Strategies For People With Memory Problems
Memory is the ability to store, hold on to, and retrieve the information that we experience. For individuals with mood disorders, treatment of the mood disorder itself may result in improved memory function, but individuals may benefit from intervention directed at co-occurring cognitive impairments. For individuals with stroke or traumatic brain injury, memory difficulties will show some spontaneous improvement over time, but this improvement is greater with targeted intervention. Interventions are broadly divided between compensatory and restorative approaches. Restorative approaches aim to directly improve the memory, whereas difficulty and compensatory approaches teach strategies to help manage the impairment.
The Strategies For People With Memory Problems information handout is designed to introduce clients to memory strategies that can help to improve the encoding, storage and retrieval of important information. It can be used to introduce and highlight a particular aspect of memory processing and set of strategies relevant for a particular client or symptom. It may be used as part of a package of intervention, to start discussion of which strategies to trial once the client’s particular circumstances are taken into account. The design and language have been kept simple so that the handout can be used with a wide range of clients, including those with neurological conditions.
In our day to day lives we encounter all kinds of different information. Simple visual images, auditory signals, tastes and smells, as well as more complex experiences like conversations, cooking a meal or navigating a route to a new location. Memory is the ability to store, hold on to, and retrieve the information that we experience.
“Memory [is]... an array of interacting systems, each capable of encoding or registering information, storing it and making it available by retrieval. Without this capability for information storage, we could not perceive adequately, learn from our past, understand the present, or plan for the future”
(Baddeley, 2013, p.18)
In cognitive science, theories of memory have made several important distinctions (Baddeley, 1997):
- The modality of input – visual, verbal/auditory, haptic, taste/smell and motoric.
- The duration of storage – sensory memory, short term memory / working memory, and long term memory.
- Coherent bodies of knowledge that are learnt or stored over a life-time – explicit memory for episodic and semantic information, and implicit procedural memory.
Memory is comprised of three processes: encoding, storage and retrieval.
Information is perceived via the senses and held for a brief period in short term memory or working memory. For information to be stored over a longer period, it needs to be encoded into something more durable for long term storage (Baddeley, 2013). For example, the format of the information may be changed to facilitate encoding (e.g. verbally rehearsing a written telephone number to remember it) or a person may try to make semantic links to something they already know (e.g. linking a new person you meet to their partner, who you work with) (Craik & Lockhart, 1972).
This is the way information is held or retained. For information to be stored successfully, it has to be organised in some way. Over shorter durations, such as remembering a telephone number or completing mental arithmetic, storage is facilitated by maintenance strategies such as rehearsal and chunking information (Baddeley, 1997). For long term memory, it is broadly accepted that there are three coherent stores of information. Two kinds hold explicit, declarative knowledge that can be verbally described upon recall. Episodic memory, also known as autobiographical memory, stores incidents from your lived experience that have a time and place, such as your first day at school or a new job. Semantic memory stores generalised knowledge about the world, such as the capital of Germany, what a dog looks like, or a recipe for scones. This knowledge is not tied to a specific place or time (Tulving, 1972). The third kind of memory is implicit, procedural memory, and it is closely tied to the motor system. This is memory for how to do something, like ride a bike or touch type. This knowledge can be enacted but it cannot be described easily.
Storage of episodic and semantic information can be facilitated by using a ‘deeper’ level of processing, which aims to create a larger network of associations for a given memory. For example, actively recalling specific sensory qualities of your first day at school (the weather, what you were wearing, etc.) or linking the name of the capital of Germany with its location on a map. The storage of implicit, procedural memories is aided by practice of the skill itself (Baddeley, 2013).
This is how people get stored information when they need it. Much of what they remember cannot be immediately recalled, but given the right cue they can access it (Baddeley, 2013). To be most useful, retrieval cues need to have been present when the information was encoded. For example, you might forget where you have left your glasses, but when you go back over your movements during the day, you remember that you left them on a shelf by the door when you got home. You might forget the name of someone you have met recently, but when you remember that it started with ‘s’, this eventually helps you to recall ‘Sarah’.
Perhaps unsurprisingly, retrieval is improved by retrieval practice. That is, the act of immediately recalling something will improve the chances that the information can be recalled again later. Retrieving information at regular and spaced intervals (e.g. once a day, and then once a week) will improve the chances that the information can be recalled long into the future (Linton, 1975). Retrieval practice has been found to help both normal, healthy adults and those who have suffered a traumatic brain injury (Sumowski et al, 2010; Baddeley, 2013).
Problems with memory
Like other aspects of cognition, transient difficulties with memory can be caused by stress or fatigue (e.g. DeLuca, 2005) and there is a documented decline in memory function as individuals become elderly (Spaan, Raaijmakers, & Jonker, 2003). Memory difficulties are frequently reported by individuals with psychological disorders. For example, individuals with anxiety consistently show poorer performance on working memory tasks (Moran, 2016), and those with depression are less able to recall positive or happy memories (as are healthy individuals who have a low mood induced experimentally – Baddeley, 2013).
For individuals with neurological disorders, memory is one of the most frequently reported cognitive impairments. A third to a half of individuals will experience memory difficulties post-stroke (Evans et al, 2020), and almost all individuals with moderate to severe traumatic brain injury demonstrate impairments on measures of memory function (Levin et al, 1987; Mathias & Mansfield, 2005). For those with progressive neurological disorders, impairments in memory can be part of the diagnostic criteria (e.g., in the dementias; WHO, 1993) or a frequent to near universal experience (e.g., in Multiple-Sclerosis; DeLuca, 2005).
There are weak to moderate positive associations between depression and anxiety scores and self-reports of memory problems for individuals post-stroke, so it is important to consider and treat mood disorders; these may contribute to memory difficulties for individuals with neurological conditions (and vice-versa; Evans et al, 2020).
For a client who is experiencing memory difficulties, psychoeducation about memory, memory processes and how memory fails can serve multiple functions. It can help to normalise the experience of memory difficulties, especially when memory impairments are a common occurrence for a given diagnosis. Normalisation helps to reduce anxiety and distress, and to situate symptoms in a framework that the client understands. Psychoeducation will help the client to understand why they are having memory difficulties, as well as to develop awareness of memory failures and why they may be occurring (Mateer & Sira, 2006). Awareness of difficulties will influence motivation for and engagement with therapeutic activities.
Strategies to help with memory problems
For individuals with mood disorders, treatment of the mood disorder itself (e.g., through CBT) may result in improved memory function (e.g., Imboden et al, 2020), but individuals may benefit from intervention directed at co-occurring cognitive impairments (Knight & Baune, 2018).
For individuals with stroke or traumatic brain injury, memory difficulties will show some spontaneous improvement over time, but this improvement is greater with targeted intervention (Elliott & Parente, 2014).
Interventions are broadly divided between compensatory and restorative approaches. Restorative approaches aim to directly improve the memory, whereas difficulty and compensatory approaches teach strategies to help manage the impairment. It is worth noting that restorative approaches do not often generalise to other contexts, and improvements may be in the short term only (das Nair, Cogger, Worthington & Lincoln, 2016), but they can be effective if there is domain limited, specific knowledge that has to be memorised, such as an emergency contact (Mateer & Sira, 2006). Compensatory approaches can be in the form of internal or external strategies, and to be effective, they need to be explicitly taught, well supported and practised as part of a comprehensive rehabilitation programme (Mateer & Sira, 2006; Dams-O’Connor & Gordon 2013).
The Strategies for people with memory problems information handout is designed to introduce clients to memory strategies that can help to improve the encoding, storage and retrieval of important information. It can be used to introduce and highlight a particular aspect of memory processing and set of strategies relevant for a particular client or symptom. It may be used as part of a package of intervention, to start discussion of which strategies to trial once the client’s particular circumstances are taken into account. The design and language have been kept simple so that the handout can be used with a wide range of clients, including those with neurological conditions.
InstructionsThis is a Psychology Tools information handout. Suggested uses include:
- Client handout – use as a psychoeducation resource
- Discussion point – use to provoke a discussion and explore client beliefs
- Therapist learning tool – improve your familiarity with a psychological construct
- Teaching resource – use as a learning tool during training
- Baddeley, A. D. (1997). Human memory: Theory and practice. Psychology press.
- Baddeley, A. (2013). Essentials of human memory (classic edition). Psychology Press.
- Craik, F. I., & Lockhart, R. S. (1972). Levels of processing: A framework for memory research. Journal of verbal learning and verbal behavior, 11(6), 671-684.
- Dams-O’Connor, K., & Gordon, W. A. (2013). Integrating interventions after traumatic brain injury: A synergistic approach to neurorehabilitation. Brain Impairment, 14(1), 51-62.
- das Nair, R., Cogger, H., Worthington, E., & Lincoln, N. B. (2016). Cognitive rehabilitation for memory deficits after stroke. Cochrane Database of Systematic Reviews, (9).
- DeLuca, J. (2005), Fatigue, Cognition and Mental Effort, Ch. 2 in: DeLuca, J. (ed.), Fatigue as a Window to the Brain, MIT Press, USA.
- Evans, F.A., Wong, D., Lawson, D.W., Withiel, T.D. & Stolwyk, R.J. (2020) What are the most common memory complaints following stroke? A frequency and exploratory factor analysis of items from the Everyday Memory Questionnaire-Revised, The Clinical Neuropsychologist, 34:3, 498-511,
- Imboden, C., Gerber, M., Beck, J., Holsboer-Trachsler, E., Pühse, U., & Hatzinger, M. (2020). Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. Journal of Affective Disorders, 276, 866-876.
- Knight, M. J., & Baune, B. T. (2018). Cognitive Dysfunction in Major Depressive Disorder. Current opinion in psychiatry, 31(1), 26-31.
- Levin, H. S., Amparo, E., Eisenberg, H. M., Williams, D. H., High, W. M., McArdle, C. B., & Weiner, R. L. (1987). Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. Journal of neurosurgery, 66(5), 706-713.
- Linton, M. (1975). Memory for real-world events. In: D. A. Norman & D. E. Rumelhart (Eds.), Explorations in cognition (pp. 376404). San Francisco: W. H. Freeman.
- Mathias, J. L. & Mansfield, K. M. (2005) Prospective and declarative memory problems following moderate and severe traumatic brain injury, Brain Injury, 19:4, 271-282,
- Madison, E. & Parente, F. (2014) Efficacy of memory rehabilitation therapy: A meta-analysis of TBI and stroke cognitive rehabilitation literature, Brain Injury, 28:12, 1610-1616.
- Mateer, C. A., & Sira, C. S. (2006). Cognitive and emotional consequences of TBI: intervention strategies for vocational rehabilitation. NeuroRehabilitation, 21(4), 315-326.
- Moran, T. P. (2016). Anxiety and working memory capacity: A meta-analysis and narrative review. Psychological bulletin, 142(8), 831.
- Spaan, P. E., Raaijmakers, J. G., & Jonker, C. (2003). Alzheimer’s disease versus normal ageing: A review of the efficiency of clinical and experimental memory measures. Journal of Clinical and Experimental Neuropsychology, 25(2), 216-233.
- Sumowski, J. F., Wood, H. G., Chiaravalloti, N., Wylie, G. R., Lengenfelder, J., & Deluca, J. (2010). Retrieval practice: A simple strategy for improving memory after traumatic brain injury. Journal of the International Neuropsychological Society, 16(6), 1147-1150.
- Tulving, E. (1972). Episodic and Semantic Memory. Chapter 12 in: Tulving & W. Donaldson (Eds.), Organization of memory, NY: Academic Press, 381-403.
- World Health Organization (WHO). (1993). The ICD-10 classification of mental and behavioural disorders. World Health Organization.