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Cognitive Therapy and Research
https://doi.org/10.1007/s10608-023-10353-0
ORIGINAL ARTICLE
The Properties ofInvoluntary andVoluntary Autobiographical
Memories inChinese Patients withDepression andHealthy Individuals
YanyanShan1· ShuyaYan2· YanbinJia2 · YileiHu2· DavidC.Rubin1,3· DortheBerntsen3
Accepted: 24 June 2022
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023
Abstract
Background Research on depression has largely focused on negative intrusive memories with little research on general
involuntary memories as they occur in everyday life. In addition, all studies have been conducted on Western participants,
and there are no studies on general involuntary memory in Eastern patients with depression.
Methods Thirty Chinese patients with depression and 30 healthy controls completed a memory diary in which they recorded
a total of 10 involuntary and 10 voluntary memories. They were requested to fill out corresponding questionnaires of invol-
untary and voluntary memories as well.
Results Both patients with depression and healthy controls reported involuntary memories that had a more negative impact,
were more specific, and were associated with more maladaptive emotion regulation when compared to voluntary memories.
For both retrieval modes, patients with depression reported more negative and fewer positive memories, more negative and
less positive mood impact, more avoidance, rumination, worry, negative interpretation, and less positive interpretation in
response to the memories. Patients with depression rated their memories as more central, less specific, and rehearsed more
frequently. Negative mood impact and maladaptive emotion regulation associated with involuntary memories were ampli-
fied in depression.
Conclusions These findings support the view that general involuntary memories could be a potential target to promote the
treatment for depression.
Keywords Involuntary memory· Autobiographical memory· Depression· Emotion regulation
“I struggle with depression where I ruminate and live in
the past, feeling shame and regret. The past keeps me from
being able to enjoy the present and connect with people. I
feel stuck and trapped inside myself.”
“Those sweet memories of my life spent with my friends
are the best. They make me feel grateful no matter what
happens in my life.”
These two examples illustrate how differently autobio-
graphical memories can affect the present life of a patient
with depression. Autobiographical memories are memories
of events from one’s personal past and are crucial for devel-
oping and maintaining personal identity across the life span
(Conway & Pleydell-Pearce, 2000; Rubin, 1986). Autobio-
graphical memories can be retrieved either voluntarily or
involuntarily (Berntsen, 1996). Involuntary autobiographical
memories are conscious memories of personal events that
come to mind spontaneously—that is, with no preceding
attempt at retrieval (e.g., Berntsen, 1996, 2010). Research on
autobiographical memory in depression has focused mostly
on voluntary autobiographical memory– that is, memories
retrieved deliberately. Although there have been studies on
involuntary memory in depression, these studies have pre-
dominantly focused on negative intrusive memories (e.g.,
Brewin etal., 1998, 1999; Kremer etal., 2004; Newby &
Moulds, 2010, 2011; Parry & O’Kearney, 2014; Reynolds
& Brewin, 1998; Spenceley etal., 1997). This oversight is
problematic, since general involuntary memories have been
claimed to serve a number of functions in everyday life,
such as providing a sense of continuity across time, emotion
* Yanbin Jia
yanbinjia2006@163.com
1 Department ofPsychology andNeuroscience, Duke
University, Durham, USA
2 Department ofPsychiatry, The First Affiliated Hospital
ofJinan University, Guangzhou, China
3 Center onAutobiographical Memory Research, Department
ofPsychology, Aarhus University, Aarhus, Denmark

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regulation, suggesting solutions to problems or instigating
a direct change in ongoing activity (Berntsen, 2009; Del
Palacio Gonzalez & Berntsen, 2020; Rasmussen & Bern-
tsen, 2009). Because such functions may be both adaptive
and maladaptive depending on the context, it is relevant to
study general involuntary memory in depression. By better
understanding the properties of general involuntary memo-
ries in patients with depression, rather than just negative
intrusive memories, we can improve our understanding of
how depression can affect patients’ autobiographical memo-
ries and thus improve our understanding of the mechanisms
of depression. It may also provide some useful targets for
future work on improving the effectiveness of depression
interventions.
At present, only five studies have explored general invol-
untary memories among individuals with depression or dys-
phoria (Bywaters etal., 2004; Del Palacio-Gonzalez etal.,
2017; Kvavilashvili & Schlagman, 2011; Watson etal.,
2012, 2013). Three of the five studies were conducted on
non-clinical participants (Bywaters etal., 2004; Del Palacio-
Gonzalez etal., 2017; Kvavilashvili & Schlagman, 2011).
Bywaters etal. (2004) asked participants to generate as
many involuntary and voluntary memories as possible from
the prior 2weeks. They found that involuntary memories
were common in undergraduates with and without depres-
sion, and there was evidence that involuntary memories were
mood-congruent, as well as associated with higher levels
of vividness. Kvavilashvili and Schlagman (2011) used a
laboratory-based task to assess properties of involuntary
memories in participants with and without dysphoria. They
found that participants with dysphoria did not recall more
memories of objectively negative events (e.g., accidents, ill-
nesses, deaths) than non-dysphoric participants. However,
participants with dysphoria rated their memories as more
negative than participants without dysphoria. They did not
observe significant differences in several memory charac-
teristics such as vividness, specificity (high in both groups),
and ratings of rehearsal frequency (low in both groups).
Del Palacio-Gonzalez etal. (2017) conducted a diary study
assessing basic emotions and regulation strategies employed
upon retrieval of involuntary and voluntary memories in par-
ticipants with and without dysphoria. Involuntary memories
were overall associated with more intense emotion and more
emotion regulation responses at retrieval. Both involuntary
and voluntary memories showed higher levels of negative
emotions and maladaptive emotion regulation among indi-
viduals with dysphoria. However, individuals with dysphoria
did not rate their involuntary memories as more central to
their identity and life story.
Only two of the five studies involved participants with
clinical depression, and these two studies were based on the
same sample and data collection (Watson etal., 2012, 2013).
Watson etal. (2012) compared involuntary and voluntary
autobiographical memories in individuals with and without
depression using a diary study. In both groups, involuntary
memories tended to trigger stronger reactions than volun-
tary memories. In both retrieval modes, individuals with
depression reported more frequent negative reactions, rated
memories as more central to their identity, and reported
more rumination and avoidance than individuals without
depression. In a followup analysis, Watson etal. (2013)
found that both the depressed and control group remem-
bered more specific events during involuntary than voluntary
memory retrieval. However, there was an interaction effect
when participants with non-remitted depression were com-
pared to participants with partially remitted depression and
without depression, participants with non-remitted depres-
sion reported fewer specific events during voluntary recall,
but not during involuntary recall.
These studies suggest that involuntary memory may play
an important role in the development of depression and that
they may provide potential therapeutic targets for improv-
ing interventions for depression. The above studies also
revealed several unresolved issues in the scarce literature on
general, everyday involuntary memory in depression. First,
the previous studies did not exclude comorbidities. Since
depression is more likely to co-occur with other mental dis-
orders, failure to exclude other mental disorders may affect
study results. For example, some findings may be driven
by symptoms of PTSD or anxiety, rather than depression
per se. Second, deficits in adaptive emotion regulation (e.g.,
positive interpretation, reappraisal, problem-solving) may
contribute to the development of depression. Interventions
systematically enhancing adaptive emotion regulation skills
may help prevent and treat depression symptoms (Carl etal.,
2013; Vanderlind etal., 2020). Nonetheless, previous stud-
ies have mainly focused on maladaptive emotion regulation
(e.g., rumination, suppression, negative interpretation) and
overlooked the possible role of adaptive emotion regulation
of involuntary memories in depression. Third, inconsist-
ency remains regarding how central involuntary memories
are to the life story of individuals with depression. Watson
etal. (2012) found that individuals with depression rated
involuntary memories more central to their life story, while
Del Palacio-Gonzalez etal. (2017) found no such differ-
ence between individuals with dysphoria and healthy con-
trols. Fourth, few studies have examined the cues that are
reported to trigger the memories in individuals with depres-
sion. For example, in their laboratory study, Kvavilashvili
and Schlagman (2011) found that more memories were trig-
gered by internal thoughts in participants with dysphoria.
Examining whether the triggers of involuntary memories are
different in patients with depression is important to under-
stand the mechanisms potentially underlying the enhanced
frequency of general involuntary memories in affective dis-
orders (Berntsen etal., 2015). Fifth, although researchers

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have studied intrusive involuntary memories in the clinical
field for more than four decades (Berntsen, 2009; Brewin
etal., 2010), most of the studies were conducted in Western
countries. General involuntary memories in patients with
depression have not yet been investigated in Eastern coun-
tries, despite robust evidence that autobiographical memory
in general is influenced by culture (Wang, 2011). Culture
also plays an important role in the emotion regulation of
intrusive memories. Comparing two depressed groups from
different cultures, Mihailova and Jobson (2020) found that
East Asians reported significantly greater brooding and
avoidance in response to intrusive memories than Austral-
ians. There is little published data on cultural differences in
involuntary memories of patients with depression. Examin-
ing involuntary autobiographical memories in diverse sam-
ples can broaden the applicability of the research findings
and enhance our understanding of how depression differs
across cultures. As such, we selected Chinese participants
who were depressed and without comorbidities to be consid-
ered for the study. We investigated key properties of involun-
tary memory, including maladaptive and adaptive emotion
regulation in response to having a memory, centrality, cues,
and other important properties of autobiographical memo-
ries (i.e. specificity, vividness, person perspective, rehearsal
frequency, time and age of the memory) to address issues
that have not been addressed or are controversial in previ-
ous studies.
Purpose ofthePresent Study
In the present study, we aim to replicate and extend previous
work by Watson etal., (2012, 2013) in a Chinese sample of
patients with depression by examining important properties
of involuntary and voluntary memories. The general aim of
the present study is to investigate autobiographical memory
properties and the associated adaptive and maladaptive emo-
tion regulation in patients with depression who did not have
co-morbid mental disorders. In this way, we hope to iden-
tify indicators and targets of autobiographical memory that
can be used for optimizing the diagnosis and treatment of
depression.
On the basis of previous research comparing involuntary
and voluntary autobiographical memories between individu-
als with and without depression or dysphoria, we expected
to see a number of group effects in terms of more negative
reactions and dysfunctional emotion regulation accompany-
ing the memories, as well as higher centrality of memories
in the depressed group. Consistent with past research, we
expected involuntary memories to be associated with more
intense emotional reactions and emotion regulation efforts in
both groups. We also expected involuntary memories to be
more specific. Based on past research, we expected few (if
any) interactions between group and retrieval mode.
Method
Participants
Sixty-eight participants took part in the study at the Depart-
ment of Psychiatry at Jinan University in Guangzhou
between May 2020 and April 2021. All the participants
who volunteered to participate in this study received free
mental health assessments, including the Structured Clinical
Interview for DSM-5, Patient Health Questionnaire-9 (PHQ-
9), General Anxiety Disorder-7 (GAD-7), Beck Depres-
sion Inventory-Second Edition (BDI-II), 24-item Hamilton
depression rating scale (HAMD-24), and Young mania rat-
ing scale (YMRS). We used the translated versions of these
measures, which have been translated and back-translated
by other scholars. These scales are commonly used in clini-
cal practice and research in China, and their reliability and
validity have been consistently confirmed; see Instruments
for more details. Eight of the participants (5 patients with
depression and 3 healthy controls) were not able to finish
the memory diary due to time constraints. Final results were
obtained from 60 participants (30 depressed, 30 healthy con-
trols). The participants were all Han Chinese. The demo-
graphics and diagnostic characteristics of each group are
shown in Table1. All participants have undergone psycho-
logical evaluations by psychiatrists involved in the study.
The study was approved by the ethics committee at the First
Affiliated Hospital of Jinan University.
Depression Group
A sample of 30 adults diagnosed with Major Depressive
Disorder (MDD) was recruited by advertising. Inclusion cri-
teria of MDD group were (i) diagnosis of MDD according
to DSM-5 criteria, (ii) age between 18 and 50years, (iii)
the scores of HAMD-24> 8, (iv) the scores of BDI-II> 13,
(v) the scores of YMRS< 6 and without bipolar history, (vi)
psychiatric drug-naive and treatment-naive, (vii) educational
level above junior high school to ensure the ability to read
and answer questionnaires, (viii) voluntarily participated in
the study and signed informed consent.
Exclusion criteria of the MDD group were (i) co-morbid
with other mental disorders, (ii) with brain organic mental
disorders or severe somatic complaints, and (iii) with a his-
tory of alcohol or drug abuse.
The BDI-II scores of the patients with depression ranged
from 16 to 51 prior to the beginning of the diary (T1), and
from 16 to 48 after completing the diary (T2). The HAMD-
24 scores of the patients with depression ranged from 12 to

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36 at T1, and from 12 to 36 at T2. The YMRS scores of the
patients with depression ranged from 0 to 5 at T1, and from
0 to 3 at T2.
Healthy Control Group
A sample of 30 healthy volunteers was recruited by adver-
tising. Inclusion criteria of the control group were (i) age
between 18 and 50, (ii) the scores of HAMD-24 < 8, (iii)
the scores of BDI-II < 13; (iv) the scores of YMRS < 6, (v)
participated in the study voluntarily and signed informed
consent.
Exclusion criteria of the control group were (i) a psychi-
atric history or family history of mental disorder, (ii) brain
organic mental disorders or severe somatic complaints, (iii)
a history of alcohol or drug abuse.
The BDI-II scores of the healthy controls ranged from 0
to 7 at T1, and from 0 to 6 at T2. The HAMD-24 scores of
the healthy controls ranged from 0 to 12 at T1, and from 1 to
10 at T2. The YMRS scores of the healthy controls ranged
from 0 to 2 at T1, and from 0 to 1 at T2.
Instruments
The Structured Clinical Interview forDSM‑5 —
Clinician Version (SCID‑5‑CV)
The SCID-5-CV guides the clinician step-by-step through
the DSM-5 diagnostic process (First etal., 2016). The
SCID-5 was administered by psychiatrists with full
SCID-5 training and extensive experience in using this
instrument in clinical research settings. In addition to
MDD, all potential comorbidities were assessed using
the SCID-5. The interrater reliability coefficient (ICC) of
SCID-5 for MDD was 0.93. The ICC of SCID-5 for all the
other diagnoses was 0.90. Interrater reliability was calcu-
lated based on all the participants.
Beck Depression Inventory‑Second Edition
The BDI-II (Beck etal., 1996) is the most widely used
self-reported test of depressive symptoms. The scale
has 21 items rated on a 0–3 scale and the sum score is
reported. We used the Chinese version (Wang et al.,
2011), which has shown excellent internal consistency
(Cronbach’s alpha = 0.94). The Cronbach coefficient in
the current sample was 0.96, likewise indicating excellent
internal consistency.
Hamilton Depression Rating Scale (HAMD‑24)
The HAMD-24 (Hamilton etal., 1960) is the most widely
used clinician-rated scale for the assessment of depression
severity in patients who were already diagnosed with a
depressive disorder. The scale has 24 items rated on a 0–4
scale and the sum score is reported. We used the Chinese
version of the scale (Zheng etal., 1988), which has shown
acceptable internal consistency in terms of a Cronbach’s
alpha of 0.74. In the present study, the internal consistency
was good for HAMD-24 (Cronbach’s alpha = 0.88).
Table 1 Sample and
demographic characteristics
BDI-II Beck Depression Inventory, HAMD Hamilton Rating Scale for Depression-24, HAMA Hamilton
Anxiety Rating Scale, YMRS Young Mania Rating Scale
N = 60
a Chi-square
* p < .05
** p < .01
*** p < .001
**** p < .0001
MDD HC t(58) pCohen’s d
M SD M SD
Gender (% female) 83.33 – 80.00 – 0.11a0.739 –
Age (years) 24.80 4.28 23.57 3.59 1.21 0.231 0.31
Education (years) 15.23 1.65 16.27 1.46 −2.57 0.013 −0.67
BDI-II 30.27 8.96 3.80 3.24 15.21 < 0.001 3.93
HAMD-24 24.37 5.10 1.77 1.72 23.00 < 0.001 5.94
YMRS 0.80 1.61 0.07 0.37 2.44 0.018 0.62
Current episode (years) 3.19 3.14 – – – – –
Age of first episode (years) 21.60 4.88 – – – – –

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Young Mania Rating Scale (YMRS)
The YMRS (Young etal., 1978) is one of the most fre-
quently utilized clinician-rated scales to assess manic
symptoms. The scale has 11 items rated on a 0–4 scale
and sum score is reported. Cronbach’s alpha in the present
sample was 0.80, indicating good internal consistency. No
study has examined the reliability and validity of the Chi-
nese version of YMRS. However, many published studies
have used the Chinese version of YMRS to measure manic
symptoms (e.g., Chen etal., 2021; Zhang etal., 2018).
Three‑Step Structured Diary
A well-established method of collecting involuntary and
voluntary autobiographical memories was modified and
employed in the current study (Berntsen & Hall, 2004;
Watson etal., 2012). The original English version of
instructions and questionnaires for assessing involuntary
memories and voluntary memories was translated and
back-translated. First, the diary and questionnaires were
translated from English into Chinese by the first author.
Then a second independent person who was proficient in
both English and Chinese translated the Chinese diary and
questionnaires back into English. Finally, the last author
checked the new English version of the diary and question-
naires to ensure that the original meaning of the document
remained intact.
All steps of the research process were explained in a video
produced by the first author. After watching the video of
the research explanation, participants participated in a face-
to-face video meeting at which they were asked to confirm
whether they understood the research steps, and potential
remaining questions were clarified. Questionnaires regard-
ing involuntary memories and their voluntary counterparts
could be completed on a website accessible to computers,
tablets, and mobile devices.
Step 1: Recording anInvoluntary Memory
Participants were required to carry a small notebook at all
times. When they had an involuntary memory, they were
instructed to record it in the notebook immediately follow-
ing the memory retrieval. The participants were asked to
briefly summarize key characteristics related to the memory.
In their notebook, participants were asked to record answers
regarding attention, concentration, mood in the ongoing
situation preceding the memory as well as memory con-
tent, commonalities between memory and current situation
(i.e., cues), mood impact, physical reaction, and emotional
valence. We have noted in Table2 with an (NB) the detailed
questions to assess these measures.
Step 2: The Involuntary Memory
Questionnaire
Later the same day, participants were asked to fill out a more
extensive questionnaire regarding their involuntary memory,
supported by the answers in the notebook (see Table2).
These are standard measures in structured diaries on invol-
untary memories (e.g., Berntsen & Hall, 2004; Watson etal.,
2012) reflecting key properties of autobiographical memory
associated with the recollective quality (e.g., Brewer, 1996;
Rubin & Umanath, 2015). A number of properties related
directly to the research hypotheses, which included mood
impact, physical reactions, emotion regulation strategies
(i.e., avoidance, rumination, worry, negative interpretation,
positive interpretation, problem-solving, and reappraisal),
centrality, importance and specificity. Also related to the
experimental research questions, participants were asked
about characteristics of the ongoing situation in terms of
attention, concentration, and mood before the memory
occurred (‘pre-mood’ in Table2). Participants were also
asked about a number other of memory characteristics not
directly related to the experimental hypothesis but which
have been investigated both in studies of autobiographical
memory in the general population and in relation to psy-
chopathology: cues, rehearsal frequency, vividness, person-
perspective, time and age of the memory (e.g., Berntsen &
Hall, 2004; Watson etal, 2012). Table2 presents the ques-
tions assessing these properties.
In addition to the original questions in Watson etal.
(2012), five items regarding emotion regulation strategies
were added in the current study, following the research
strategy by Del Palacio-Gonzalez etal. (2017). These new
questions were marked with an asterisk in Table2. These
items were taken from well-established inventories assess-
ing trait-like emotion regulation strategies (Emotion Regu-
lation Questionnaire [ERQ], Gross & John, 2003; Cogni-
tive Emotion Regulation Questionnaire [CERQ], Jermann
etal., 2006) and were slightly adjusted for the context of the
memory diary. The new entries included two items regard-
ing maladaptive emotion regulation: Worry (When this
memory occurred to me, I was worried that it might hap-
pen again) and negative interpretation (When this memory
occurred to me, I thought “I can’t handle this problem” or
“I might have mental problems” or “this world is terrible”).
Three items regarding adaptive emotion regulation were also
included: Positive interpretation (When this memory came
to my mind, I thought “I am loved” or “I am valuable” or
“this world is wonderful”), problem-solving (this memory
reminded me of some solutions to solve similar problems)

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and reappraisal (I thought more positively about the event
that happened in the memory).
Step 3: The Voluntary Memory
Questionnaire
Immediately following the involuntary memory question-
naire, participants were instructed to fill out the voluntary
memory questionnaire. Each participant was required to
remove a sticker from their notebooks to reveal a word
underneath. Word cues were adapted from those previously
used by Berntsen and Hall (2004). The cue words included
‘party’, ‘book’, ‘rain’, ‘leave’, ‘cleaning’, ‘flowers’, ‘fam-
ily’, ‘sad’, ‘school’, and ‘happy’. The order of word cues
between the healthy control group and the depressed group
was counterbalanced. Participants were then asked to recall
a memory related to the word, and as soon as they recalled
it, they filled out a voluntary memory questionnaire. Since
questions addressing retrieval context (item 1–6) and cueing
(item 8–9) were only relevant for the involuntary memory,
the Voluntary Memory Questionnaire only included items
7, 10 to 27 of the questions shown in Table2.
During the study, participants were required to record
10 involuntary memories and 10 voluntary memories at
their own pace. Every day, a text message would be sent
Table 2 Autobiographical Memory Questionnaire
The questions marked with (NB) were required to record in the participant’s notebook. The questions marked with an asterisk are new additions
to Watson etal.’s (2012) original questionnaire
1. Where were you when the memory came to mind? (NB)
2. What were you doing when the memory came to mind? (NB)
3. [attention] Did you think of something else while you were doing this? (yes/no response) (NB)
4. [concentration] Was your attention concentrated on certain tasks or thoughts? (1 = not at all concentrated, 5 = extremely concentrated) (NB)
5. [pre-mood] How was your mood just before the memory came to mind? (-2 = very poor, 2 = very good) (NB)
6. Describe the situation in which the memory came to mind. (NB)
7. Describe the memory. (NB)
8. [Cues] Compare the content of the memory with what had taken place in your thoughts and surroundings right before the memory came to
your mind. Did anything in your surroundings or activities or anything in your thoughts or on your mind repeat itself in the memory? Check
the commonalities which stand out (people / places / sensory experiences / objects / feelings / life themes / activities / wording / no commonali-
ties / other). (NB)
9. [Commonalities] Were the commonalities present in your physical surroundings (i.e. external) or only present in your thoughts (i.e. internal)
or both places (i.e. mixed)? (internal/ external/mixed). (NB)
10. [specificity] Does this memory refer to a specific event in your past? (yes/no response)
11. [vividness] How vivid is the memory? (1 = cloudy and imageless, 5 = clear and vivid)
12. [mood impact] Did the memory affect your mood? (better/ worse/ no impact). (NB)
13. [person perspective] What is your location in the memory? (1 = looking out from my own eyes, 5 = looking out of an outside observer)
14. [reaction] Did you physically react in response to the memory (i.e. talking to yourself, smiling, crying, shivering, laughing etc.) (yes/ no
response), if yes, describe. (NB)
15. [frequency] Have you previously thought about this memory? (1 = never, 5 = often)
16. [centrality] Is this memory central to your identity? (1 = not central, 5 = very central)
17. [importance] Does this memory refer to an important event in your life (1 = not important, 5 = very important)
18. [valence] How do you remember your emotions at the time of the event? (1 = very negative, 5 = very positive) (NB)
19. [time] How old is the memory? (today or yesterday / yesterday to one week / one week to two weeks / two weeks to one month / one month
to six months / six months to one year / one year to five years / five years ago)
20. [age] How old were you when the event happened?
21. [avoidance] Is this one of those memories you try to avoid thinking about? (1 = not at all, 5 = strongly agree)
22. [rumination] When these memories occurred to me, I wondered “Why do I always behave this way?”” or “Why did this event happen to
me?” (1 = not at all, 5 = strongly agree)
*23. [worry] When this memory occurred to me, I was worried that it might happen again
*24. [negative interpretation] When this memory occurred to me, I thought “I can’t handle this problem” or “I might have mental problems” or
“this world is terrible” (1 = not at all, 5 = strongly agree)
*25. [Positive interpretation] When this memory came to my mind, I thought “I am loved” or “I am valuable” or “this world is wonderful”
(1 = not at all, 5 = strongly ag ree)
*26. [problem-solving] This memory reminded me of some solutions to solve similar problems (1 = not at all, 5 = strongly agree)
*27. [reappraisal] I thought more positively about the event happened in the memory (1 = not at all, 5 = strongly agree)

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out at 9 PM to remind participants that if an involuntary
memory occurs, they should complete the corresponding
questionnaire. In order to minimize disruption to everyday
life, ensure variety in memory retrieval context, and prevent
participants from purposefully generating memories, a maxi-
mum of two memories per day was asked of participants,
without an explicit time limit for the diary study, following
standard procedure (e.g., Berntsen & Hall, 2004; Watson
etal., 2012).
Coding
The memory characteristics reported in Tables3 and 4 were
based on participants’ original answers, with the exception
of emotional valence and mood impact, which were numeri-
cally recoded and physical reaction, which required raters’
coding.
Emotional Valence
We measured the percentage of positive, neutral, and nega-
tive memories in addition to the mean score to determine
the emotional valence of memories. Participants were asked,
"How do you remember your emotions at the time of the
event?" on a scale of 1 to 5. Accordingly, if the participant
scored 1 or 2, it was classified as a negative memory; if the
score was 3, it was classified as a neutral memory; if the
score was 4 or 5, it was classified as a positive memory.
Mood Impact
We asked participants "Did the memory affect your mood?"
in order to measure the valence of mood impact. The par-
ticipants were given the options "better", "worse" or "no
impact". The answer "better" was classified as a positive
mood impact, while "worse" was classified as a negative
mood impact.
Physical Reaction
We asked participants “Did you physically react in response
to the memory (i.e. talking to yourself, smiling, crying, shiv-
ering, laughing etc.)?” If they replied yes, they were required
to describe their physical reactions. To assess the valence
of participants’ physical reactions, two independent-raters
coded the written description (e.g., ‘smiling’ or ‘crying’)
provided by participants. Memories were coded into 2 cat-
egories, positive (e.g., smiling or laughing) and negative
(e.g., crying or sighing). Inter-rater reliability was excel-
lent (k = 0.91, p < 0.001). Disagreements were resolved by
discussion.
Procedure
Participants were screened through the website assess-
ments for eligibility before undergoing a video or
face-to-face interview two weeks after the website
Table 3 Attention, emotion
and commonalities prior to
involuntary memories
Information in brackets () represents the scale used to measure the variable
a Proportion of memories
* p < .05, **p < .01, ***p < .001, ****p < .0001
Variable MDD (n = 30) HC (n = 30) F ηp
2
Means SD Means SD
Attention (1–5) 2.63 0.51 2.76 0.56 0.85 0.01
Mood (1–5) 1.88 0.39 2.19 0.34 10.91** 0.16
Commonality
 Peoplea0.20 0.21 0.21 0.15 0.08 0.00
 Placesa0.06 0.09 0.15 0.11 9.68** 0.14
Sensory experiencesa0.11 0.10 0.11 0.12 0.00 0.00
 Objectsa0.06 0.11 0.14 0.18 4.27*0.07
 Feelingsa0.12 0.15 0.11 0.12 0.14 0.00
Life themesa0.09 0.16 0.04 0.18 1.76 0.03
 Activitiesa0.03 0.05 0.06 0.09 2.91 0.05
 Wordinga0.02 0.05 0.03 0.07 0.40 0.01
 Othera0.04 0.09 0.02 0.05 1.96 0.03
No commonalitiesa0.26 0.19 0.13 0.19 7.38** 0.11
Internal commonalitiesa0.27 0.20 0.26 0.22 0.03 0.00
External commonalitiesa0.23 0.21 0.31 0.23 2.09 0.04
Mixed commonalitiesa0.24 0.14 0.30 0.22 1.49 0.03

Cognitive Therapy and Research
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assessments. The SCID-5, BDI-II, HAMD-24, and
YMRS were utilized to assess clinical symptoms dur-
ing this interview. After the interview, participants were
instructed on how to record their memories in the diary
and fill out the corresponding questionnaires. After fin-
ishing the memory diary, the clinical assessments were
repeated in the same order at the final meeting to ensure
that group differences in level of depression were stable
across the diary study.
Data Analysis
All data were analyzed in SPSS Statistics version 20 (IBM,
2011). Independent samples t-tests with group (Depressed
vs. Healthy Controls) as the between-subjects factor were
used to compare demographic and diagnostic character-
istics. The exception to this was for the categorical vari-
ables (gender), for which a chi-square test was used. A
series of 2 (Retrieval: Involuntary versus Voluntary) by 2
Table 4 The characteristics of involuntary and voluntary autobiographical memories in MDD patients and healthy controls
Information in brackets () represents the scale used to measure the variable
* p < .05, ** p < .01, *** p < .001, **** p < .0001
a Proportion of memories
b Items were rated from − 1( negative) to + 1(positive)
c Items were rated from 1 (not at all) to 5 (strongly agree)
Variable MDD (n = 30) HC (n = 30) Statistics F(1, 58)
Involuntary Voluntary Involuntary Voluntary Retrieval Group Interactions
Means SD Means SD Means SD Means SD Fηp
2Fηp
2Fηp
2
Emotion at time of the event
 Emotionsc1.66 0.55 1.88 0.41 2.37 0.44 2.35 0.43 2.76 0.05 33.79**** 0.37 3.52 0.06
 Negativea0.50 0.20 0.42 0.15 0.25 0.15 0.27 0.12 1.72 0.03 33.37**** 0.37 5.01*0.08
 Neutrala0.21 0.17 0.25 0.18 0.26 0.22 0.23 0.17 0.12 < 0.01 0.78 < 0.01 2.04 0.03
 Positivea0.29 0.16 0.32 0.17 0.48 0.21 0.50 0.15 1.04 0.02 24.15**** 0.29 0.07 < 0.01
Emotion impact and physical reaction
Mood impactb−0.26 0.42 −0.05 0.26 0.15 0.28 0.18 0.22 5.98*0.09 26.70**** 0.32 3.59 0.06
Negative impacta0.52 0.24 0.35 0.13 0.24 0.17 0.22 0.11 13.59*** 0.19 35.31**** 0.38 8.47** 0.13
Positive impacta0.25 0.22 0.30 0.19 0.38 0.19 0.40 0.19 1.07 0.02 7.35** 0.11 0.36 0.01
Physical reactionb−0.17 0.27 −0.09 0.21 0.01 0.13 0.01 0.17 2.15 0.04 9.96**** 0.15 2.52 0.04
Negative reactiona0.29 0.20 0.19 0.17 0.06 0.12 0.07 0.11 7.34** 0.11 23.95**** 0.29 9.50** 0.14
Positive reactiona0.11 0.14 0.10 0.11 0.07 0.10 0.07 0.10 0.11 0.00 1.57 0.02 0.11 < 0.01
Maladaaptive emotion regulation
 Avoidancec2.21 0.65 1.95 0.60 1.34 0.44 1.30 0.30 6.12*0.02 40.95**** 0.41 3.68 0.06
 Ruminationc2.48 0.84 2.26 0.67 1.60 0.51 1.47 0.33 4.38*0.07 39.02**** 0.40 0.28 0.01
 Worryc2.51 0.70 2.16 0.49 1.63 0.49 1.60 0.41 6.79*0.11 39.47**** 0.41 4.49*0.07
Negative interpretation 2.61 0.83 2.26 0.48 1.32 0.34 1.29 0.33 5.98*0.09 95.13**** 0.62 4.56*0.07
Adaptive emotion regulation
Positive interpretationc2.32 0.81 2.35 0.72 2.83 0.84 2.99 0.81 1.79 0.03 9.97**** 0.13 0.78 0.01
Problem-solvingc2.69 0.95 2.40 0.94 2.33 0.99 2.18 0.84 7.65** 0.11 1.63 0.03 0.77 0.01
 Reappraisalc2.46 0.95 2.38 0.99 2.27 0.97 2.22 0.97 1.05 0.02 0.51 0.01 0.05 < 0.01
Other variables
 Centralityc2.91 0.73 2.88 0.60 2.27 0.70 2.36 0.65 0.19 < 0.01 13.75**** 0.19 0.55 0.01
 Importancec3.05 0.76 2.96 0.75 2.22 0.80 2.28 0.80 0.02 < 0.01 18.12**** 0.24 0.64 0.01
Rehearsal frequencyc2.53 0.52 2.57 0.68 2.24 0.53 2.28 0.53 0.36 0.01 4.77*0.08 < 0.01 < 0.01
 Vividnessc3.80 0.66 3.77 0.60 3.58 0.59 3.72 0.63 0.87 0.02 0.83 0.01 2.23 0.04
 Perspectivec2.11 0.83 2.04 0.80 1.82 0.81 1.78 0.81 0.46 0.01 2.02 0.03 0.16 < 0.01
 Specificitya0.76 0.22 0.67 0.22 0.85 0.16 0.79 0.20 8.64** 0.13 5.28*0.08 0.38 0.01
Age of memory 20.32 3.56 19.68 3.58 20.54 3.45 20.81 4.01 0.22 < 0.01 0.62 0.01 1.38 0.02

Cognitive Therapy and Research
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(Group: Depressed vs. Healthy Controls) mixed ANOVAs
were conducted to examine within-subject differences in
properties of autobiographical memories retrieved invol-
untarily and voluntarily, and between-subject differences
by the depressed group.
Results
Demographic Data
The demographics and clinical data of depression and con-
trol group are showed in Table1. There were no signifi-
cant differences between groups in terms of age or gender.
The difference in educational level was statistically signifi-
cant. However, when education was included as a covari-
ate, all group differences replicated. For instance, depres-
sion group still reported more negative, F(1, 58) = 28.05;
p < 0.001; ŋp
2 = 0.33, and less positive memories, F(1,
58) = 18.00; p < 0.001; ŋp
2 = 0.24, had more mood impact,
F(1, 58) = 26.70; p < 0.001; ŋp
2 = 0.31, and more physical
reactions following memories, F(1, 58) = 9.96; p < 0.001;
ŋp
2 = 0.15. Also, among the memory variables, years of edu-
cation only correlated significantly with negative valence of
involuntary memories (r = −0.28, p = 0.03), positive valence
of involuntary memories (r = 0.36, p = 0.005) and negative
reaction following involuntary memories (r = − 0.263,
p = 0.043). For the reasons above, we chose not to include
years of education as a covariate.
Attention, Emotion, andCues Prior
toInvoluntary Autobiographical Memories
We measured the level of concentration, emotion before
the event, and cues in terms of commonalities between
each memory and the retrieval context (external envi-
ronment and internal thoughts). These results are pre-
sented in Table3. In terms of concentrated attention, both
patients with depression and healthy controls reported
moderately low levels of concentration on average
when recalling involuntary memories, with no signifi-
cant differences between the groups. In terms of mood
prior to the memory, patients with depression reported
more negative mood. In terms of commonalities (cues)
between involuntary memories and external environment
and internal thoughts right before the memory came to
the mind, “healthy controls reported more common-
alities classified as places and objects.” Patients with
depression also reported more “no commonalities” than
healthy controls. No significant differences in internal
commonalities, external commonalities, and mixed com-
monalities were found, ps > 0.15.
Comparisons ofInvoluntary andVoluntary
Memories intheDepressed andControl
Group
We compared involuntary and voluntary autobiographi-
cal memories in patients with depression and control par-
ticipants using a series of two-by-two analyses of vari-
ance with group (depression vs. control participants) as
a between-subjects variable and type of retrieval (invol-
untary vs. voluntary) as a within-subjects variable (see
Table4). All variables were analyzed based on the mean
value or the proportion of memories (calculated for each
participant) retrieved by the patients with depression and
healthy controls. Table4 is divided up into four Sects.(1)
participants’ emotion at the time of the event, rated retro-
spectively, (2) participants’ emotion impact following the
memory, (3) the emotion regulation strategies associated
with the memory, and (4) other important memory charac-
teristics, including time, centrality, importance, rehearsal
frequency, vividness, perspective, and specificity.
Emotion attheRemembered Event
There were several main effects of group, indicating dif-
ferences between the emotion of patients’ and controls’
remembered events (Table4). Overall, patients with
depression rated their autobiographical memories as more
negative. By percentage, patients with depression reported
more negative memories (i.e., memories rated < 0) and
fewer positive memories (i.e., memories rated > 0) than
controls.
No main effects of retrieval condition were observed on
these ratings (all ps > 0.10; ŋp
2s < 0.05). One significant
interaction of negative valence between memory retrieval
and group was identified. Post-hoc analyses showed that
in the depressed group, involuntary memories were rated
as more negative than voluntary memories (p = 0.014),
whereas no such difference was observed in the control
group (p = 0.532). See Table4 for descriptive and inferen-
tial statistics.
Emotion Impact ofAutobiographical Memories
There were several main effects of group, indicating differ-
ences between the emotional impact of patients’ and con-
trols’ autobiographical memories (Table4). Compared with
healthy controls, patients with depression reported more

Cognitive Therapy and Research
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overall mood impact, negative mood impact, overall physi-
cal reaction, negative physical reaction, and less positive
mood impact following autobiographical memories, Fs(1,
58) > 7.53; ps < 0.009; ŋp
2s > 0.11 (see Table4).
Several main effects of retrieval condition were found,
showing that compared with voluntary memories, involun-
tary autobiographical memories caused more overall mood
impact, more negative mood impact, and more negative
physical reaction, Fs(1, 58) > 5.98; ps < 0.02; ŋp
2s > 0.09
(see Table4).
Two significant interactions of negative mood impact and
negative physical reactions between memory retrieval and
group were observed. Post-hoc analyses showed that in the
depressed group, involuntary memories caused more nega-
tive mood impact (p < 0.001) and negative physical reactions
(p = 0.002) than voluntary memories, whereas no such dif-
ference was observed in controls group (ps > 0.55).
Emotion Regulation ofAutobiographical Memories
There were several main effects of group, indicating dif-
ferences between the emotion regulation of patients’ and
controls’ autobiographical memories (Table4). Compared
with healthy controls, patients with depression reported
more avoidance, rumination, worry, negative interpretation
and less positive interpretation following autobiographical
memories, Fs(1, 58) > 8.97; ps < 0.005; ŋp
2s > 0.13.
Several main effects of retrieval condition were found
(Table4), showing that compared with voluntary memories,
involuntary autobiographical memories were accompanied
by more avoidance, rumination, worry, negative interpre-
tation, and problem solving, Fs(1, 58) > 4.38; ps < 0.05;
ŋp
2s > 0.07.
Two significant interactions of worry and negative
interpretation between memory retrieval and group were
observed (Table4). Post-hoc analyses showed that in the
depressed group, involuntary memories were accompa-
nied by more worry (p = 0.038) and negative interpretation
(p = 0.021) than voluntary memories, whereas no difference
was observed in controls group (p > 0.635).
Other Variables ofAutobiographical Memories
There were several main effects of group, indicating differ-
ences between the other important properties of patients’ and
controls’ autobiographical memories (Table4). Compared
with healthy controls, patients with depression reported
more centrality, importance, rehearsal frequency, and less
specificity of autobiographical memories, Fs(1,58) > 5.28;
ps < 0.04; ŋp
2s > 0.07. Regarding Time of autobiographical
memories, the effect of Group was significant for “5years
ago”, F(1, 58) = 7.22; p = 0.009; ŋp
2 = 0.11. In the depression
group, 28% of events in involuntary memories and 31% of
events in voluntary memories happened 5years ago. How-
ever, in healthy controls, 20% of events in involuntary mem-
ories and 18% of events in voluntary memories happened
5years ago, suggesting that participants with depression had
more remote memories.
Only one main effect of retrieval condition were found,
showing that compared with voluntary memories, involun-
tary memories were more specific. All the interactions were
non-significant (all ps > 0.16; ŋp
2s < 0.04).
Discussion
Only few studies have been conducted on involuntary memo-
ries in everyday life in clinical samples. To date all have
been conducted in Western populations. For depression, only
two studies (Watson et. al., 2012, 2013) have used clinically
diagnosed participants and these were based on the same
dataset and did not control for comorbidities. To begin to
fill this research gap, we tested clinically diagnosed Chi-
nese participants with major depressive disorder control-
ling for comorbidity with other clinical disorders. We used
a structured diary method to compare voluntary memories
versus involuntary memories in both general and clinical
populations. The main focus was on the emotion valence,
emotion impact, and emotion regulation of autobiographical
memories. Several other non-emotional characteristics were
also examined.
In terms of the emotions associated with involuntary
autobiographical memories, several differences were found
between groups. First, compared to control participants,
patients with depression tended to have more negative mem-
ories and fewer positive memories, as well as more mood
impact and physical reactions following autobiographical
memories, which is consistent with Watson etal. (2012)
and Del Palacio-Gonzalez etal.’s (2017) findings in patients
with depression and individuals with dysphoria, respec-
tively. Second, patients with depression in the present study
reported more avoidance, rumination, worry, negative inter-
pretation and less positive interpretation of autobiographical
memories. Interpretation biases have long been theorized
to play a central role in depression. Everaert etal. (2017)
found that higher levels of depression were associated with a
decrease in positive interpretations and an increase in nega-
tive interpretations, which is in agreement with our findings.
A decrease in positive interpretation could prevent patients
with depression from gaining the benefits of this strategy,
such as increased positive emotions, decreased negative
emotions, and faster stress recovery. Similar to our find-
ings, Watson etal. (2012) found that patients with depres-
sion reported more rumination and avoidance in response
to their memories than individuals without depression. Del

Cognitive Therapy and Research
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Palacio-Gonzalez etal. (2017) also found that maladaptive
regulation strategies, including brooding, emotional sup-
pression and memory suppression were greater for indi-
viduals with dysphoria for both involuntary and voluntary
memories. Isham etal. (2020) reported heightened brooding
in response to autobiographical memories when memory
retrieval occurred involuntarily in individuals with remitted
depression, and their trait mindfulness was low, showing
that maladaptive mood regulation persists even in patients
in remission.
In terms of other characteristics associated with invol-
untary memories, several group differences were found.
Patients with depression reported more centrality, impor-
tance, rehearsal frequency, and less specificity of autobio-
graphical memories than healthy controls. These findings are
in line with those of Watson etal. (2012) who also found that
patients with depression considered memories to be more
central and important to their identity and they rehearsed
their autobiographical memories more frequently. However,
our findings differ from previous studies showing no reduc-
tion in the specificity of autobiographical memories in indi-
viduals with dysphoria (Del Palacio-Gonzalez etal., 2017;
Kvavilashvili & Schlagman, 2011). Relatedly, Watson etal.
(2013) found that individuals with depression were less spe-
cific only during voluntary, but not during involuntary recall,
when controlling for remission. More research involving
clinically depressed participants is needed to clarify whether
these divergent findings reflect cultural differences between
the study populations included here and in former studies.
The present study replicated most of the differences pre-
viously found between involuntary and voluntary memory in
general and in clinical populations. First, involuntary memo-
ries caused more mood impact and physical reactions and
were more specific than their voluntary counterparts, which
is consistent with many previous studies in individuals both
with and without mental health problems–e.g., healthy adults
(Berntsen & Hall, 2004), PTSD (Rubin etal., 2008, 2011),
depression (Del Palacio-Gonzalez etal., 2017; Watson etal.,
2012, 2013), social anxiety (Del Palacio-Gonzalez & Bernt-
sen, 2020) and schizophrenia (Allé etal., 2020, 2021).
Second, we found that involuntary memories were fol-
lowed by more maladaptive emotion regulation strategies
(i.e., avoidance, rumination, worry, and negative interpre-
tation) than voluntary memories. A similar finding was
reported in Del Palacio-Gonzalez etal.’s (2017) study on
individuals with dysphoria, where brooding, memory sup-
pression, and emotional suppression were higher for invol-
untary than voluntary memories. In their study of social
anxiety, Del Palacio-Gonzalez and Berntsen (2020) found
brooding, thought suppression, emotion suppression, reflec-
tion, and reappraisal were all rated higher for involuntary
versus voluntary processes. The activation of involuntary
memories requires less executive control than voluntary
recall, which likely leads to involuntary memories being
processed in a more uncontrolled manner. This may cause
stronger emotional reactions and dysfunctional emotional
regulation in response to the memories (Berntsen, 2009).
Additionally, as involuntary memories can arise in a vari-
ety of contexts, in some situations the recall could interrupt
activity during that time, and as a result, individuals may feel
a greater need to regulate involuntary memories.
Nevertheless, involuntary memories were also followed
by more emotion regulation directed at problem-solving in
the present study. Since involuntary memories yield fast
access to memories of specific events with a distinctive con-
tent-overlap to the current situation, Rasmussen and Bernt-
sen (2009) proposed that they may serve important directive
functions in novel situations. The finding that involuntary
memories involved more emotion regulation directed at
problem-solving is consistent with this proposal. We also
found that in terms of commonalities between the content of
involuntary memories and features of the ongoing situation
right before the memory came to the mind, patients with
depression reported more “no commonalities” than healthy
controls, suggesting more difficulties with identifying cues.
Past research has reported a similar phenomenon in OCD
patients. According to Coughtrey etal. (2015), involuntary
images "come out of the blue" for most OCD patients, which
may increase their sense of loss of control, causing a more
intense emotional response. Kvavilashvili and Schlagman
(2011) found that participants with dysphoria reported more
memories triggered by internal thoughts. Similarly, Allé
etal. (2020) also found that patients with schizophrenia had
more involuntary memories in response to internal triggers
than features of the external environment.
In contrast to most previous work, we found a number
of interactions between memory retrieval and depression
status on some measures of negative affect, that is, nega-
tive emotion, negative impact, negative reaction, worry, and
negative interpretation of memory retrieval. This pattern is
different from the pattern observed in Watson etal. (2012)
and Del Palacio-Gonzalez etal., (2017, 2020), where both
controls and clinical groups show higher reaction to invol-
untary memories (e.g., for mood impact, physical reaction,
emotion, avoidance, brooding, etc.). The similarity in the
form of the interaction, their occurrence only in measures
related to negative affect, is thus noteworthy. The reason
these interaction effects were present in the present study in
contrast to previous work may be cultural differences and/
or the fact that the present study, unlike previous work, con-
trolled for comorbidity with other disorders. Also, two of
the rating scale questions, for which interaction effects were
observed in the present study (negative interpretation and
worry), were not included in earlier work. Moreover, Wat-
son etal. (2012) also observed an interaction trend between
memory retrieval and depression status on a measure of

Cognitive Therapy and Research
1 3
negative reaction. Besides, among a remitted depressed
sample, Isham etal. (2020) found a significant group by
retrieval interaction predicting cognitive reappraisal, indicat-
ing that compared to individuals with no depression history,
participants with remitted depression reported significantly
greater employment of cognitive reappraisal during invol-
untary memories but not for voluntary memories. They also
found a significant trait mindfulness by retrieval by group
3-way interaction for brooding, i.e., individuals with remit-
ted depression reported heightened brooding in response to
memories retrieved involuntarily, but only if they scored
low on trait mindfulness. For voluntary memories, remit-
ted depression did not predict brooding, irrespective of trait
mindfulness level. Future studies should examine these ques-
tions using larger samples of patients with depression from
diverse cultural backgrounds.
Another important topic left for future research is the
treatment implications of involuntary memory studies in
patients with depression. For instance, in cognitive behav-
ior therapy, many patients with depression have difficulty
pinpointing the activating event of their mood swings. By
assigning patients the practice of recording involuntary
memories, therapists may better help patients recognize
the activating event, beliefs about the event and its emo-
tional consequences, facilitate collecting information from
patients, as well as identify areas in which patients need
intervention more efficiently. Involuntary memories might
be a better way to discover issues bothering the person in the
world outside the therapy session, which is the environment
that really matters for everyday spontaneous thoughts and
memories that could induce negative affect and trigger rumi-
nation. Our findings suggest that involuntary memories may
have a greater impact on patients with depression than vol-
untary memories and therefore should be given more atten-
tion by clinicians and researchers. We should not only focus
on the negative intrusive memories of patients with depres-
sion, but also their general, everyday involuntary memories
should also be explored in more detail. For example, our
findings suggest that it may be important to develop strate-
gies to increase adaptive emotion regulation and decrease
maladaptive emotion regulation in patients with depression
in response to these involuntary memories. Researchers
may also explore if decreasing the centrality of involuntary
memories that negatively affect patients with depression and
increasing the specificity of involuntary memories that posi-
tively affect patients with depression will have an improve-
ment on depressive symptoms.
Several limitations should be acknowledged. First, there
was only one entry in the questionnaire regarding each
type of emotion regulation in order to keep the length
of the questionnaire manageable for the participants.
Although this was also the case in the previous diary stud-
ies (Watson etal. 2012; Del Palacio-Gonzalez etal., 2017,
2020), the measurements may have been less accurate and
robust as a result. Second, we did not measure all pos-
sible emotion regulation responses, and some potentially
relevant types were left out, such as distraction and dis-
sociation. Future studies of emotion regulation in response
to involuntary memory in patients with depression should
find ways to remedy these shortcomings. Third, we used a
word-cue paradigm to sample voluntary memories, in line
with previous work. However, eliciting autobiographical
memories with word cues may not be representative of
voluntary memories in everyday life (Rasmussen etal.,
2014). Future studies may examine whether our results
hold for voluntary memories evoked in everyday contexts
(e.g., in response to social interactions). Fourth, as com-
pared to interviews and questionnaire studies that exam-
ined the properties of involuntary memories from the past
several weeks, the diary study has reduced retrospective
recall bias to some extent (e.g., Berntsen, 1996; Brewin
etal., 1998; Bywater etal., 2004; Newby & Moulds, 2010;
Reynolds & Brewin, 1999). However, the retrospective
recall bias is still a possible limitation of this study, as
there was still a time lag between the emergence of invol-
untary memory and the completion of the questionnaire. A
major strength of the present study is the use of a clinically
depressed sample of Chinese individuals with no comorbid
disorders, enabling us to identify properties of involun-
tary memories specific to depression in this understudied
population.
In conclusion, the present study was the first to examine
the properties of involuntary autobiographical memories in
Chinese patients with depression. The results demonstrated
that both involuntary memories and their voluntary counter-
parts are altered in depression. Both were more emotionally
negative and followed by more negative impact and mala-
daptive emotion regulation responses in the depressed group,
relative to controls. In both groups, involuntary memories
were associated with more emotional impact and more emo-
tion regulation responses than voluntary memories. These
findings replicate previous studies and extend them to a Chi-
nese population of clinically diagnosed patients with depres-
sion, underscoring their robustness and generalizability. In
addition, the study adds important new findings regarding
negative interpretation and worry associated with involun-
tary memories in major depression. The findings may have
important implications for psychological interventions by
suggesting centrality, specificity of involuntary memories,
and emotion regulation responses to involuntary memories
as possible targets for therapy.
Author Contributions All authors contributed to the study conception
and design. Material preparation, data collection and analysis were
performed by YS, DB, SY and YH. The first draft of the manuscript

Cognitive Therapy and Research
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was written by YS and all authors commented on previous versions of
the manuscript. All authors read and approved the final manuscript.
Funding This study was funded by the National Natural Science Foun-
dation of China (Grant No. 81801347).
Data Availability The datasets generated during and/or analyzed dur-
ing the current study are available from the corresponding author on
reasonable request.
Declarations
Conflict of Interest Yanyan Shan, Shuya Yan, Yanbin Jia, Yilei Hu,
David C. Rubin, Dorthe Berntsen declare that they have no conflict
of interest.
Informed Consent Informed consent was obtained from all individual
participants included in the study.
Human and Animal Rights No animal studies were conducted by the
authors for this paper
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