Altrecht Academic Anxiety Center, Mimosastraat 2-4, 3511 DC, Utrecht, The Netherlands.
Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, The Hague, The Netherlands.
Behav Res Ther. 2016 Jul;82:11-20. doi: 10.1016/j.brat.2016.04.002. Epub 2016 Apr 27.
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.
对于焦虑障碍患者的低自尊问题，目前知之甚少。本研究评估了两种针对不同机制的治疗方法：（1）眼动脱敏再处理（EMDR），旨在使维持低自尊的消极记忆表征脱敏；（2）竞争性记忆训练（COMET），旨在激活积极的记忆表征以提升自尊。
采用随机对照试验（RCT）和交叉设计。组 1 先接受六次 EMDR 治疗，然后接受六次 COMET 治疗；组 2 反之。在基线（T0）、第一次治疗结束（T1）和第二次治疗结束（T2）进行评估。主要结局为自尊。共纳入 47 例患者，并进行线性混合模型分析。
COMET 在提升自尊方面的效果优于 EMDR：治疗后效应大小分别为 1.25 和 0.46。出乎意料的是，当 EMDR 作为首先进行的治疗时，与 COMET 作为首项干预相比，COMET 的后续效果显著降低。对于 EMDR，治疗顺序没有差异。焦虑和抑郁的减轻是通过更好的自尊来介导的。
与 EMDR 相比，COMET 可显著提升焦虑障碍患者的自尊水平。EMDR 治疗降低了随后 COMET 的治疗效果。改善的自尊可介导焦虑和抑郁症状的减轻。
