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Behav Res Ther. 2016 Jul;82:11-20. doi: 10.1016/j.brat.2016.04.002. Epub 2016 Apr 27.

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.

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Altrecht Academic Anxiety Center, Mimosastraat 2-4, 3511 DC, Utrecht, The Netherlands. Electronic address:
Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, The Hague, The Netherlands. Electronic address:
Altrecht Academic Anxiety Center, Mimosastraat 2-4, 3511 DC, Utrecht, The Netherlands; Utrecht University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands. Electronic address:
PsyQ, Parnassia Psychiatric Institute, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands; Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. Electronic address:
Utrecht University, Clinical and Health Psychology, PO Box 80140, 3508 TC, Utrecht, The Netherlands. Electronic address:
PsyQ, Parnassia Psychiatric Institute, Lijnbaan, 4, 2512 VA, The Hague, The Netherlands; Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands. Electronic address:



Little 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.


A 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.


COMET 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.


COMET 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.


Anxiety disorders; COMET; EMDR; Memory representations; Self-esteem

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