Competitive Memory Training (COMET) for Low Self-Esteem in Patients with Personality Disorders: A Randomized Effectiveness Study

Parnassia-Bavo Psychiatric Centre, The Hague, The Netherlands.
Behavioural and Cognitive Psychotherapy (Impact Factor: 1.69). 01/2011; 39(1):1-19. DOI: 10.1017/S1352465810000469
Source: PubMed


Self-esteem is a major concern in the treatment of patients with personality disorders in general. In patients with borderline personality disorder, low self-esteem is associated with factors contributing to suicidal and self-injurious behaviour. At the moment there are no well-proven interventions that specifically target low self-esteem. Recently, a new approach, Competitive Memory Training or COMET, aimed at the enhancement of retrieving beneficial information from memory, appeared to be successful in addressing low self-esteem in different patient populations.
To assess whether COMET for low self-esteem is also an effective intervention for patients with personality disorders.
91 patients with personality disorders who were already in therapy in a regular mental health institution were randomly assigned to either 7 group sessions of COMET in addition to their regular therapy or to 7 weeks of ongoing regular therapy. These latter patients received COMET after their “7 weeks waiting period for COMET”. All patients that completed COMET were contacted 3 months later to assess whether the effects of COMET had remained stable.
Compared to the patients who received regular therapy only, patients in the COMET + regular therapy condition improved significantly and with large effect sizes on indices of self-esteem and depression. Significant differential improvements on measures of autonomy and social optimism were also in favour of COMET, but had small to intermediate effect sizes. The therapeutic effects of COMET remained stable after 3 months on three out of the four outcome measures.
COMET for low self-esteem seems to be an efficacious trans-diagnostic approach that can rather easily be implemented in the treatment of patients with personality disorders.

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Available from: Kees Korrelboom, Jun 17, 2015
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    • "Starting from these general ideas, one variant of COMET (COMET-self-esteem) proved efficacious in enhancing self-esteem and reducing depression in patients with eating disorders (Korrelboom et al. 2009), personality disorders (Korrelboom et al. 2011) and depressive disorders (Korrelboom et al. 2012). Another COMET protocol (COMETworry and rumination) was successful in reducing rumination and depression in a group of elderly depressed patients (Ekkers et al. 2011). "
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    ABSTRACT: While various psychological interventions, among them Applied Relaxation (AR), are effective in treating patients with panic disorder, there is still room for improvement. Competitive Memory Training (COMET) is a transdiagnostic intervention, slightly different variants of which have proven to be successful in several psychopathological conditions in different patient populations. The objective of this study is to compare the effectiveness of COMET for panic disorder with AR in a group of panic-disordered patients (with or without agoraphobia) in a routine clinical setting. A total of 143 panic-disordered patients were randomized over two (group) treatment conditions: seven sessions of AR, or seven sessions of COMET. Measurements were made at pre- and post intervention. Both treatments resulted in significant amelioration of panic and phobic symptoms; this beneficial effect was relatively large for the primary outcome measure. However, there were no significant differences between the two treatments for any of the outcome measures. COMET and AR appear to be equally effective in treating panic in panic-disordered patients.
    Full-text · Article · Sep 2014 · Journal of Contemporary Psychotherapy
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    • "The practical translation of this suggested learning principle into a therapy protocol, means that the main issue is whether or not we can intrude on the over-learned connection between voice content, negative self-esteem, and submissiveness. Korrelboom et al. developed competitive memory training (COMET) as a transdiagnostic imagery training protocol to learn to feel (experientially) what you already know (intellectually), and to use imagery to enhance positive self-esteem (Korrelboom, de Jong, Huijbrechts, & Daansen, 2009; Korrelboom, Marissen, & van Assendelft, 2011; Korrelboom, Van der Gaag, Hendriks, Huijbrechts, & Berretty, 2008; Korrelboom, van der Weele, Gjaltema, & Hoogstraten, 2009). Adaptations have been made to the procedure to accommodate severely psychotic patients who often suffer attention and memory problems. "
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    ABSTRACT: This study investigates whether depression can be ameliorated by weakening the associations between auditory verbal hallucinations and easily activated networks with negative self-evaluations, by strengthening the access to competing memories of positive self-esteem. Design.  A randomized controlled clinical trial comparing competitive memory training (COMET) with treatment as usual (TAU) in schizophrenia patients with persistent auditory hallucinations. Patients with schizophrenia-spectrum disorders were randomized into COMET (n = 39) versus TAU (n = 38). COMET consisted of seven sessions with four stages: (1) identification of aspects of negative self-esteem reinforced by the voice; (2) retrieval and re-living of memories associated with positive self-esteem; (3) positive self-esteem is brought in to compete with the content of the voices to weaken the association between voice content and negative self-evaluation; and (4) learning to disengage from the voices and to accept the voices as psychic phenomena. Compared to TAU the COMET group improved on depression but there were no significant effects on auditory hallucinations. The effect of COMET on depression was fully mediated by self-esteem and acceptance of voices, and partially mediated by social rank and attributed power to the voices. COMET can be helpful in reappraising the meaning and changing the emotional impact of auditory hallucinations. These findings are consistent with the results of comparable COMET protocols applied in other psychiatric diagnoses. The technique can be used within regular cognitive behavioural therapy.
    Full-text · Article · Jun 2012 · British Journal of Clinical Psychology
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    ABSTRACT: Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥ 65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.
    Full-text · Article · Jul 2011 · Behaviour Research and Therapy
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