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

Published online by Cambridge University Press:  01 September 2010

Kees Korrelboom*
Parnassia-Bavo Psychiatric Centre, The Hague, The Netherlands
Marlies Marissen
Parnassia-Bavo Psychiatric Centre, The Hague, The Netherlands
Tanja van Assendelft
Parnassia-Bavo Psychiatric Centre, The Hague, The Netherlands
Reprint requests to Kees Korrelboom, Head of the Department of Research and Development, PsyQ, Parnassia-Bavo Psychiatric Centre, Stadhoudersplantsoen 2, 2517 JL The Hague, The Netherlands. E-mail:


Background: 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. Aims: To assess whether COMET for low self-esteem is also an effective intervention for patients with personality disorders. Method: 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. Results: 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. Conclusion: 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.

Empirically Grounded Clinical Interventions
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

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American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn. rev.). Washington DC: American Psychiatric Association.Google Scholar
Appelo, M. T. (2005). Positieve uitkomsten lijst (PUL). (Positive Outcome Scale). Nijmegen: Cure and Care Publishers.Google Scholar
Bados, A., Balaguer, G. and Saldana, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585592.CrossRefGoogle ScholarPubMed
Beck, A. T., Freeman, A., Davis, D. D. and Associates (2004). Cognitive Therapy of Personality Disorders (2nd edn.). New York: The Guilford Press.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 18, 561571.CrossRefGoogle Scholar
Blascovich, J. and Tomaka, J. (1991). Measures of self-esteem. In Robinson, J. P., Shaver, P. R. and Wrightsman, L. S. (Eds.), Measures of Personality and Social Psychological Attitudes, Volume I (pp. 115160). San Diego: Academic Press.CrossRefGoogle Scholar
Bouman, T. K. (1989). Assessment van stemmingsstoornissen (Assessment of mood disorders). In Albersnagel, F. A., Emmelkamp, P. M. G. and van den Hoofdakker, R. H. (Eds.), Depressie: theorie, diagnostiek en behandeling (pp. 4362). (Depression: theory, diagnostics and treatment (pp. 4362). Deventer: Van Loghum Slaterus.Google Scholar
Bouman, T. K., Luteijn, F., Albersnagel, F. A. and Ploeg, F. A. E. van der (1985). Enige ervaringen met de Beck Depression Inventory (BDI). (Some experiences with the Beck Depression Inventory (BDI)). Gedrag-tijdschrift voor Psychologie, 13, 1324.Google Scholar
Brewin, C. R. (2006). Understanding cognitive behaviour therapy: a retrieval competition account. Behaviour Research and Therapy, 44, 765784.CrossRefGoogle ScholarPubMed
Crocker, J. and Park, L. E. (2004). The costly pursuit of self-esteem. Psychological Bulletin, 130, 392414.CrossRefGoogle ScholarPubMed
De Raedt, R., Schacht, R., Franck, E. and De Houwer, J. (2006). Self-esteem and depression revisited: implicit positive self-esteem in depressed patients? Behaviour Research and Therapy, 44, 10171028.CrossRefGoogle ScholarPubMed
DuBois, D. L. and Flay, B. R. (2004). The healthy pursuit of self-esteem: comment on and alternative to the Crocker and Park (2004) formulation. Psychological Bulletin, 130, 415420.CrossRefGoogle Scholar
Ellis, A. (2005). The Myth of Self-Esteem: how rational emotive behavior therapy can change your life forever. Amherst, NY: Prometheus Books.Google Scholar
Fennell, M. J. V. (1997). Low self-esteem: a cognitive perspective. Behavioural and Cognitive Psychotherapy, 25, 125.CrossRefGoogle Scholar
Fennell, M. and Jenkins, H. (2004). Low self-esteem. In Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M. and Westbrook, D. (Eds.), Oxford Guide to Behavioural Experiments in Cognitive Therapy (pp. 413433). Oxford: Oxford University Press.CrossRefGoogle Scholar
Gilbert, P., Baldwin, M. W., Irons, C., Baccus, J. R. and Palmer, M. (2006). Self-criticism and self-warmth: an imagery study exploring their relationship to depression. Journal of Cognitive Psychotherapy, 20, 183200.CrossRefGoogle Scholar
Hall, P. L. and Tarrier, N. (2003). The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behaviour Research and Therapy, 41, 317332.CrossRefGoogle ScholarPubMed
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.CrossRefGoogle ScholarPubMed
Kampman, M., Keijsers, G. P. J., Hoogduin, C. A. L. and Hendriks, G-J. (2008). Outcome prediction of cognitive therapy for panic disorder: initial symptom severity is predictive for treatment outcome, comorbid anxiety or depressive disorder, cluster C personality disorder and initial motivation are not. Behavioural and Cognitive Psychotherapy, 36, 99112.CrossRefGoogle Scholar
Korrelboom, C. W. (2000). Versterking van het zelfbeeld bij patiënten met persoonlijkheidspathologie: “hot cognitions” versus “cold cognitions”. (Strengthening self-esteem in patients with personality disorders: hot cognitions versus cold cognitions). Directieve Therapie, 20, 282302.CrossRefGoogle Scholar
Korrelboom, C. W., de Jong, M., Huijbrechts, I. and Daansen, P. (2009). Competitive Memory Training (COMET) for treating low self-esteem in patients with eating disorders: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 77, 974980.CrossRefGoogle ScholarPubMed
Korrelboom, C. W., van der Weele, K., Gjaltema, M. and Hoogstraten, C. (2009). Competitive memory training (COMET) for treating low self-esteem: a pilot study in a routine clinical setting. The Behavior Therapist, 32, 38.Google Scholar
Kuyken, W., Padesky, C. A. and Dudley, R. (2009). Collaborative Case Conceptualization: working effectively with clients in cognitive-behavioral therapy. New York: The Guilford Press.Google Scholar
Lynum, L. I., Wilberg, T. and Karterud, S. (2008). Self-esteem in patients with borderline and avoidant personality disorders. Scandinavian Journal of Psychology, 49, 469477.CrossRefGoogle ScholarPubMed
McManus, F., Waite, P. and Shafran, R. (2008). Cognitive-behavior therapy for low self-esteem. Cognitive and Behavioral Practice, 16, 266275.CrossRefGoogle Scholar
Olij, R. J. B., Korrelboom, C. W., Huijbrechts, I. P. A. M., Jong, M. de, Cloin, P. A., Maarsingh, M. and Paumen, B. N. W. (2006). De module zelfbeeld in een groep: werkwijze en eerste bevindingen (Treating low self-esteem in a group: procedure and first results) Directieve Therapie, 26, 307325.CrossRefGoogle Scholar
Overholser, J. C., Adams, D. M., Lehnert, K. I. and Brinkman, D. C. (1995). Self-esteem deficits and suicidal tendencies among adolescents. Journal of the American Academy for Child and Adolescent Psychiatry, 34, 919928.CrossRefGoogle ScholarPubMed
Pyszczynski, T. and Cox, C. (2004). Can we really do without self-esteem? Comment on Crocker and Park (2004). Psychological Bulletin, 130, 425429.CrossRefGoogle Scholar
Pyszczynski, T., Greenberg, J., Solomon, S., Arndt, J. and Schimel, J. (2004). Why do people need self-esteem? A theoretical and empirical review. Psychological Bulletin, 130, 435468.CrossRefGoogle ScholarPubMed
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton, New Jersey: Princeton University Press.CrossRefGoogle Scholar
Rüsch, N., Lieb, K., Göttler, I., Hermann, C., Schramm, E., Richter, H., Jacob, G. A., Corrigan, P. W. and Bohus, M. (2007). Shame and implicit self-concept in women with borderline personality disorder. American Journal of Psychiatry, 164, 500508.CrossRefGoogle ScholarPubMed
Schmitt, D. P. and Allik, J. (2005). Simultaneous administration of the Rosenberg self-esteem scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89, 623642.CrossRefGoogle ScholarPubMed
Stice, E. (2002). Risk and maintenance factors for eating pathology: a meta-analytic review. Psychological Bulletin, 128, 825848.CrossRefGoogle Scholar
Schmitz, N., Kugler, J. and Rollnik, J. (2003). On the relation between neuroticism, self-esteem, and depression: results from the National Comorbidity Survey. Comprehensive Psychiatry, 44, 169176.CrossRefGoogle ScholarPubMed
Tarrier, N. (2001). The use of coping strategies and self-regulation in the treatment of psychosis. In Morrison, A. (Ed.), Casebook of Cognitive Therapy for Psychosis. London: Routledge.Google Scholar
Thalheimer, W. and Cook, S. (2002). How to calculate effect sizes from published research: a simplified methodology. Retrieved 20 July 2009 from Scholar
Westbrook, D. and Kirk, J. (2005). The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy, 43, 12431261.CrossRefGoogle ScholarPubMed
Wilson, J. K. and Rapee, R. M. (2005). The interpretation of negative social events in social phobia: changes during treatment and relationship to outcome. Behaviour Research and Therapy, 43, 373389.CrossRefGoogle ScholarPubMed
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