Samenvatting van:
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
Objectives: 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.
Methods: 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.
Results: 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.
Conclusions: 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.