Competitive Memory Training Research Articles

A Novel Psychological Group Intervention Targeting Appearance-Related Distress Among People With a Visible Disfigurement (Inside Out): A Case Study

People with a medical condition that leads to visible disfigurement often face significant psychosocial challenges related to their disfigurement, such as psychological distress, negative self-esteem and feelings of shame. In addition, they often encounter social difficulties including stigmatization, dealing with reactions of others and limitations in personal relationships. The availability of evidence-based psychological support tailored to these specific patients’ needs is limited. The aim of this study is to describe the development and content of Inside Out, a 5-session, theory-based psychological group intervention for people with a visible disfigurement due to a medical condition. This group intervention is based on a combination of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Competitive Memory Training. One case, a woman with facial palsy and psychological distress due to appearance-related problems, is presented to illustrate the intervention. This detailed description provides an in-depth illustration of the course and content of this treatment. Qualitative results show that this treatment is feasible and highly valued by the patient. Scores on pre-, post- and 3-month follow-up assessments showed improvements in psychological distress and level of acceptance of the condition. This case study shows how a psychological group intervention might contribute to the improvement of psychological wellbeing in individuals with a visible disfigurement.

The Effectiveness of Transdiagnostic Applications of Competitive Memory Training (COMET) on Low Self-Esteem and Comorbid Depression: A Meta-analysis of Randomized Controlled Trials

BackgroundLow self-esteem is a relevant transdiagnostic condition in the etiology, manifestation, and aggravation of different types of psychopathology. While low self-esteem is expected to ameliorate automatically after successful treatment of the principal emotional disorder the patient is suffering from, this does not always happen. Therefore, several specific interventions for enhancing low self-esteem have been developed, amongst them competitive memory training or COMET. The current meta-analysis investigated the efficacy of COMET in a variety of patient populations.MethodsSeveral databases were simultaneously examined after which 11 randomized COMET studies were identified. They encompassed a total of 662 patients with a diversity of emotional disorders of whom 344 had been treated in the experimental COMET conditions. Effects of COMET were expressed as Hedges’ g and were assessed on self-esteem and comorbid depression. When heterogeneity or publication bias were detected, original outcomes were corrected.ResultsLow self-esteem was enhanced (g = 0.50; after correction g = 0.61), while comorbid depression was reduced (g = 0.68; after correction g = 0.54).ConclusionsCOMET is a promising transdiagnostic intervention producing moderate enhancements in low self-esteem and moderate reductions in comorbid depression compared to control conditions in a variety of emotional disorders.Study RegistrationProspero ID: CRD42021237905.

Effectiveness of Competitive Memory Training (COMET) for low self-esteem in youth with Autism Spectrum Disorder: A randomized controlled pilot study

Introduction Autism spectrum disorders (ASD) are pervasive neurodevelopmental disorders, affecting 1 in 160 children worldwide [1]. The core features that characterize individuals within this spectrum are deficits in social communication and interaction as well as the presence of repetitive patterns of behavior [2]. Several underlying mechanisms have been proposed that can

Psychotherapy Reduces Self Esteem Scizophrenic Patients: Literature Review

Low self-esteemis all the thoughts, beliefs and beliefs that an individual knows about him self and affects his relationships with others. This study aims to determine what interventions can be given to over come chronic low self-esteem problems. The method used in this research is descriptive review by conducting literature reviews both from within and outside the country. Literature searches were carried out through several databases, namely Google Scholar, Pubmed, and Science Direct. The strategy used to search the literature is touse the keyword "chronic low self-esteem, psychotherapy, schizophrenia/schizophrenia". Based on the search, we found 839.112 articles, but after filtering the articles peryear,the complete articles and the suitability of keywords and article contents, it became 10 articles. Based on the results of the study, it can be concluded that several interventions that canbe given to reduce chronic lowself-esteem in patients with early psychotic symptoms and schizophrenia are CBT (Cognitive Behavior Therapy), EMDR (Eye Movement Desensitization and Reprocessing). GAT (Group Activity Therapy). Perceptual stimulation; told, therapy as usual (TAU) and Competitive Memory Training (COMET)/ Competitive Memory Training. Family involvement as care giver at home in the process of psychotic patient therapy can help the patient's recovery process.)

Autobiographical memory bias in cancer-related post traumatic stress disorder and the effectiveness of competitive memory training

Cancer as a life-threatening illness can be shocking and may lead to Post Traumatic-Stress Disorder (PTSD), which is associated with autobiographical memory bias as its core defining symptom. This study investigated the effectiveness of Competitive Memory Training (COMET) as an intervention for modifying the processing of autobiographical information and reducing PTSD symptoms. Autobiographical memory bias was measured using an Autobiographical Memory Task (AMT) modified for our population, who was diagnosed with cancer and experienced from PTSD. The Posttraumatic Stress Disorder Checklist (PCL) was employed to measure symptoms of PTSD and the Beck Depression Inventory II (BDI-II) questionnaire was used to assess depression symptoms. These measures were administered to a COMET (n = 30) and a MEmory Specificity Training (MEST) (n = 30) group. The COMET and the MEST groups underwent seven and six weekly sessions, respectively. All the assessments were re-conducted after the treatment and three-months later (follow-up). There was a significant alleviation in autobiographical memory bias and significantly fewer depression symptoms in the COMET group compared to the MEST group. This study indicates that the COMET intervention is a promising intervention for targeting cognitive biases including memory bias in cancer patients with PTSD.

Comparing the Efficacy of Competitive Memory Training (COMET) and MEmory Specificity Training (MEST) on Posttraumatic Stress Disorder Among Newly Diagnosed Cancer Patients

Cancer has been considered a potentially traumatic experience and is a distinct pathway by which one might develop symptoms of posttraumatic stress disorder (PTSD). This study compared the efficacy of COmpetitive MEmory Training (COMET), an intervention aimed at altering dysfunctional self-representations, and MEmory Specificity Training (MEST), an intervention targeting autobiographical memory deficits, on PTSD and depression symptoms. As a secondary aim, we also investigated the effect of COMET and MEST on trauma-related attentional biases. Sixty newly diagnosed cancer patients with PTSD were randomly assigned to either the COMET (n = 30) or MEST groups (n = 30). Each participant completed the Posttraumatic Stress Disorder Checklist-5, Beck Depression Inventory-II and a dot-probe task. The groups then underwent either COMET or MEST. All the assessments were re-conducted after the treatment (post-treatment) and at three months post-treatment (follow-up). The COMET group had significantly fewer PTSD and depression symptoms compared to the MEST group at post-training and follow-up. Both groups indicated a significant reduction in attentional biases following training. This study suggests that COMET is a promising brief intervention for the treatment of PTSD in cancer patients.

Effectiveness of Competitive Memory Training in Generalized Anxiety Disorder: Reducing Anxiety and Worry

Background: Although anxiety is an important mediator of generalized anxiety disorder (GAD), there is inadequate evidence to treat people particularly for anxiety symptoms that improve the state of health in people with GAD. Methods: The present study with pretest and posttest design and experimental and control groups was conducted on patients with GAD in Shiraz, Iran. According to the tendency of the participants, structured diagnostic interview, and inclusion criteria, 20 patients were randomly selected for the treatment group and 20 subjects with GAD for the waitlist control group. Participants were given competitive memory training (COMET) for GAD in four sessions. Results: The current study findings showed that COMET decreased the rate of worry and anxiety. Conclusions: The current study illustrated that the COMET protocol for GAD might have a positive effect on worry and anxiety.

Self-esteem treatment in anxiety: A randomized controlled crossover trial of Eye Movement Desensitization and Reprocessing (EMDR) versus Competitive Memory Training (COMET) in patients with anxiety disorders

Background and purposeLittle is known about treating low self-esteem in anxiety disorders. This study evaluated two treatments targeting different mechanisms: (1) Eye Movement Desensitization and Reprocessing (EMDR), which aims to desensitize negative memory representations that are proposed to maintain low self-esteem; and (2) Competitive Memory Training (COMET), which aims to activate positive representations for enhancing self-esteem. MethodsA Randomized Controlled Trial (RCT) was used with a crossover design. Group 1 received six sessions EMDR first and then six sessions COMET; group 2 vice versa. Assessments were made at baseline (T0), end of first treatment (T1), and end of second treatment (T2). Main outcome was self-esteem. We included 47 patients and performed Linear Mixed Models. ResultsCOMET showed more improvements in self-esteem than EMDR: effect-sizes 1.25 versus 0.46 post-treatment. Unexpectedly, when EMDR was given first, subsequent effects of COMET were significantly reduced in comparison to COMET as the first intervention. For EMDR, sequence made no difference. Reductions in anxiety and depression were mediated by better self-esteem. ConclusionsCOMET was associated with significantly greater improvements in self-esteem than EMDR in patients with anxiety disorders. EMDR treatment reduced the effectiveness of subsequent COMET. Improved self-esteem mediated reductions in anxiety and depression symptoms.

The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review.

It is widely acknowledged that mental disorders are common in old age and that depression is one of the most serious threats to the mental health of older adults. The lives of older adults are adversely affected both by major depression and subsyndromal depression. Depression should be approached with both pharmacotherapy and complementary therapies. The disadvantages posed by psychopharmacotherapy may be more prominent among older adults and there is a greater probability of drug interference. Different nonpharmacological interventions have been reported to reduce depressive symptoms in older adults with no adverse side effects. This review aimed to identify and synthesize the best available evidence on the effectiveness of nonpharmacological interventions for older adults with depressive disorders. This review considered studies that included older adults: adult patients, aged over 65 years with any type of depressive disorder, regardless of comorbidities and any previous treatments, but excluded those with manic or psychotic episodes/symptoms. Patients receiving pharmacological treatment for depression or other illnesses were included. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: This review considered studies that used nonpharmacological interventions for older adults with depressive disorders. TYPES OF STUDIES: This review considered any experimental study design, including randomized controlled trials, non-randomized controlled trials, or other quasi-experimental studies, including before and after studies. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: depressive symptomatology. The secondary outcomes were the level of autonomy in activities of daily living, cognitive function, health-related quality of life and wellbeing. An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 2000 to March 2012 of major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included in the review. Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Two independent reviewers assessed 23 studies. There was general agreement among the reviewers to include six of the studies in this review. Data were extracted using the Joanna Briggs Institute data extraction form for experimental studies and included participant characteristics, intervention characteristics and methods of the study. The impact of interventions on depression outcomes was described in a narrative format for each specific intervention. Data from two studies were pooled in a meta-analysis. Twenty-three studies met the inclusion criteria. Of those, 17 studies were excluded after assessment of their methodological quality. The remaining six original articles, which included 520 participants, were included in this review. Five were randomized clinical trials and one was a quasi-experimental study. The interventions included in this systematic review were: cognitive behavior therapy, competitive memory training, reminiscence group therapy, problem-adaptation therapy, and problem-solving therapy in home care. Evidence suggests that all of these interventions reduce depressive symptoms. Data from two studies reporting the effectiveness of problem-solving therapy in home care were pooled in a meta-analysis. The meta-analysis showed homogeneity (heterogeneity Chi-squared=2.83, p=0.09). The analysis estimated a statistically significant reduction (z= 11.19; p< 0.0001) of -10.23 points (CI: -12.03, -8.44) in the 17-item Hamilton Depression Rating Scale (HAM-D-17). Evidence suggests that all of these interventions reduce depressive symptoms and, therefore, may be useful in practice. However, due to the diversity of interventions and the low number of studies per intervention included in this systematic review, evidence is not strong enough to produce a best practice guideline.

Competitive Memory Training (COMET) for OCD: A Self-treatment Approach to Obsessions

Competitive Memory Training (COMET) is a cognitive intervention that aims to change the maladaptive cognitive-emotional networks underlying obsessive-compulsive disorder (OCD). COMET has not been previously tried as a self-help intervention. The present study tested the preliminary feasibility, acceptability, and effectiveness of COMET for OCD implemented as a self-help intervention. Sixty-five participants with OCD recruited through online OCD self-help fora completed an online baseline assessment including measures of OCD symptoms, self-esteem, and depression. Participants were randomly assigned to either COMET or a wait-list control group. All participants were approached 4 weeks later to complete an online post-assessment. There was no evidence for a greater decline of OCD symptoms or depression under COMET. When analyses were limited to only those participants who reported reading the entire manual at least once, self-esteem was higher at post-assessment in the COMET group. Although 78.1% of patients in the COMET group rated it as appropriate for self-administration, only 56.5% performed COMET exercises regularly and 26.4% read the entire manual at least once. The feasibility and effectiveness of COMET as a self-help internet intervention for OCD was not supported in this study. Further work is needed to better understand if modifications to our implementation of COMET may yield improved outcomes.

Competitive Memory Training (COMET) for Panic and Applied Relaxation (AR) Are Equally Effective in the Treatment of Panic in Panic-Disordered Patients

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.

'Third wave' cognitive and behavioural therapies versus treatment as usual for depression

So-called 'third wave' cognitive and behavioural therapies represent a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third-wave cognitive and behavioural therapy (CBT) approaches as treatment for acute depression remain unclear. 1. To examine the effects of all third wave CBT approaches compared with treatment as usual/waiting list/attention placebo/psychological placebo control conditions for acute depression.2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, dialectical behaviour therapy, MBCT, extended behavioural activation and metacognitive therapy) compared with treatment as usual/waiting list/attention placebo/psychological placebo control conditions for acute depression.3. To examine the effects of all third wave CBT approaches compared with different types of comparators (treatment as usual, no treatment, waiting list, attention placebo, psychological placebo) for acute depression. We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT therapies was conducted in March 2013 (CCDANCTR to 01/02/13). Randomised controlled trials that compared third wave CBT therapies with control conditions for acute depression in adults. Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information when required. We rated the quality of evidence using GRADE methods. Four small studies (224 participants) were included in the review. Little information was provided about the process of allocating participants to groups. None of the studies used independent outcome assessors, and evidence suggested researcher allegiance towards the active treatments. The four studies examined a diversity of third wave CBT approaches (extended behavioural activation, acceptance and commitment therapy and competitive memory training) and control conditions. None of the studies conducted follow-up assessments. The results showed a significant difference in clinical response rates in favour of third wave CBT when compared with treatment as usual (TAU) conditions (three studies, 170 participants, risk ratio (RR) 0.51, 95% confidence interval (CI) 0.27 to 0.95; very low quality). No significant difference in treatment acceptability based on dropout rates was found between third wave CBT approaches and TAU (four studies, 224 participants, RR 1.01, 95% CI 0.08 to 12.30; very low quality). Both analyses showed substantial statistical heterogeneity. Very low quality evidence suggests that third wave CBT approaches appear to be more effective than treatment as usual in the treatment of acute depression. The very small number of available studies and the diverse types of interventions and control comparators, together with methodological limitations, limit the ability to draw any conclusions on their effect in the short term or over a longer term. The increasing popularity of third wave CBT approaches in clinical practice underscores the importance of completing further studies of third wave CBT approaches in the treatment of acute depression, on a short- and long-term basis, to provide evidence of their effectiveness to policy-makers, clinicians and users of services.

COMPETITIVE MEMORY TRAINING (COMET) FOR TREATING LOW SELF-ESTEEM IN PATIENTS WITH DEPRESSIVE DISORDERS: A RANDOMIZED CLINICAL TRIAL

Self-esteem is a major concern in mood disorders. Low self-esteem is a symptom of depressive disorders and is considered by some to be a predictor for relapse, whereas high self-esteem seems to buffer against depression. Recently, Competitive Memory Training (COMET) has shown to be effective for the enhancement of self-esteem in several psychopathological conditions. The current study assesses whether COMET is also an effective intervention for patients with depressive disorders. Sixty-one patients with depressive disorders who were already in therapy in an outpatient mental health institution were randomly assigned to either eight group sessions of COMET in addition to their regular therapy (COMET + therapy as usual [TAU]: the experimental group) or to 8 weeks of ongoing regular therapy (TAU only: the control group). These latter (control) patients received COMET after their TAU only period. All patients in both groups that completed COMET were contacted 3 and 6 months later to assess whether the effects of COMET had remained stable. Compared to the patients who received TAU only, patients in the COMET + TAU condition showed significant improvement with large effect sizes on indices of self-esteem, depression, and depressive rumination. The therapeutic effects of COMET + TAU remained stable after 3 and 6 months on all outcome measures or improved even further. COMET for low self-esteem seems to be an efficacious trans-diagnostic intervention that can relatively easily be added to the regular treatment of patients with depressive disorders.

Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia‐spectrum patients with persistent auditory verbal hallucinations: A randomized controlled trial

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.

Insights into hallucinations in schizophrenia: novel treatment approaches

Novel strategies are needed in the treatment of hallucinations as a subgroup of patients with pathological hallucinations (>30%) do not respond to antipsychotics or are not compliant with medication. We review recently developed biological and cognitive treatments. Repetitive transcranial magnetic stimulation concerns neuromodulation targeted at aberrant activity in regions shown to be hyperactive in neuroimaging studies. Repetitive transcranial magnetic stimulation has been shown to reduce auditory hallucinations in several studies. However, not all studies have confirmed such effects, and a number of questions remain. With regard to cognitive therapeutic approaches, new proposals include attention training, acceptance and commitment therapy, and competitive memory training. After a brief discussion of these approaches, we take stock of recent advances and discuss avenues for future research.

Competitive Memory Training for treating depression and rumination in depressed older adults: A randomized controlled trial

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.

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

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.

Competitive memory training (COMET) for treating low self-esteem in patients with eating disorders: A randomized clinical trial.

This study evaluates a short stepwise cognitive-behavioral intervention for the treatment of low self-esteem in patients with eating disorders. Competitive memory training (COMET) for low self-esteem is based on insights and findings from experimental psychology. A total of 52 patients with eating disorders and low self-esteem were treated with COMET in a routine mental health center in addition to their regular treatment. These patients were randomized to receive 8 weeks of COMET + therapy as usual (TAU) or to receive TAU only. Differential effects in favor of COMET + TAU were found for 2 indexes of self-esteem and for 1 index of depressive mood. Shortcomings of this study and possible clinical implications are discussed.