the emotion experienced during the event (0 = Very
Weak, 10 = Very Strong); 3) the frequency of recollec-
tion of the event during childhood (0 = Never, 10 = Very
Often); and 4) the vividness of the memory today (0 =
Very Fuzzy, 10 = Very Clear). For Question 3, the sub-
ject was asked to consider the period before age 16, but
we used this question to estimate current processing bi-
ases. The experimenter was always the same. He was
both a clinician and researcher at the University. The
procedure was strictly respected and the experimenter
was trained in the procedure in order to limit methodo-
logical bias.
The variables for the study were chosen on the basis of
a body of theoretical research. In particular, we consid-
ered the work of Plutchik [34,35], who proposed defining
the pathological character of emotions in terms of their
intensity, and suggested that emotions are opposed in
their valence, as in happiness and sadness. These ideas
were adopted by Lazarus [36] and also Bower [37,38] in
their descriptions of emotional semantic-memory net-
works, where repetition of information reinforces its
memory trace. The general theory underlying our study
was the theory of disordered schemas postulated by Beck
[16-19], in which all of these variables are important. But
our justifications were also empirical, being based, for
example, on Cassidy and Delaoche [39] work showing
that for children as young as 4 years-old, the fact of re-
collecting something (talking about it again) improved
the child’s memory of it; or on Pillemer et al. [40] re-
search, where 4-year-old children were able to accurately
remember details of a fire alarm in their school that had
affected them; or more recently, the study of Andersson
et al. [41] on subjects suffering from anxiety-related diz-
ziness, where poorer recall was found for autobiographi-
cal memories of dizziness induced by positive words.
The “emotional shock of an event” can thus be translated
by how vividly it is remembered.
3. Results
While every subject remembered more negative events
than positive ones, anxious subjects averaged as many
negative events as controls (t [32] = 1.391, p = 17.38,
Copyright © 2012 SciRes. OJMP
manxious = 7.824, mcontrol = 6.941) (Table 1). For positive
events, anxious subjects who recalled fewer positive
events than controls. Note also that none of the remem-
bered events were rated as strictly neutral.
In the processing reported below, each variable was
considered as a function of the overall valence of the
remembered events. The means and comparisons of
means are presented in Tables 2 and 3. In order to avoid
statistical artefacts due to the large number of compare-
sons, we set a significance level of p = 0.001.
For positive events, there was only one significant dif-
ference: recollected-event intensity was greater for anx-
ious subjects. This same difference existed for negative
events, which in addition were rated more negatively by
anxious subjects than by non-anxious ones. Thus, re-
gardless of event valence, emotional intensity seems to
be exaggerated among persons with generalized anxiety,
especially for negative events.
When comparisons were made across paired positive/
negative events to determine whether any particular class
of events had a particular status in memory, no signifi-
cant differences were found.
Table 1. Mean number of memories, by event valence.
Anxious Controls
Mean number of
negative memories
(σ = 1.916)
(σ = 1.784)
Mean number of
positive memories
(σ = 1.912)
(σ = 1.784)
Table 2. Means and comparisons of means on positive
Anxious Controls t32 p
(σ = 1.214)
(σ = 1.434) 2.094 0.0443
Intensity 8.226
(σ = 0.911)
(σ = 1.411) 5.148 <0.0001
Vividness 7.212
(σ = 1.907)
(σ = 1.680) 0.282 0.7801
Frequency of
(σ = 1.936)
(σ = 2.134) 1.544 0.1325
Table 3. Means and comparisons of means on negative
Anxious Controls t32 p
Tonality (valence) 1.918
(σ = 1.227)
(σ = 1.001) 3.609 0.0010
Intensity 8.463
(σ = 1.237)
(σ = 1.057) 5.993 <0.0001
Vividness 7.886
(σ = 1.515)
(σ = 1.714) 2.224 0.0333
Frequency of
(σ = 2.060)
(σ = 2.231) 0.067 0.9469
4. Discussion
The results showed that anxious patients remembered
more negative events than positive ones. The emotional
intensity of negative or positive events remembered by
anxious patients is also considered more important. As
we predicted, anxious patients remember negative events
more often.
There are at least three explanations for the results of
this study. Firstly, the anxious subjects may have actually
experienced more intense and more emotional loaded
events during their childhood, which could even be the
reason explaining their disorder. However, comparing
the number of negative events experienced for anxious
and non-anxious children, Boer and colleagues [42] were
unable to really conclude that more negative events had
actually occurred in the former group. Alternative possi-
bility is that when recalling childhood events, the anxious
patients reinterpreted them as more intense and more
emotional loaded than they actually were, in which case
they were subject to an interpretation bias at recall time.
Lastly, as anxious children, these individuals may have
interpreted events in this way during childhood, unlike
non-anxious children. This means that their anxiety al-
ready existed in childhood and caused them to bias their
interpretations of information and their encoding in
Although Boer et al. [42] findings did not provide a
definitive answer, these authors hesitated between sev-
eral explanations: a greater number of negative events
experienced by anxious children, their greater vulnerabil-
ity, and potential recall biases in both the anxious chil-
dren and their parents reporting the events. In our ap-
proach, which aims to show that anxiety is generated by
a processing bias, we lean towards the last two hypothe-
ses, which are not in fact mutually exclusive. An earlier
study of Rusinek et al. [43] provided an indication sup-
porting the idea of an encoding bias among anxious chil-
dren. Middle school children were tested on trait-anxiety
before experiencing a slightly anxiety-generating event.
The event was a speech given by the school principal
about the poor grades of certain students and the good
grades of others (of course, no names were mentioned).
A week later, the students were asked to rate their mem-
ory of the event, using the same measures as in the ex-
periment reported in the present paper: emotional valence,
emotional intensity, recollection frequency, and vivid-
ness of the memory. The results showed that the most
anxious children, both girls and boys, had already exag-
gerated the intensity of the emotion and the valence of
the event, they remembered the headmaster’s speech as
more intense and more negative than the other children
did. These results can be compared to the findings ob-
tained by Calvo et al. [44] and by Mathews and Mackin-
Copyright © 2012 SciRes. OJMP
tosh [45], who found a threat-confirming anxiety bias on
tasks with ambiguous stimuli, especially when the stim-
uli were related to the self.
It could be, then, that already in childhood, some chil-
dren acquire an emotional-event interpretation process
that is biased by phenomena such as exaggeration of the
intensity and valence of experienced emotions, especially
when the events are negative. While certain anxious
adults may have lived through very intense, emotionally
loaded events, we can also say that the large number of
experienced emotional events probably depends both on
the interpretation made of them during childhood and on
a biased reinterpretation at recall time. There is obviously
a methodological problem here, which is the control for
the equivalence of memories reported by different sub-
jects. We can unfortunately only note this problem, but it
lead us to hypothesize without evidence, that different
scores in fact reflect differences in information process-
ing, not real differences in the characteristics of the ex-
perienced events themselves. In addition, there are other
restrictions in interpretations. First, the sample size is
quite small. Similarly, only men who suffered general-
ized anxiety disorders are among them. It should be in-
teresting to test women and other anxiety disorders. It
shall be interesting to verify that indeed, the specificity
of a disorder also leads to recall biases depending on this
disorder. Concerning the latter, a more complex proce-
dure must be established and future research could be
directed towards this prospect.
From the clinical standpoint, however, these findings
suggest that we exercise caution regarding the life events
related by patients. These events certainly have their sig-
nificance, since the patients themselves feel they are im-
portant, but the filter of anxiety may very well distort
them. Thus, it is important to develop and apply new
therapeutic interventions that can effectively reduce
negative attentional biases [46,47], while treating the
problems associated with anxiety disorders. For example,
the “Cognitive-Reminiscence Therapy” [48,49], which
combines cognitive therapy and reminiscence, appears to
be an interesting approach for the treatment of anxious
patients. Therefore, the therapeutic work will award a
crucial place in the awareness by the patient of his cogni-
tive biases. The patient must get into Metacognition and
take awareness of the influence of his biases in his vision
of past, present and future events. Therefore, it is not the
past that will be used to understand the present, but the
patient’s cognitive functioning those impacts on his per-
ception of past events. Moreover, the work of reminis-
cence therapy based on the difficult events of the past
can help the patient to be reconciled with certain events
in its history. This work of reminiscence therapy pro-
motes a questioning of thoughts and beliefs that crystal-
lized on the negative. The modification of negative
events in long-term memory of an anxious patient will
allow him to have a more positive view of himself. The
anxious patient can better manage his memories in order
to define himself differently. Thus, the anxious person
integrate an approach that aims to reduce to the minimum
interpretation biases responsible of an anxious and nega-
tive perception of self, of the world and of the future.
5. Acknowledgements
We wished to thank PhD. student Alhadi Chafi for his
support in the writing of this paper.
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