Skip to main content
Log in

Errorless Learning in the Rehabilitation of Memory Impairment: A Critical Review

  • Published:
Neuropsychology Review Aims and scope Submit manuscript

Abstract

This review considers the origins of the errorless learning (EL) concept, its application in memory rehabilitation, the evidence for its effectiveness, and the theoretical basis for the observed findings. The evidence suggests that EL offers valuable benefits for at least some people with memory impairments when teaching certain types of tasks. However, the benefits are not evident for all groups, some findings are equivocal, and there are some limitations associated with this approach. We discuss methodological issues impacting on these mixed findings, consider which theoretical explanations might account for the findings regarding benefits and limitations of EL, and comment on the implications for rehabilitation practitioners of the current state of evidence in this area.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Abrahams, J. P., & Camp, C. J. (1993). Maintenance and generalization of object naming training in anomia associated with degenerative dementia. Clinical Gerontologist, 12, 57–72.

    Article  Google Scholar 

  • Anderson, N., & Craik, F. I. M. (2006). The mnemonic mechanisms of errorless learning. Neuropsychologia, 44, 2806–2813.

    Article  PubMed  Google Scholar 

  • Baddeley, A. (2002). The psychology of memory. In A. D. Baddeley, M. D. Kopelman, & B. A. Wilson (Eds.), Handbook of memory disorders. Chichester: Wiley.

    Google Scholar 

  • Baddeley, A. D., & Wilson, B. A. (1994). When implicit learning fails: Amnesia and the problem of error elimination. Neuropsychologia, 32, 53–68.

    Article  PubMed  CAS  Google Scholar 

  • Bjork, R. A. (1989). Retrieval inhibition as an adaptive mechanism in human memory. In H. L. Roediger III & F. I. M. Craik (Eds.), Varieties of memory and consciousness: Essays in honour of Endel Tulving. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Bourgeois, M. S., Camp, C. J., Rose, M., White, B., Malone, M., Carr, J., et al. (2003). A comparison of training strategies to enhance use of external aids by persons with dementia. Journal of Communication Disorders, 36, 361–379.

    Article  PubMed  Google Scholar 

  • Camp, C. J. (1989). Facilitation of new learning in Alzheimer’s disease. In G. Gilmore, P. Whitehouse, & M. Wykle (Eds.), Memory and aging: Theory, research and practice. New York: Springer.

    Google Scholar 

  • Camp, C. J., Foss, J. W., O’Hanlon, A. M., & Stevens, A. B. (1996). Memory interventions for persons with dementia. Applied Cognitive Psychology, 10, 193–210.

    Article  Google Scholar 

  • Camp, C. J., & Stevens, A. B. (1990). Spaced retrieval: A memory intervention for dementia of the Alzheimer’s type (DAT). Clinical Gerontologist, 10, 58–61.

    Google Scholar 

  • Cherry, K. E., Simmons, S., & Camp, C. J. (1999). Spaced retrieval enhances memory in older adults with probable Alzheimer’s disease. Journal of Clinical Geropsychology, 5, 159–175.

    Article  Google Scholar 

  • Christensen, H., & Birrell, P. (1991). Explicit and implicit memory in dementia and normal ageing. Psychological Research, 53, 149–161.

    Article  PubMed  CAS  Google Scholar 

  • Clare, L., McKenna, P. J., Mortimer, A. M., & Baddeley, A. D. (1993). Memory in schizophrenia: What is impaired and what is preserved? Neuropsychologia, 31, 1225–1241.

    Article  PubMed  CAS  Google Scholar 

  • Clare, L., & Wilson, B. A. (2004). Memory rehabilitation for people with early-stage dementia: A single case comparison of four errorless learning methods. Zeitschrift für Gerontopsychologie und-Psychiatrie, 17, 109–117.

    Article  Google Scholar 

  • Clare, L., Wilson, B. A., Breen, K., & Hodges, J. R. (1999). Errorless learning of face–name associations in early Alzheimer’s disease. Neurocase, 5, 37–46.

    Google Scholar 

  • Clare, L., Wilson, B. A., Carter, G., Gosses, A., Breen, K., & Hodges, J. R. (2000). Intervening with everyday memory problems in early Alzheimer’s disease: An errorless learning approach. Journal of Clinical and Experimental Neuropsychology, 22, 132–146.

    PubMed  CAS  Google Scholar 

  • Clare, L., Wilson, B. A., Carter, G., & Hodges, J. R. (2003). Cognitive rehabilitation as a component of early intervention in dementia: A single case study. Aging and Mental Health, 7, 15–21.

    Article  PubMed  CAS  Google Scholar 

  • Clare, L., Wilson, B. A., Carter, G., Hodges, J. R., & Adams, M. (2001). Long-term maintenance of treatment gains following a cognitive rehabilitation intervention in early dementia of Alzheimer type: A single case study. Cognitive Rehabilitation in Dementia: A Special Issue of Neuropsychological Rehabilitation, 11, 477–494.

    Google Scholar 

  • Clare, L., Wilson, B. A., Carter, G., Roth, I., & Hodges, J. (2002). Relearning of face–name associations in early-stage Alzheimer’s disease. Neuropsychology, 16, 538–547.

    Article  PubMed  Google Scholar 

  • Duffy, L., & Wishart, J. G. (1987). A comparison of two procedures for teaching discrimination skills to Down’s Syndrome and non-handicapped children. British Journal of Educational Psychology, 57, 265–278.

    PubMed  Google Scholar 

  • Dunn, J. (2003). Learning of face–name associations using errorless and effortful processes for people with dementia. DClinPsy thesis, University College London.

  • Dunn, J., & Clare, L. (2007). Learning face–name associations in early-stage dementia: Comparing the effects of errorless learning and effortful processing. Neuropsychological Rehabilitation, 17 735–754.

    Google Scholar 

  • Evans, J. J., Wilson, B. A., Schuri, U., Andrade, J., Baddeley, A., Bruna, O., et al. (2000). A comparison of ‘errorless’ and ‘trial and error’ learning methods for teaching individuals with acquired memory deficits. Neuropsychological Rehabilitation, 10, 67–101.

    Article  Google Scholar 

  • Fillingham, J. K., Hodgson, C., Sage, K., & Ralph, M. A. L. (2003). The application of errorless learning to aphasic disorders: A review of theory and practice. Neuropsychological Rehabilitation, 13(3), 337–363.

    Article  Google Scholar 

  • Fridriksson, J., Holland, A. L., Beeson, P., & Morrow, L. (2005). Spaced retrieval treatment of anomia. Aphasiology, 19, 99–109.

    Article  PubMed  Google Scholar 

  • Glisky, E. (1995). Acquisition and transfer of word processing skill by an amnesic patient. Neuropsychological Rehabilitation, 5, 299–318.

    Article  Google Scholar 

  • Glisky, E., Schacter, D., & Tulving, E. (1986). Learning and retention of computer-related vocabulary in memory-impaired patients: Method of vanishing cues. Journal of Clinical and Experimental Neuropsychology, 8, 292–312.

    Article  PubMed  CAS  Google Scholar 

  • Gollin, E. S., & Savoy, P. (1968). Fading procedures and conditional discrimination in children. Journal of the Experimental Analysis of Behavior, 11, 443–451.

    Article  PubMed  CAS  Google Scholar 

  • Graf, P., & Schacter, D. L. (1985). Implicit and explicit memory for new associations in normal and amnesic subjects. Journal of Experimental Psychology: Learning, Memory, and Cognition, 11, 501–518.

    Article  PubMed  CAS  Google Scholar 

  • Hamman, S. B., & Squire, L. R. (1995). On the acquisition of new declarative knowledge in amnesia. Behavioral Neuroscience, 109, 1027–1044.

    Article  Google Scholar 

  • Haslam, C., Gilroy, D., Black, S., & Beesley, T. (2006). How successful is errorless learning in supporting memory for high and low-level knowledge in dementia? Neuropsychological Rehabilitation, 16, 505–536.

    Article  PubMed  Google Scholar 

  • Haude, R. H. (1973). Failure to establish errorless discrimination in monkeys. Perceptual and Motor Skills, 37, 299–304.

    Google Scholar 

  • Hawley, K. S., & Cherry, K. E. (2004). Spaced-retrieval effects on name–face recognition in older adults with probable Alzheimer’s disease. Behavior Modification, 28(2), 276–296.

    Article  PubMed  Google Scholar 

  • Hochhalter, A. K., Overmier, J. B., Gasper, S. M., Bakke, B. L., & Holub, R. J. (2005). A comparison of spaced retrieval to other schedules of practice for people with dementia. Experimental Aging Research, 31, 101–118.

    PubMed  Google Scholar 

  • Holland, J. G., & Skinner, B. F. (1961). The analysis of behavior: A program for self-instruction. New York: McGraw-Hill.

    Google Scholar 

  • Hopper, T., Mahendra, N., Kim, E., Azuma, T., Bayles, K. A., Cleary, S. J., et al. (2005). Evidence-based practice recommendations for working with individuals with dementia: Spaced retrieval training. Journal of Medical Speech–Language Pathology, 13, 27–34.

    Google Scholar 

  • Hunkin, N. M., Squires, E. J., Parkin, A. J., & Tidy, J. A. (1998). Are the benefits of errorless learning dependent on implicit memory? Neuropsychologia, 36, 25–36.

    Article  PubMed  CAS  Google Scholar 

  • Jones, R. S. P., & Eayrs, C. B. (1992). The use of errorless learning procedures in teaching people with a learning disability: A critical review. Mental Handicap Research, 5(2), 204–212.

    Google Scholar 

  • Kalla, T., Downes, J. J., & van den Broek, M. (2001). The pre-exposure technique: Enhancing the effects of errorless learning in the association of face–name associations. Neuropsychological Rehabilitation, 11, 1–16.

    Article  Google Scholar 

  • Kern, R. S., Green, M. F., Mintz, J., & Liberman, R. P. (2003). Does ‘errorless learning’ compensate for neurocognitive impairments in the work rehabilitation of persons with schizophrenia? Psychological Medicine, 33, 433–442.

    Article  PubMed  CAS  Google Scholar 

  • Kern, R. S., Green, M. F., Mitchell, S., Kopelowicz, A., Mintz, J., & Lieberman, R. P. (2005). Extensions of errorless learning for social problem-solving deficits in schizophrenia. American Journal of Psychiatry, 162, 513–519.

    Article  PubMed  Google Scholar 

  • Kern, R. S., Liberman, R. P., Kopelowicz, A., Mintz, J., & Green, M. F. (2002). Applications of errorless learning for improving work performance in persons with schizophrenia. American Journal of Psychiatry, 159, 1921–1926.

    Article  PubMed  Google Scholar 

  • Kessels, R. P. C., & de Haan, E. H. F. (2003). Implicit learning in memory rehabilitation: A meta-analysis on errorless learning and vanishing cues methods. Journal of Clinical and Experimental Neuropsychology, 25, 805–814.

    PubMed  Google Scholar 

  • Kessels, R. P. C., van Loon, E., & Wester, A. J. (2007). Route learning in amnesia: a comparison of trial-and-error and errorless learning in Korsakoff patients. Clinical Rehabilitation, 21, 905–911.

    Google Scholar 

  • Kirsch, I., Lynn, S. J., Vigorito, M., & Miller, R. R. (2004). The role of cognition in classical and operant conditioning. Journal of Clinical Psychology, 60, 369–392.

    Article  PubMed  Google Scholar 

  • Komatsu, S. -I., Mimura, M., Kato, M., Wakamatsu, N., & Kashima, H. (2000). Errorless and effortful processes involved in the learning of face–name associations by patients with alcoholic Korsakoff’s syndrome. Neuropsychological Rehabilitation, 10, 113–208.

    Article  Google Scholar 

  • Lancioni, G. E., Hoogeveen, F. R., Smeets, P. M., & Boelens, H. (1989). Errorless discrimination of reversible letters: Superimposition and fading combined with an intervening response. Psychological Record, 39, 373–385.

    Google Scholar 

  • Landauer, T. K., & Bjork, R. A. (1978). Optimum rehearsal patterns and name learning. In K. M. Gruneberg, P. E. Morris, & R. N. Sykes (Eds.), Practical aspects of memory. New York: Academic.

    Google Scholar 

  • Lawrence, D. H. (1952). The transfer of a discrimination along a continuum. Journal of Comparative and Physiological Psychology, 45, 511–516.

    Article  PubMed  CAS  Google Scholar 

  • Llorente, C., & Gaffan, E. A. (1989). Coin identification and relative value: a training program for adults with a mental handicap. Behavioral Psychotherapy, 17, 332–346.

    Google Scholar 

  • Lovibond, P. F., & Shanks, D. R. (2002). The role of awareness in Pavlovian conditioning: Empirical evidence and theoretical implications. Journal of Experimental Psychology: Animal Behavior Processes, 28, 3–26.

    Article  PubMed  Google Scholar 

  • Lowe, C. F. (1979). Determinants of human operant behavior. In M. D. Zeiler & P. Harzem (Eds.), Advances in analysis of behavior: Reinforcement and the organization of behavior (vol. 1, (pp. 159–192)). Chichester, UK: Wiley.

    Google Scholar 

  • Lowe, C. F., Horne, P. J., & Higson, P. J. (1987). Operant conditioning: The hiatus between theory and practice in clinical psychology. In H. J. Eysenck & I. Martin (Eds.), Theoretical foundations of behavior therapy (pp. 153–165). New York: Plenum.

    Google Scholar 

  • Luciano, M. C. (1986). Acquisition, maintenance, and generalization of productive intraverbal behavior through transfer of stimulus control procedures. Applied Research in Mental Retardation, 7, 1–20.

    Article  PubMed  CAS  Google Scholar 

  • McAvinue, L., O’Keefe, F., McMackin, D., & Robertson, I. H. (2005). Impaired sustained attention and error awareness in traumatic brain injury: Implications for insight. Neuropsychological Rehabilitation, 15, 569–587.

    Article  PubMed  Google Scholar 

  • McCoy, J. & Pratt, M. E. (1976). Reversal following errorless discrimination learning. Psychological Reports, 38, 971–978.

    Google Scholar 

  • McKissock, S., & Ward, J. (2007). Do errors matter? Errorless and errorful learning in anomic picture naming. Neuropsychological Rehabilitation, 17, 355–373.

    Article  PubMed  Google Scholar 

  • McKitrick, L. A., & Camp, C. J. (1993). Relearning the names of things: The spaced-retrieval intervention implemented by a caregiver. Clinical Gerontologist, 14, 60–62.

    Google Scholar 

  • Melton, A. K., & Bourgeois, M. S. (2005). Training compensatory memory strategies via the telephone for persons with TBI. Aphasiology, 19, 353–364.

    Article  Google Scholar 

  • Mitchell, K. J., & Johnson, M. K. (2000). Source monitoring: Attributing mental experiences. In E. Tulving & F. I. M. Craik (Eds.), Handbook of memory. Oxford: Oxford University Press.

    Google Scholar 

  • Moore, R., & Goldiamond, I. (1964). Errorless establishment of visual discrimination using fading procedures. Journal of the Experimental Analysis of Behavior, 7, 269–272.

    Article  PubMed  CAS  Google Scholar 

  • Morris, R., & Hannesdottir, K. (2004). Loss of ‘awareness’ in Alzheimer’s disease. In R. Morris & J. Becker (Eds.), Cognitive neuropsychology of Alzheimer’s disease. Oxford: Oxford University Press.

    Google Scholar 

  • Moscovitch, M. (1989). Confabulation and the frontal systems: Strategic versus associated retrieval in neuropsychological theories of memory. In H. L. Roediger III & F. I. M. Craik (Eds.), Varieties of memory and consciousness: Essays in honour of Endel Tulving. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • O’Carroll, R. E., Russell, H. H., Lawrie, S. M., & Johnstone, E. C. (1999). Errorless learning and the cognitive rehabilitation of memory-impaired schizophrenic patients. Psychological Medicine, 29, 105–112.

    Article  PubMed  CAS  Google Scholar 

  • Page, M., Wilson, B. A., Shiel, A., Carter, G., & Norris, D. (2006). What is the locus of the errorless-learning advantage? Neuropsychologia, 44, 90–100.

    Article  PubMed  Google Scholar 

  • Parkin, A. J., Hunkin, N. M., & Squire, E. J. (1998). Unlearning John Major: Tthe use of errorless learning in the reacquisition of proper names following herpes simplex encephalitis. Cognitive Neuropsychology, 15, 361–375.

    Article  Google Scholar 

  • Reading, J. C., & Ager, A. K. (1990). Teaching age and gender discrimination by the enhancement of criterion-related cues. Behavioral Psychotherapy, 18, 207–219.

    Article  Google Scholar 

  • Riley, G. A., Sotiriou, D., & Jaspal, S. (2004). Which is more effective in promoting implicit and explicit memory: The method of vanishing cues or errorless learning without fading? Neuropsychological Rehabilitation, 14(3), 257–384.

    Article  Google Scholar 

  • Rodriguez-Fornells, A., Kofidis, C., & Muente, T. F. (2004). An electrophysiological study of errorless learning. Cognitive Brain Research, 19, 160–173.

    Article  PubMed  Google Scholar 

  • Roediger III, H. L., Weldon, M. S., & Challis, B. H. (1989). Explaining dissociations between implicit and explicit measures of retention: a processing account. In H. L. Roediger III & F. I. M. Craik (Eds.), Varieties of memory and consciousness: Essays in honour of Endel Tulving. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Ruis, C., & Kessels, R. P. C. (2005). Effects of errorless and errorful face–name associative learning in moderate to severe dementia. Aging Clinical and Experimental Research, 17, 514–517.

    PubMed  Google Scholar 

  • Schacter, D. L., Rich, S. A., & Stampp, M. S. (1985). Remediation of memory disorders: experimental evaluation of the spaced-retrieval technique. Journal of Clinical and Experimental Neuropsychology, 7, 79–96.

    Article  PubMed  CAS  Google Scholar 

  • Sidman, M., & Rosenberger, P. B. (1967). Several methods for teaching serial position sequences to monkeys. Journal of the Experimental Analysis of Behavior, 10, 467–478.

    Article  PubMed  CAS  Google Scholar 

  • Sidman, M., & Stoddard, L. T. (1967). The effectiveness of fading in programming a simultaneous form discrimination for retarded children. Journal of the Experimental Analysis of Behavior, 10, 3–15.

    Article  PubMed  Google Scholar 

  • Skinner, B. F. (1948). ‘Superstition’ in the pigeon. Journal of Experimental Psychology, 38, 168–172.

    Article  PubMed  CAS  Google Scholar 

  • Skinner, B. F. (1958). Teaching machines. Science, 128, 137–158.

    Article  Google Scholar 

  • Skinner, B. F. (1968). Technology of teaching. Engelwood Cliffs, NJ: Prentice Hall.

    Google Scholar 

  • Skinner, B. F., & Ferster, C. B. (1957). Schedules of reinforcement. New York: Appleton-Century-Crofts.

    Google Scholar 

  • Sohlberg, M. M., Ehlhardt, L., & Kennedy, M. (2005). Instructional techniques in cognitive rehabilitation: A preliminary report. Seminars in Speech Language Pathology, 26, 268–279.

    Article  Google Scholar 

  • Spiker, C. C. (1956). The stimulus generalization gradient as a function of the intensity of stimulus lights. Child Development, 27, 85–98.

    Article  PubMed  CAS  Google Scholar 

  • Spiker, C. C. (1957). The effects of type of stimulus pretraining on discrimination performance in preschool children. Child Development, 28, 79–84.

    Article  PubMed  Google Scholar 

  • Squire, L. R., & Knowlton, B. J. (1995). Memory, hippocampus, and brain systems. In M. Gazzaniga (Ed.), The cognitive neurosciences. Boston: MIT.

    Google Scholar 

  • Squires, E. J., Hunkin, N. M., & Parkin, A. J. (1997). Errorless learning of novel associations in amnesia. Neuropsychologia, 35(8), 1103–1101.

    Article  PubMed  CAS  Google Scholar 

  • Stark, C., Stark, S., & Gordon, B. (2005). New semantic learning and generalization in a patient with amnesia. Neuropsychology, 19, 139–151.

    Article  PubMed  Google Scholar 

  • Stoddard, L. T., & Sidman, M. (1967). The effects of errors on children’s performance on a circle–ellipse discrimination. Journal of the Experimental Analysis of Behavior, 10, 261–270.

    Article  PubMed  CAS  Google Scholar 

  • Tailby, R., & Haslam, C. (2003). An investigation of errorless learning in memory-impaired patients: improving the technique and clarifying theory. Neuropsychological Rehabilitation, 41(9), 1230–1240.

    Google Scholar 

  • Terrace, H. S. (1963a). Discrimination learning with and without “errors”. Journal of the Experimental Analysis of Behavior, 6(1), 1–27.

    Article  PubMed  CAS  Google Scholar 

  • Terrace, H. S. (1963b). Errorless transfer of a discrimination across two continua. Journal of the Experimental Analysis of Behavior, 6, 223–232.

    Article  PubMed  CAS  Google Scholar 

  • Tulving, E., & Schacter, D. (1990). Priming and human memory. Science, 247, 301–306.

    Article  PubMed  CAS  Google Scholar 

  • Verfaellie, M., & Keane, M. M. (2002). Impaired and preserved memory processes in amnesia. In L. R. Squire & D. L. Schacter (Eds.), Neuropsychology of memory (3rd ed.). New York: Guilford.

    Google Scholar 

  • Wagner, A. D. (2002). Cognitive control and episodic memory: contributions from prefrontal cortex. In L. R. Squire & D. L. Schacter (Eds.), Neuropsychology of memory (3rd ed.). New York: Guilford.

    Google Scholar 

  • Wilson, B. A., Baddeley, A., Evans, J. J., & Shiel, A. (1994). Errorless learning in the rehabilitation of memory impaired people. Neuropsychological Rehabilitation, 4(3), 307–326.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linda Clare.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clare, L., Jones, R.S.P. Errorless Learning in the Rehabilitation of Memory Impairment: A Critical Review. Neuropsychol Rev 18, 1–23 (2008). https://doi.org/10.1007/s11065-008-9051-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11065-008-9051-4

Keywords

Navigation