Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of psychiatric disorders (5th ed.). American Psychiatric Association.

    Book  Google Scholar 

  • Balci, S., Kwakman, M., & Boyer, B.E. (2020). Effectiveness of Competitive Memory Training (COMET) for low self-esteem in youth with Autism Spectrum Disorder: A randomized controlled pilot study. Manuscript submitted for publication.

  • Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest, 4, 1–44.

    Article  Google Scholar 

  • Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2005). Exploding the self-esteem myth. Scientific American, 292, 84–92.

    Article  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. Psychological Corporation.

    Google Scholar 

  • Bloemers, E., & de Vogel, V. (2020). COMET for self-esteem and paranoia in paranoid patients: A small-scale RCT in forensic psychiatry. (Dutch: COMET voor zelfbeeld en paranoia bij paranoïde patiënten: Een kleinschalige RCT binnen de forensische psychiatrie). Gedragstherapie, 53, 82–102.

    Google Scholar 

  • Bos, A. E. R., Huijding, J., Muris, P., Vogel, L. R. R., & Biesheuvel, J. (2010). Global, contingent and implicit self-esteem and psychopathological symptoms in adolescents. Personality and Individual Differences, 4, 311–316. https://doi.org/10.1016/j.paid.2009.10.025

    Article  Google Scholar 

  • Brewin, C. R. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765–784. https://doi.org/10.1016/j.brat.2006.02.005

    Article  PubMed  Google Scholar 

  • Brink, A., Yesavage, J. A., Lum, P. H., Heersema, M., Adey, T., & Rose, T. L. (1982). Screening tests for geriatric depression. Clinical Gerontology, 1, 37–43. https://doi.org/10.1300/J018v01n01_06

    Article  Google Scholar 

  • Brown, G. W., Bifulco, A., & Andrews, B. (1990). Self-esteem and depression. IV. Effect on course and recovery. Social Psychiatry and Epidemiology, 25, 244–249. https://doi.org/10.1007/BF00788645

    Article  CAS  Google Scholar 

  • Churchill, R., Moore, T. H. M., Furukawa, T. A., Caldwell, D. M., Davies, P., Jones, H., Shinohara, K., Imai, H., Lewis, G., & Hunot, V. (2013). “Third wave” cognitive and behavioural therapies versus treatment as usual for depression. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD008705.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  • Creemers, D. H. M., Scholte, R. H. J., Engels, R. C. M. E., Prinstein, M. J., & Wiers, R. W. (2012). Implicit and explicit self-esteem as concurrent predictors of suicidal ideation, depressive symptoms, and loneliness. Journal of Behavior Therapy & Experimental Psychiatry, 43, 638–646. https://doi.org/10.1016/j.jbtep.2011.09.006

    Article  Google Scholar 

  • Crocker, J., & Wolfe, C. T. (2001). Contingencies of self-worth. Psychological Review, 108, 593–623.

    Article  CAS  Google Scholar 

  • de Jong, M., Spinhoven, Ph., Korrelboom, K., Deen, M., van der Meer, I., Danner, U. N., van der Schuur, M., Schoorl, M., & Hoek, M. (2020). Effectiveness of enhanced cognitive behavior therapy for eating disorders: A randomized controlled trial. International Journal of Eating Disorders, 53, 447–457. https://doi.org/10.1037/a0016742

    Article  PubMed  Google Scholar 

  • de Jong, M., Sinke, S.E., de Jong, P.J., Korrelboom, K., Deen, M.L., & Spinhoven, Ph. (submitted). Explicit, implicit and discrepant self-esteem in eating disorders.

  • DuBois, D. L., & Flay, B. R. (2004). The healthy pursuit of self-esteem: Comment on and alternative to the Crocker and Park (2004) formulation. Psychological Bulletin, 130, 415–420. https://doi.org/10.1037/0033-2909.130.3415

    Article  PubMed  Google Scholar 

  • Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x

    Article  CAS  PubMed  Google Scholar 

  • Ekkers, W. D. J., Korrelboom, K., Huijbrechts, I. P. A. M., Smits, N., Cuijpers, P., & van der Gaag, M. (2011). Competitive Memory Training for treating depression and rumination in depressed older adults: A randomized controlled trial. Behaviour Research and Therapy, 49, 588–596. https://doi.org/10.1016/j.brat.2011.05.010

    Article  PubMed  Google Scholar 

  • Ellis, A. (2005). The myth of self-esteem: How rational emotive therapy behaviour therapy can change your life forever. Prometheus Books.

    Google Scholar 

  • Fairburn, C. G., Peveler, R. C., Jones, R., Hope, R. A., & Doll, H. A. (1993). Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight. Journal of Consulting and Clinical Psychology, 61, 696–698. https://doi.org/10.1037//0022-006x.61.4.696

    Article  CAS  PubMed  Google Scholar 

  • Farahimanesh, S., Moradi, A., & Sadeghi, M. (2021). Autobiographical memory bias in cancer-related post-traumatic stress disorder and the effectiveness of competitive memory training. Current Psychology. https://doi.org/10.1007/s12144-021-01648-0

    Article  Google Scholar 

  • Farahimanesh, S., Moradi, A., Sadeghi, M., & Jobson, L. (2020). Comparing the efficacy of competitive memory training (COMET) and memory specificity training (MEST) on posttraumatic stress disorder among newly diagnosed cancer patients. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-020-10175-4

    Article  Google Scholar 

  • Fennell, M. J. V. (1998). Low self-esteem. In N. Tarrier, A. Wells, & G. Haddock (Eds.), Treating complex cases: The cognitive behavioural therapy approach. Wiley.

    Google Scholar 

  • Fennell, M. J. V., & Jenkins, H. (2004). Low self-esteem. In J. Bennett-Levy, G. Butler, M. Fennell, A. Hackmann, M. Mueller, & D. Westbrook (Eds.), Oxford guide to behavioural experiments in cognitive therapy (pp. 413–433). Oxford University Press.

    Chapter  Google Scholar 

  • Franck, E., De Raedt, R., & De Houwer, J. (2007). Implicit but not explicit self-esteem predicts future depressive symptomatology. Behaviour Research and Therapy, 45, 2448–2455. https://doi.org/10.1016/j.brat.2007.01.008

    Article  PubMed  Google Scholar 

  • Griffioen, B. T., van der Vegt, A. A., de Groot, I. W., & de Jongh, A. (2017). The effect of EMDR and CBT on low self-esteem in a general psychiatric population: A randomized controlled Trial. Frontiers in Psychology, 8, 1910. https://doi.org/10.3389/fpsyg.2017.01910

    Article  PubMed  PubMed Central  Google Scholar 

  • Hall, P. L., & Tarrier, N. (2003). The cognitive-behavioural treatment of low self-esteem in psychotic patients: A pilot study. Behaviour Research and Therapy, 41, 317–332. https://doi.org/10.1016/S0005-7967(02)00013-X

    Article  PubMed  Google Scholar 

  • Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Academic Press.

    Google Scholar 

  • Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analysis. British Medical Journal, 327, 557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  • Hilbert, S., Goerigk, S., Padberg, F., Nadjiri, A., Übleis, A., Jobst, A., Dewald-Kaufmann, J., Falkai, P., Bühner, M., Naumann, F., & Sarubin, N. (2019). The role of self-esteem in depression: A longitudinal study. Behavioural and Cognitive Psychotherapy, 47, 244–250. https://doi.org/10.1017/S1352465818000243

    Article  PubMed  Google Scholar 

  • Hitchcock, C., Werner-Seidler, A., Blackwell, S. E., & Dalgleish, T. (2017). Autobiographical episodic memory-based training for the treatment of mood, anxiety and stress-related disorders: A systematic review and meta-analysis. Clinical Psychology Review, 52, 92–107. https://doi.org/10.1016/j.cpr.2016.12.003

    Article  PubMed  Google Scholar 

  • Kernis, M. H., Cornell, D. P., Sun, C.-R., Berry, A., & Harlow, T. (1993). There‘s more to self-esteem than whether it is high or low: The importance of stability of self-esteem. Journal of Personality and Social Psychology, 65, 1190–1204. https://doi.org/10.1037/0022-3514.65.6.1190

    Article  CAS  PubMed  Google Scholar 

  • Kolubinski, D. C., Frings, D., Nikčević, A. V., Lawrence, J. A., & Spada, M. M. (2018). A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem. Psychiatry Research, 267, 296–305. https://doi.org/10.1016/j.psychres.2018.06.025

    Article  PubMed  Google Scholar 

  • Korrelboom, K. (2016). Self-esteem and psychopathology: Do we need specific treatments? (German: Selbstwertgefühl und Psychopathologie: Sind spezielle Behandlungen notwendig?). Verhaltenstherapie & Verhaltensmedizin, 37, 373–392.

    Google Scholar 

  • Korrelboom, K., de Jong, M., Huijbrechts, I., & Daansen, P. (2009). Competitive memory training (COMET) for treating low self-esteem in patients with eating disorders: A randomized clinical trial. Journal of Consulting & Clinical Psychology., 77, 974–980. https://doi.org/10.1037/a0016742

    Article  Google Scholar 

  • Korrelboom, K., IJdema, T., Karreman, A., & van der Gaag, M. (2021). The effectiveness of transdiagnostic applications of competitive memory training (COMET) on self-esteem and depression: a meta-analysis. PROSPERO 2021 CRD42021237905. Retrieved from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021237905

  • Korrelboom, K., Maarsingh, M., & Huijbrechts, I. (2012). Competitive memory training (COMET) for treating low self-esteem in patients with depressive disorders: A randomized clinical trial. Depression & Anxiety., 29, 102–110. https://doi.org/10.1002/da.20921

    Article  PubMed  Google Scholar 

  • Korrelboom, K., Marissen, M., & van Assendelft, T. (2011). Competitive memory training (COMET) for low self-esteem in patients with personality disorders: A randomized effectiveness study. Behavioural and Cognitive Psychotherapy, 39, 1–19. https://doi.org/10.1017/S1352465810000469

    Article  PubMed  Google Scholar 

  • Korrelboom, K., Peeters, S., Blom, S., & Huijbrechts, I. (2014). Competitive Memory Training (COMET) for panic and Applied Relaxation (AR) are equally effective in the treatment of panic in panic-disordered patients. Journal of Contemporary Psychotherapy, 44, 183–190. https://doi.org/10.1007/s10879-013-9259-3

    Article  Google Scholar 

  • Lecomte, T., Corbière, M., & Laisné, F. (2006). Investigating self-esteem in individuals with schizophrenia: Relevance of the self-esteem rating scale-short form. Psychiatry Research, 143, 99–108. https://doi.org/10.1016/j.psychres.2005.08.019

    Article  PubMed  Google Scholar 

  • Mancini, A. D., Prati, G., & Black, S. (2011). Self-worth mediates the effects of violent loss on PTSD symptoms. Journal of Traumatic Stress, 24, 116–120.

    Article  Google Scholar 

  • Mecca, A. M., Smelser, N. J., & Vasconcellos, J. (1989). The social importance of self-esteem. University of Chicago Press.

    Google Scholar 

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Open Medicine, 3, 123–130. https://doi.org/10.1371/journal.pmed.1000097

    Article  Google Scholar 

  • Morton, L., Roach, L., Reid, H., & Stewart, S. H. (2012). An evaluation of CBT group for women with low self-esteem. Behavioural and Cognitive Psychotherapy, 40, 221–225.

    Article  Google Scholar 

  • Orth, U., Robins, R. W., Trzesniewski, K. H., Maes, J., & Schmitt, M. (2009). Low self-esteem is a risk factor for depressive symptoms from young adulthood to old age. Journal of Abnormal Psychology, 118, 472–478. https://doi.org/10.1037/a0015922

    Article  PubMed  Google Scholar 

  • Pyszczynski, T., Greenberg, J., Solomon, S., Arndt, J., & Schimel, J. (2004). Why do people need self-esteem? A theoretical and empirical review. Psychological Bulletin, 130, 435–468. https://doi.org/10.1037/0033-2909.130.3.435

    Article  PubMed  Google Scholar 

  • Rosenberg, M. (1979). Components of Rosenberg’s self-esteem scale. Conceiving the self. Basic Books.

    Google Scholar 

  • Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., Markowitz, J. C., Ninan, P. T., Kornstein, S., Manber, R., Thase, M. E., Kocsis, J. H., & Keller, M. B. (2003). The 16-item Quick Inventory of Depressive Symptomatology (QIDS) clinician rating (QIDS-C) and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry. https://doi.org/10.1016/s0006-3223(02)01866-8

    Article  PubMed  Google Scholar 

  • Scheff, T. J., & Fearon, D. S. (2004). Cognition and emotion? The dead end in self-esteem research. Journal for the Theory of Social Behaviour, 34, 73–91.

    Article  Google Scholar 

  • Schneider, B. C., Wittekind, C. E., Talhof, A., Korrelboom, K., & Moritz, S. (2014). Competitive memory training (COMET) for OCD: A self-treatment approach to obsessions. Cognitive Behaviour Therapy. https://doi.org/10.1080/16506073.2014.981758

    Article  PubMed  Google Scholar 

  • Sedikides, C., Rudich, E. A., Gregg, A. P., Kumashiro, M., & Rusbult, C. (2004). Are normal narcissists psychologically healthy?: Self-esteem matters. Journal of Personality and Social Psychology, 7, 400–416. https://doi.org/10.1037/0022-3514.87.3.400

    Article  Google Scholar 

  • Silverstone, P. H., & Salsali, M. (2003). Low self-esteem and psychiatric patients: Part 1. The relationship between low self-esteem and psychiatric diagnosis. Annals of General Hospital Psychiatry, 2, 2. https://doi.org/10.1186/1475-2832-2-2

    Article  PubMed  PubMed Central  Google Scholar 

  • Sitarenios, G., & Kovacs, M. (1999). Use of the Children’s Depression Inventory. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp. 267–298). Lawrence Erlbaum Associates Publishers.

    Google Scholar 

  • Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139, 213–240. https://doi.org/10.1037/a0028931

    Article  PubMed  Google Scholar 

  • Staring, A. B., van den Berg, D. P., Cath, D. C., Schoorl, M., Engelhard, I. M., & Korrelboom, C. W. (2016). 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. Behaviour Research and Therapy., 82, 11–20. https://doi.org/10.1016/j.brat.2016.04.002

    Article  CAS  PubMed  Google Scholar 

  • Steel, C., van der Gaag, M., Korrelboom, K., Simon, J., Phiri, P., Baksh, M. F., Wykes, T., Rose, D., Hardcastle, M., Enright, S., Evans, G., & Kingdom, D. (2015). A randomised controlled trial of positive memory training for the treatment of depression within Schizophrenia. BMC Psychiatry, 15(85), 1–5. https://doi.org/10.1186/s12888-015-0453-6

    Article  Google Scholar 

  • Steel, C., Korrelboom, K., Baksh, M. F., Kingdom, D., Simon, J., Wykes, T., Phiri, P., & van der Gaag, M. (2020). Positive memory training for the treatment of depression in schizophrenia: A randomised controlled trial. Behaviour Research and Therapy, 135, 103734. https://doi.org/10.1016/j.brat.2020.103734

    Article  PubMed  Google Scholar 

  • Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825–848. https://doi.org/10.1037/0033-2909.128.5.825

    Article  PubMed  Google Scholar 

  • Swann, W., Chang-Schneider, C., & McClarty, K. (2007). Do people’s self-views matter? Self-concept and self-esteem in everyday life. American Psychologist, 62(2), 84–94. https://doi.org/10.1037/0003-066X.62.2.84

    Article  PubMed  Google Scholar 

  • Tajikzade, F., Taghavi, M. R., Goodarzi, M. A., & Aflakseir, A. (2019). Effectiveness of competitive memory training in generalized anxiety disorder: Reducing anxiety and worry. Archives of Neuroscience, 6(4), e87763. https://doi.org/10.5812/ans.87763

    Article  Google Scholar 

  • Tarrier, N., & Wykes, T. (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or a cautionary tale? Behaviour Research and Therapy, 42, 1377–1401. https://doi.org/10.1016/j.brat.2004.06.020

    Article  PubMed  Google Scholar 

  • van der Gaag, M., van Oosterhout, B., Daalman, K., Sommer, I. E., & Korrelboom, K. (2012). 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. British Journal of Clinical Psychology., 51, 158–171. https://doi.org/10.1111/j.2044-8260.2011.02025.x

    Article  PubMed  Google Scholar 

  • van Tuijl, L. (2017). Self-esteem in depression and anxiety. (dissertation). Groningen: Rijksuniversiteit Groningen.

  • van Tuijl, L. A., & de JongSportelde HulluNauta, P. J. B. E. E. M. H. (2014). Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: A longitudinal study in adolescents. Journal of Behavior Therapy and Experimental Psychiatry, 45, 113–121. https://doi.org/10.1016/j.jbtep.2013.09.007

    Article  PubMed  Google Scholar 

  • van Vreeswijk, M. F., Spinhoven, P., Zedlitz, A. M. E., & Eurelings-Bontekoe, E. H. M. (2020). Mixed results of a pilot RCT of time-limited schema mindfulness-based cognitive therapy and competitive memory therapy plus treatment as usual for personality disorders. Personality Disorders: Theory, Research, & Treatment, 11, 170–180. https://doi.org/10.1037/per0000361

    Article  Google Scholar 

  • Watson, D., Suls, J., & Haig, J. (2002). Global self-esteem in relation to structural models of personality and affectivity. Journal of Personality and Social Psychology, 83, 185–197. https://doi.org/10.1037/0022-3514.83.1.185

    Article  PubMed  Google Scholar 

  • Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523–537. https://doi.org/10.1093/schbul/sbm114

    Article  PubMed  Google Scholar 

  • Zeigler-Hill, V. (2011). The connections between self-esteem and psychopathology. Journal of Contemporary Psychotherapy, 41(3), 157–164. https://doi.org/10.1007/s10879-010-9167-8

    Article  Google Scholar 

Download references

Funding

No funding was raised for this meta-analysis.

Author information

Authors and Affiliations

  1. Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

    Kees Korrelboom, Tom IJdema & Annemiek Karreman

  2. Department of Clinical Psychology, Public Mental Health Research Institute, VU University, Amsterdam, The Netherlands

    Mark van der Gaag

Authors
  1. Kees Korrelboom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tom IJdema
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annemiek Karreman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark van der Gaag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kees Korrelboom.

Ethics declarations

Conflict of interest

The first author (Kees Korrelboom) has presented workshops on the subject of Competitive Memory Training for which he received a fee. He has also published 2 books on the subject of COMET for which he received royalties. The other three authors (Tom IJdema, Annemiek Karreman, and Mark van der Gaag) do not have possible conflicting interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Korrelboom, K., IJdema, T., Karreman, A. et al. The Effectiveness of Transdiagnostic Applications of Competitive Memory Training (COMET) on Low Self-Esteem and Comorbid Depression: A Meta-analysis of Randomized Controlled Trials. Cogn Ther Res 46, 532–543 (2022). https://doi.org/10.1007/s10608-021-10286-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-021-10286-6

Keywords

Search

Navigation