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Memory Training for OlderAdults with Low Education:Mental Images VersusCategorizationHenrique Salmazo da Silva a & Mônica SanchesYassuda aa School of Arts, Sciences, and Humanities ,University of São Paulo , São Paulo, BrazilPublished online: 17 Sep 2009.

To cite this article: Henrique Salmazo da Silva & Mônica Sanches Yassuda(2009) Memory Training for Older Adults with Low Education: Mental ImagesVersus Categorization, Educational Gerontology, 35:10, 890-905, DOI:10.1080/03601270902782487

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MEMORY TRAINING FOR OLDER ADULTS WITH LOWEDUCATION: MENTAL IMAGES VERSUSCATEGORIZATION

Henrique Salmazo da SilvaMonica Sanches Yassuda

School of Arts, Sciences, and Humanities,University of Sao Paulo, Sao Paulo, Brazil

This study aimed to describe the benefits of memory training for olderadults with low education. Twenty-nine healthy older adults with zeroto two years of formal education participated. Sixteen participantsreceived training based on categorization (categorization group¼CATG)and 13 received training based on mental images (imagery group¼ IMG).One group served as control for the other because they trained with dif-ferent strategies. Training was offered in eight sessions of 90 minutes.The participants were evaluated pre- and posttraining. IMG improvedperformance in episodic memory tests and had reduced depressivesymptoms. CATG increased the use of categorization but did not increaseperformance in episodic memory tests. Results suggest that the strategybased on the creation of mental images was more effective for older adultswith low formal education.

The impact of education on cognitive aging is studied in at least twomain research areas: epidemiological studies, which aim to establishthe prevalence and incidence of cognitive decline among literateand illiterate individuals; and comparative studies, which test the per-formance of literate and illiterate individuals in a variety of cognitivetasks. Epidemiological studies conducted in Latin America and

This work was upported by grants from FAPESP processes no. 07/00441-6 and

07/00110-0.

Address correspondence to Monica Sanches Yassuda, Escola de Artes, Ciencias e Huma-

nidades (USP-EACH). Av. Arlindo Bettio, 1000–CEP: 03828-000 Ermelino Matarazzo, Sao

Paulo/SP, Brazil. E-mail: yassuda@usp.br

Educational Gerontology, 35: 890–905, 2009

Copyright # Taylor & Francis Group, LLC

ISSN: 0360-1277 print=1521-0472 online

DOI: 10.1080/03601270902782487

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Brazil, in agreement with studies conducted in many other countries,have documented that education is one of the sociodemographic fac-tors associated to vulnerability to cognitive decline (Almeida, 1998;Ardila, Ostrosky-Solis, Rosseli, & G�oomez, 2000; Brucki & Rocha,2004; Herrera, Caramelli, Silveira, & Nitrini, 2002; Kramer, Bherer,Colcombe, Dong, & Greenough, 2004; Laks, Baptista, Contino,Paula, & Engelhardt, 2007; Maia, Durante, & Ramos, 2004; Ramos,2007; Scazufca et al., 2002; Veras & Coutinho, 1991).

In Veras and Coutinho (1991) the prevalence of cognitive declinewas seven times higher in individuals with low education. Herrera,Caramelli, Silveira, and Nitrini (2002) found greater risk of cognitivedecline among illiterate older adults (prevalence of 12%) than forolder adults with eight years or more years of education (prevalenceof 2%). Nevertheless, increased prevalence of decline among illiteratesmay be partially explained by methodological difficulties associatedwith study design and the level of sensitivity and specificity of theassessment scales (Scazufca et al., 2002).

Studies comparing cognitive performance of literate and illiterateadults showed that learning to deal with symbols and written lan-guage may influence the development of the auditory-verbal neuralcircuitary, confirming the relationship between the brain architectureand educational experience (Reis, Petersson, Castro-Caldas, &Ingvar, 2001; Petersson, Reis, & Ingvar, 2001). Among the illiteratesthere was reduced activity in the posterior parietal cortex and theconnection between hemispheres (corpus callosum) in tasks involvingimmediate verbal repetition (Petersson, Reis, Castro-Caldas, &Ingvar, 1999; Petersson, Reis, Askelof, Castro-Caldas, & Ingvar,2000). Illiterate adults had a disadvantage while differentiating wordsfrom pseudo-words (Petersson et al., 2001), and they had better per-formance memorizing colored pictures than black and white ones(Reis, Faısca, Ingvar, & Pettersson, 2006). Objects were easier tomemorize than pictures (Reis et al., 2001). Differences between illiter-ates and literates could also be observed in visual scanning (Bramaoet al., 2007) and in executive performance (Brucki & Nitrini, 2008).

Although older adults with low education may be at greater risk forcognitive decline, the impact of memory training programs for thispopulation has yet to be investigated. Cognitive plasticity has beendemonstrated among unimpaired older adults with 11 to 15 yearsof formal education (Ball et al., 2002; Verhaeghen, Marcoen, &Goossens, 1992; Willis et al., 2006). Only one study was found inthe literature investigating cognitive plasticity among adults withlow education. Ardila, Ostrosky-Solis, and Mendoza (2000) foundthat cognitive training may help illiterates learn how to read and write.

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Considering that in developing countries such as Brazil a high per-centage of older adults are illiterate, or have limited educationalexperience, it is relevant to study cognitive plasticity in this popula-tion strata. According to a recent Brazilian study, older adults havefour years of education (57%) and 18% have never attended school(Santos, Lopes, & Neri, 2007). It is also necessary to investigatewhich training strategies may be more effective for cognitive improve-ment in this group. This study aimed to describe the potential benefitsof memory training to older adults with zero to two years of formaleducation, and to compare the effectiveness of categorization andvisual imagery training in this sample.

METHOD

Participants

Older adults who were enrolled in a literacy course based in a seniorcitizen center were invited to participate in the study. Inclusion cri-teria included having from zero to two years of formal education.The absence of depression and significant cognitive decline, measuredby screening instruments validated for the Brazilian population wasalso required. The screening tests were the MMSE, Mini Mental StateExamination (Brucki, Nitrini, Caramelli, Bertolucci, & Okamoto,2003; Folstein, Folstein, & McHugh, 1975) and the GDS, GeriatricDepression Scale (Almeida & Almeida, 1999; Yesavage et al.,1983). The cutoff point for the MMSE was 17 and for the GDSit was 6.

Forty-eight older adults were evaluated at pretest. Nineteen werenot posttested because they either had more than two years of educa-tion or they missed more than four training sessions. Thus, the samplewas comprised of 29 healthy older adults. Sixteen older adults receivedtraining sessions based on categorization (categorization group¼CATG) and 13 participated in sessions that emphasized the creationof mental images (imagery group¼ IMG). The age, education andpretest performance of the two groups in theMMSE, GDS and VerbalFluency (VF) are presented in Table 1. There was a significant differ-ence between the groups in age. Participants in GCAT were older thanin IMG. Despite this difference, the groups were statistically equiva-lent in education and cognitive performance, suggesting the groupshad no preexisting differences in mental abilities.

In this sample, 20 older adults had no educational experience:15 participants could read simple messages and 5 were illiterate.

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The education was considered zero if the participant had neverattended formal educational programs or had attended school for lessthan one year. The distribution of participants according to educa-tion between the groups can be seen in Table 2.

As to other demographic variables, 29 participants were women.26, or 86%, were born in rural areas. Twenty-seven participants wereretired or pensioners, and two carried out paid activities. Seventeen,or 58%, were widows.

Materials

To assess the general cognitive status of participants, theMini-Mental State Examination (MMSE) and Verbal Fluency Testwere applied pre- and posttest. The Geriatric Depression Scale(GDS) was used to quantify the presence of depressive symptomsdue to the inclusion criteria. GDS was also used to evaluate the effectof the intervention on depressive symptoms. The MMSE evaluatesmemory, attention, language, and praxis, and the scores range from

Table 1. Means and standard deviation for age, education, and cognitive

performance at baseline (pretest)

Groups

Categorization

group (GCAT) Imagery group (IMG) p value�

Age 72.31� 5.04 67.62� 3.48 0.006a

Education 0.69� 0.87 0.31� 0.75 0.219

MMSE 23.87� 2.03 24.00� 2.12 0.873

GDS 2.56� 2.03 3.31� 1.70 0.292

VF 13.63� 1.70 13.62� 3.18 0.992

Immediate recall RBMT story 5.06� 1.91 5.00� 2.20 0.936

Delayed recall RBMT story 4.06� 1.80 3.46� 2.44 0.468

18-pictures test 11.94� 3.45 12.38� 2.43 0.687

Note. �p value calculated by independent samples t test; a¼ p value <.05.

Table 2. Education distribution between the groups

0 years 1 year 2 years

GCAT 9 3 4

IMG 11 0 2

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0 to 20 points (Brucki et al., 2003; Folstein et al., 1975). The GDS has15 items and measures the presence of depressive symptoms (Almeida& Almeida, 1999; Yesavage et al., 1983). In the Verbal Fluency ani-mal category (VF), the older adult is asked to speak names of animalsin one minute (Brucki & Rocha, 2004). The test assesses executivefunctions, language, and semantic memory.

In addition to cognitive screening instruments, visual and auditoryepisodic memory tests were used to evaluate the effectiveness of train-ing. Visual episodic memory was assessed by a test of 18 black andwhite pictures developed by Carvalho, Neri, and Yassuda (in press).Auditory memory was assessed by the story subtest from theRivermead Behavioral Memory Test (RBMT) (Wilson, Cockburn,& Baddeley, 1985; Wilson, Cockburn, Baddeley, & Hiorns, 1989).

The 18-picture test developed by Carvalho, Neri, and Yassuda (inpress) is composed of pictures that can be divided into three semanticcategories. The pictures were extracted from a previous Brazilianstudy (Pompeia, Miranda, & Bueno, 2001), which provided norma-tive data for use of 400 pictures. The pictures that compose the testhad been classified as easy to recognize and name in the originalstudy. Carvalho, Neri, and Yassuda (in press) developed two equiva-lent versions of the test, version A and B. The versions were randomlyapplied in the pretest within each group, and in the posttest theyreceived the alternate version.

The RBMT (Wilson et al., 1985) is an ecological memory batterycomposed of 12 subdomains. It aims to assess different memory sub-systems using tasks that resemble activities of the daily life. There arefour equivalent versions. One of the subtests includes listening andrecalling a short story immediately and after a short delay. The stor-ies are made up of 21 ideas that describe events involving characters,scenarios, and actions, such as a short newspaper article. In thisstudy, we used the stories from versions C and D, which were ran-domly applied within groups in pretest, and the alternate versionwas used for posttest to minimize possible retest effect. The intervalbetween immediate and delayed recall was approximately 30 minutes.The RBMT has already been adapted to Brazilian Portuguese, andprevious studies have suggested that the Brazilian version of theRBMT retains its psychometric characteristics (Oliveira & Schmidt,1999; Yassuda et al., 2006; Yassuda et al., 2009).

The use of memory strategies was evaluated in pre- and posttestwith open questions (self-report) and with the Bousfield categoriza-tion measure, which is well established in the literature (Bousfield,1953). To obtain the Bousfield measure, a rate of recurrent intracate-gorical recall is estimated (ratio of repetition), following the formula

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[RR¼ r=n� 1], where r represents the number of items from a cate-gory that are remembered together and n the total number of itemsrecalled in the protocol. The index ranges from 0 (no categorization)to 1 (total categorization).

Procedures

Each group (CATG and IMG) received eight training sessions. Thesessions were offered twice a week and lasted for 90 minutes. Onegroup served as a control to the other because each group learneda specific mnemonic strategy and training gains were not expectedto transfer to untrained tasks. Participants were not individuallyassigned to each training group because they were nestled within a lit-eracy class. Five classes were invited to participate, and the class wasassigned to the CATG or the IMG condition. Three classes receivedcategorization training and two classes received imagery training.

In the CATG group, the sessions included exercises that targetedvisual and auditory attention, verbal fluency, and episodic memory.Episodic memory tasks involved memorizing grocery items (three-dimensional objects) and photos or pictures. Participants wereinstructed to organize objects and pictures into the categories accord-ing to function, color, or form. The exercises gradually became morecomplex in each session (Protocol for the eight sessions is detailed inthe Appendix).

Participants in the IMG group were encouraged to create mentalimages of individual items such as an apple, an umbrella, and somesupermarket objects. They were also encouraged to imagine the itemsin different states and conditions, involving movement, color, smell,and different spatial arrangements (for example, an open and closedumbrella). After the creation of mental images, pictures that could besimilar to the imagined items were shown, so that participants werestimulated to highlight the differences between what they had ima-gined and what was presented. In subsequent sessions, older adultsbegan to imagine objects in interaction with others (such as a bookand a pen) and created mental images of short sentences. The finalsessions involved creating images for short stories (Protocol for theeight sessions is detailed in the Appendix).

Statistical Analysis

The dependent variables were the scores for the MMSE, VF, the18-picture test, the number of ideas recalled in the RBMT story

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(immediate and delayed recall), the Bousfield score and the GDS. Theanswers to the open questions for strategy use were categorizedaccording to the expressed content.

Kolmogorov-Smirnov test was used to assess whether the variablesfollowed a normal distribution. Only the GDS scores did not follownormal distribution; thus, parametric tests were used for all analysesand the GDS data were also analyzed with nonparametric tests.Repeated measures ANOVAs assessed the effect of Time (pretest� -posttest) and Group (CATG� IMG), as well as possible interactionsbetween these two factors.

The data were also analyzed with paired samples t-test to investi-gate pre- to posttest changes. Data were also analyzed with indepen-dent samples t tests to look for group differences at pre- and posttest.Delta scores were calculated for each variable (posttest score minusthe pretest score). The CATG and the IMG deltas were comparedusing the independent samples t-test. The value of significance chosenfor these tests was p< .05.

RESULTS

The groups were compared in relation to session attendance. Theaverage attendance was statistically equivalent in the two groups;for CATG it was 5.88 sessions, while for IMG it was 5.54(p value¼ .476). This result does not support the hypothesis thatone group could have benefited more due to higher attendance atthe training sessions.

Table 3 presents the cognitive performance of CATG and IMG inpre- and posttest. Repeated measures ANOVAs (results shown inTable 4) revealed significant effect of the time factor for the immedi-ate (F¼ 15.63, p¼ .000) and the delayed recall (F¼ 15.09; p¼ .001) ofthe RBMT story. The interaction between the Time and Groupfactors was observed for the GDS (F¼ 4.51, p¼ .000) and for theBousfield Measure (F¼ 5.51, p¼ .034).

The effect of the Time factor on the immediate recall of the RBMTstory suggests that both groups (CATG and IMG) showed higherperformance in posttest. However, the Group�Time interaction sug-gests that the increase in the Bousfield measure and the decrease inthe GDS score were restricted to one of the groups.

Paired samples t-tests, carried out separately for each group, indi-cated there was a significant increase in performance for the IMG(p¼ .001) for the RBMT immediate story recall. Both groups appearto have benefited from the sessions, however, the benefits were higher

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for the IMG. For the RBMT delayed story recall, there was also sig-nificantly higher performance for the IMG (p¼ .004). These analysesalso showed a significant decrease in depressive symptoms frompre- to posttest for the IMG group only (p¼ .016). GDS scores werealso analyzed with nonparametric tests, which confirmed this result(Wilcoxon test, p¼ 0.023).

For the CATG, there was a significant increase in the Bousfieldmeasure (p¼ .008); however, there was no significant increase inepisodic memory performance for this group.

Independent samples t-tests comparing the deltas for the twogroups revealed significant difference for the GDS (p¼ .038) andfor the Bousfield measure (¼.038). The deltas for the other cognitivemeasures revealed no significant differences between the groups.

Table 3. Means and standard deviation for cognitive performance and

depressive symptoms at pre- and posttest

Evaluations

Pretest Posttest p-value�

MMSE

CATG 23.88� 2.03 23.88� 2.28 1.000

IMG 24.00� 2.12 23.85� 1.99 0.811

Immediate recall RBMT story

CATG 5.06� 1.91 6.25� 2.32 0.095

IMG 5.00� 2.20 7.23� 3.03 0.001a

Delayed recall RBMT story

CATG 4.06� 1.81 5.25� 2.27 0.089

IMG 3.46� 2.44 6.08� 2.75 0.004a

VF

CATG 13.63� 1.71 15.25� 3.13 0.098

IMG 13.62� 3.18 13.54� 3.57 0.929

18-picture test

CATG 11.94� 3.45 12.25� 2.84 0.664

IMG 12.38� 2.43 12.07� 2.90 0.669

Bousfield

CATG 0.34� 0.18 0.47� 0.15 0.008a

IMG 0.44� 0.18 0.41� 0.14 0.657

GDS

CATG 2.56� 2.03 2.75� 2.08 0.654

IMG 3.31� 1.70 2.31� 1.60 0.016a

Note. �p value calculated by paired samples t test.a¼ p value <.05.

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The qualitative analysis of the strategy use assessment in pretestrevealed that 23 participants did not report using strategies and6 reported using them. In the posttest 21 older adults reported theydid not use strategies and 8 mentioned having used them. The strate-gies mentioned in the pretest were remembering objects they use athome and remembering the order the items were presented in the18-picture test. In the posttest, the strategies mentioned were payingattention and creating mental images. Significant differences betweengroups in pretest and posttest were not observed.

DISCUSSION

This study investigated the benefits of memory training sessions forolder persons with low education. The results indicated that in theposttest IMG participants showed higher performance in the immedi-ate and delayed recall of RBMT stories, and there was a reduction indepressive symptoms. Conversely, GCAT showed a significantincrease in the categorization of the 18 pictures during recall.

The hypothesis that posttest gains would be specific to the strate-gies taught in each group was partially confirmed. CATG partici-pants increased the use of categorization in the 18-picture test,however, this gain was not accompanied by higher performance inthe recall of the pictures. These results suggest that a strategy basedon the creation of mental images may be more effective for olderadults with low education. Compared to previous studies carriedout with Brazilian older adults with more than four years of educa-tion (Carvalho, Neri, & Yassuda, in press), these data also seem to

Table 4. Results for repeated measures ANOVAs comparing CATG and

IMG

Variable

Group factor

(CATG� IMG)

Time factor

(Pre-� posttest)

Group� time

interaction

MMSE F¼ 0.00; p¼ 0.947� F¼ 0.05; p¼ 0.823 F¼ 0.05; p¼ 0.823

GDS F¼ 0.05; p¼ 0.817 F¼ 2.11; p¼ 0.157 F¼ 4.51; p¼ 0.043a

Immediate recall

RBMT story

F¼ 0.35; p¼ 0.558 F¼ 15.63; p¼ 0.000a F¼ 1.45; p¼ 0.238

Delayed recall

RBMT story

F¼ 0.025; p¼ 0.875 F¼ 15.09; p¼ 0.001a F¼ 2.12; p¼ 0.156

VF F¼ 0.93; p¼ 0.342 F¼ 1.46; p¼ 0.237 F¼ 0.17; p¼ 0.194

18-pictures test F¼ 0.01; p¼ 0.890 F¼ 0.00; p¼ 0.996 F¼ 0.38; p¼ 0.543

Bousfield F¼ 0.17; p¼ 0.678 F¼ 2.24; p¼ 0.145 F¼ 5.01; p¼ 0.034a

Note. �p value calculated by Repeated Measures ANOVAs; a¼ p value <.05.

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suggest that there may be less plasticity among older adults with lim-ited education.

A priori, the literature reports that the gains associated tomnemonic training are specific to the skills and strategies taught inexperimental groups (Ball et al., 2002; Verhaeghen et al., 1992; West,1995; West, Welch, & Yassuda, 2000, Willis, 2001; Willis et al., 2006).Results from the present study are consistent with the hypothesis thatIMG and CATG participants tried to use the strategies they practicedin training. However, this conclusion is tentative since there was noobjective measure of mental imagery use. Other possible explanationsfor training gains include retest effects and changes in attitudes ofparticipants regarding memory that were not assessed in the currentsample (Bandura, 2006; Freire, 1998).

Regarding the use of categorization, older adults with low educa-tion seem to have learned to use the strategy. However, the use of thestrategy did not generate improvement in episodic memory tests.Bjorklund et al. (1997) characterized strategy use in the absence ofperformance gains as utilization deficiency. In Brazil, Yassuda et al.(2006) found evidence for utilization deficiency among olderBrazilians with higher education (M¼ 8.4 years) after four sessionsof training. The authors indicated that strategy use may need tobecome fully automatic before performance may improve. Thishypothesis was confirmed by Carvalho, Neri, and Yassuda (in press)who showed that after four sessions of training emphasizing a singlestrategy the utilization deficiency may be overcome. However, parti-cipants studied by Carvalho, Neri, and Yassuda (in press) had fromfour to eight years of education. As a whole, available data seems tosuggest that low education older adults may need longer trainingprograms to fully master the use of some memory strategies.

Data presented by Copeland and Radvansky (2007) support thenotion that the creation of mental images is an effective tool for mem-orization. The results of this study also support the effectiveness ofcreating mental images for memory. The method of creating mentalimages employed in the IMG was similar to the one employed in thepretraining sessions developed by Yesavage (1983) and Brooks,Friedman, Pearman, Gray, and Yesavage (1999), that is, using imagesfrom famous painters and highlighting the similarities and differencesbetween the works. The authors observed that mental images weremore effective when coupled with the method-of-loci than when usedwith the face-name method. Possibly, the mental images helped theparticipants to create sequences and to organize the data to be learned.

Regarding the decline in depressive symptoms in IMG, the imagespresented referred to phrases and stories that, in an indirect way,

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might have greater emotional impact than the pictures presented inCATG. Carstensen, Mikels, and Mather (2006) describe that oldadults tend to emphasize the positive attributes of target items,neglecting attributes that can cause negative emotions. Imagerytraining may have elicited more discussion and socialization amongparticipants than the categorization training.

It is important to acknowledge some potential limitations ofpresent results. The characteristics of the participants may have con-tributed to the effectiveness of training, because they were assessedin literacy programs and may have been more motivated to engagein training. In addition, sample size was small and results need tobe replicated in larger samples. Assessment measures may also needto be adjusted to better capture training gains in this sample.

In summary, the results presented in this study were an initialattempt to document the presence of cognitive plasticity among olderadults with limited or no schooling. Understanding how educationand written abilities might impact cognitive plasticity in old age repre-sents an interesting area of investigation. Findings suggest that it ispossible to increase episodic memory performance in this population.This is especially so when the strategies involved the creation of mentalimages, which might be a more meaningful strategy for this population.

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APPENDIX

Protocol for Visual and Auditory Attention, Verbal Fluency, andEpisodic Memory Exercises

SESSIONS FOR THE CATG

1st session: Participants received information about memory,attention, and cognitive aging. They organized objects into cate-gories according to function. Ten items were presented.

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2nd session: Participants discussed about the role of attention inepisodic memory tasks. Ten and 15 grocery items were pre-sented. Participants organized the items into categories accord-ing to function. After categorization, verbal fluency activitiesand delayed recall of grocery items were carried out.

3rd session: Participants memorized 12 colored pictures of groceryitems. They were instructed to divide the pictures according colorand function. After categorization, participants were invited tofind the pictures represented by three-dimensional objects.

4th session: Review of the previous sessions. Older adultsobserved grocery items and pictures (two-dimensional objects).They were instructed to memorize each group of items to bestored (transportation, fruits, and groceries). Pictures werecut out and categorized individually by each participant.

5th session: Participants carried out episodic memory tasks. 12,16 and 18 pictures were categorized and recalled. Older adultswere encouraged to discuss how they grouped the pictures (con-sidering, for example, features, use, forms, and names).

6th session: Verbal fluency activities and presentation of 12, 16, and18 items to categorize and recall with a longer delay (30minutes).

7th session: 20, 25, and 30 three-dimensional objects were cate-gorized and recalled immediately and after a delay (30 minutes).

8th session: Review of previous sessions.

SESSIONS FOR THE IMG

1st session: Participants received information about memory,attention, and cognitive aging. Participants were encouragedto imagine individual objects (for example, a red applewith small leaves, an open umbrella, and a closed umbrella).Afterwards, older adults tried to imagine the movements ofthe objects, the noise, and the possible odors.

2nd session: Participants recalled the objects imagined in 1stsession. Afterwards, they created mental images for two objectsand the interaction between the objects. Next, participantscreated images for short sentences. The objects and sentenceswere immediately recalled, and again recalled after a delay.

3rd session: Participants imagined two and three objects establish-ing a connection between them (for example, umbrella, booksand cash; shirt, spoon, and dog). They were encouraged to

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create mental images for short sentences. After the creation ofmental imagery, they recalled the items included in the sentences.

4th session: Participants were encouraged to imagine phrasescomposed of two or more sentences and short stories. Picturesthat related to the short stories were shown. Later, older adultswere invited to highlight the differences between the picturesand the mental images they had created. In the short stories,participants were asked to recognize the sequence and the orderin which they were presented.

5th session: Participants imagined short stories.6th session: They imagined longer stories, and the challenge

was to create mental images that formed a short movie. Partici-pants completed attention tasks after the creation of mentalimages and, subsequently, recalled the mental movie createdfor the story.

7th session: Review of previous session, creating mental imagesfor stories.

8th session: Review of sessions.

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