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

Background: Low 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. Methods: Several 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. Results: Low 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). Conclusions: COMET 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 Registration: Prospero ID: CRD42021237905

Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial

BACKGROUND: Social anxiety disorder (SAD) with comorbid avoidant personality disorder (APD) has a high prevalence and is associated with serious psychosocial problems and high societal costs. When patients suffer from both SAD and APD, the Dutch multidisciplinary guidelines for personality disorders advise offering prolonged cognitive behavioral therapy (CBT). Recently there is increasing evidence for the effectiveness of schema therapy (ST) for personality disorders such as borderline personality disorder and cluster C personality disorders. Since ST addresses underlying personality characteristics and maladaptive coping strategies developed in childhood, this treatment might be particularly effective for patients with SAD and comorbid APD. To our knowledge, there are no studies comparing CBT with ST in this particular group of patients. This superiority trial aims at comparing the effectiveness of these treatments. As an additional goal, predictors and underlying mechanisms of change will be explored. METHODS/DESIGN: The design of the study is a multicentre two-group randomized controlled trial (RCT) in which the treatment effect of group cognitive behavioral therapy (GCBT) will be compared to that of group schema therapy (GST) in a semi-open group format. A total of 128 patients aged 18–65 years old will be enrolled. Patients will receive 30 sessions of GCBT or GST during a period of approximately 9 months. Primary outcome measures are the Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) for social anxiety disorder and the newly developed Avoidant Personality Disorder Severity Index (AVPDSI) for avoidant personality disorder. Secondary outcome measures are the MINI section SAD, the SCID-II section APD, the Schema Mode Inventory (SMI-2), the Inventory of Depressive Symptomatology Self-Report (IDS-SR), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Difficulties in Emotion Regulation Scale (DERS), the Rosenberg Self-Esteem Scale (RSES) and the Acceptance and Action Questionnaire (AAQ-II). Data will be collected at the start, halfway and at the end of the treatment, followed by measurements at 3, 6 and 12 months post-treatment. DISCUSSION: The trial will increase our knowledge on the effectiveness and applicability of both treatment modalities for patients suffering from both diagnoses. TRIAL REGISTRATION: Dutch Trial Register: NTR3921. Registered on 25 March 2013. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1605-9) contains supplementary material, which is available to authorized users

A randomised controlled trial of positive memory training for the treatment of depression within schizophrenia

Abstract Background: Depression is highly prevalent within individuals diagnosed with schizophrenia, and is associated with an increased risk of suicide. There are no current evidence based treatments for low mood within this group. The specific targeting of co-morbid conditions within complex mental health problems lends itself to the development of short-term structured interventions which are relatively easy to disseminate within health services. A brief cognitive intervention based on a competitive memory theory of depression, is being evaluated in terms of its effectiveness in reducing depression within this group. Methods/Design: This is a single blind, intention-to-treat, multi-site, randomized controlled trial comparing Positive Memory Training plus Treatment as Usual with Treatment as Usual alone. Participants will be recruited from two NHS Trusts in Southern England. In order to be eligible, participants must have a DSM-V diagnosis of schizophrenia or schizo-affective disorder and exhibit at least a mild level of depression. Following baseline assessment eligible participants will be randomly allocated to either the Positive Memory Training plus Treatment as Usual group or the Treatment as Usual group. Outcome will be assessed at the end of treatment (3-months) and at 6-month and 9-month post randomization by assessors blind to group allocation. The primary outcome will be levels of depression and secondary outcomes will be severity of psychotic symptoms and cost-effectiveness. Semi-structured interviews will be conducted with all participants who are allocated to the treatment group so as to explore the acceptability of the intervention. Discussion: Cognitive behaviour therapy is recommended for individuals diagnosed with schizophrenia. However, the number of sessions and length of training required to deliver this intervention has caused a limit in availability. The current trial will evaluate a short-term structured protocol which targets a co-morbid condition often considered of primary importance by service users. If successful the intervention will be an important addition to current initiatives aimed at increasing access to psychological therapies for people diagnosed with severe mental health problems. Trial registration: Current Controlled Trials. ISRCTN99485756. Registered 13 March 2014

Valenced Dual Tasking in Patients With Posttraumatic Stress Disorder

Objective: Dual-tasking studies show that emotionality and vividness of aversive memory decrease by engaging in a working memory task and simultaneous recall of that memory. Adding positive valence to a dual task might be a promising innovation in the amelioration of lab-induced memory. However, studies aiming to translate these findings into autobiographical memory of a posttraumatic stress disorder (PTSD) population find conflicting results or show methodological flaws. The current study assesses the benefit of adding positive valence to a dual-tasking procedure in PTSD patients. Method: In a cross-over design PTSD patients (N= 33) recalled their traumatic memory and received the following three conditions in randomized order: rating positive pictures + exposure, rating neutral pictures + exposure, and exposure only. Each of the three conditions consisted of four sets of 1 min. In the first cycle, participantswere exposed to each condition in a randomized order, which was then repeated in a second cycle. Before and after each condition, emotionality and vividness were rated on a visual analog scale (VAS), resulting in seven measurement timepoints in total. Results: Firstly, repeated measures ANOVAs showed a time effect: memories were less emotional and vivid after our summed (three) interventions. Secondly, repeated measures ANCOVAs indicated no evidence for differences between the conditions. Conclusions:We did not find evidence for a benefit of adding positive valence to a dual-task procedure in PTSD patients

The effectiveness of transdiagnostic applications of Competitive Memory Training (COMET) on low self-esteem and comorbid depression: A meta-analysis of randomized controlled trials

Background Low 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. Methods Several 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. Results Low 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). Conclusions COMET 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 Registration Prospero ID: CRD4202123790

Does valence contribute to the effects of dual tasking in aversive autobiographical memory?:Some unexpected findings

Background and objectives Lab experiments show that engaging in a working memory task while recalling an aversive memory reduces emotionality and vividness of memories. Studies targeting lab induced negative memory with valenced secondary tasks show promise, but work is needed on autobiographical memories to make it more in line with the original dual tasking research and PTSD treatment in clinical populations. In this study, we address this gap by evaluating differential effectiveness of valenced dual tasks on emotionality and vividness of aversive autobiographical memories. Methods University students (N = 178) recalled an aversive autobiographical memory while rating either positive pictures, negative pictures, or while looking at a cross in the exposure only condition. Participants were randomized to one of three aforementioned conditions and rated their memories before and after each intervention on emotionality and vividness. Results Against expectations, memories became more emotional and vivid regardless of condition. With regard to vividness, this effect was characterized by an interaction effect: memories became more vivid in the exposure only condition than in the combined dual tasking conditions. All effect sizes were small. Limitations Working memory load in the dual tasking conditions might have been insufficient. Conclusions The current study did not extend findings with regard to (valenced) dual tasking and revealed a possible sensitization effect of script driven autobiographical memory induction. Our study highlights the importance of aspects such as the total amount of exposure and characteristics of memory induction, specifically the addition of a script driven approach to the usual self-initiated memory activation in dual tasking research

Linking stressful experiences and psychological problems: The role of self-esteem

Stressful experiences have repeatedly been related to psychological problems. The current study extends previous work on stress and psychological problems by examining the link between stressful experiences and both internalizing (INT) and externalizing (EXT) problems. Additionally, individual differences are investigated by testing the moderating role of self-esteem. Questionnaire data of 750 adolescents aged 12–18 were collected and analyzed using multiple regression analyses. Analyses were controlled for sex and socioeconomic status. Results indicated that adolescents who report more stressful experiences are more likely to experience both INT and EXT problems, and these relationships were stronger for adolescents with low self-esteem. Post hoc analyses (e.g., different thresholds for determining stressful experiences) support the robustness of our findings. The findings on self-esteem emphasize the importance of taking individual differences into account in the relation between stressful experiences and psychological problems. The results can be seen as a next step in cross-sectional research

Linking Stressful Experiences and Psychological Problems: The Role of Self-Esteem

Stressful experiences have repeatedly been related to psychological problems. The current study extends previous work on stress and psychological problems by examining the link between stressful experiences and both internalizing (INT) and externalizing (EXT) problems. Additionally, individual differences are investigated by testing the moderating role of self-esteem. Questionnaire data of 750 adolescents aged 12–18 were collected and analyzed using multiple regression analyses. Analyses were controlled for sex and socioeconomic status. Results indicated that adolescents who report more stressful experiences are more likely to experience both INT and EXT problems, and these relationships were stronger for adolescents with low self-esteem. Post hoc analyses (e.g., different thresholds for determining stressful experiences) support the robustness of our findings. The findings on self-esteem emphasize the importance of taking individual differences into account in the relation between stressful experiences and psychological problems. The results can be seen as a next step in cross-sectional research