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.

BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Who are the 'no-shows' and why don't they turn up?]. / Wie zijn de no-shows en waarom blijven zij weg?

BACKGROUND: No-show is a problem in mental health care. AIM: To obtain insight into the characteristics of patients who fail to appear at their intake appointments, to find out their reasons for not turning up, and thereby, if possible, to identify aspects of the intake procedures that may require adaptation. METHOD: In a prospective study based on 333 patients, we compared the characteristics of patients who failed to show up for the intake procedure with those of patients who did show up. Via a telephone interview we asked the 'no-shows' why they had not come. RESULTS: The number of 'no-shows' was lower than expected and we found only two very small differences: patients with a non-western background were less likely to turn up, as were patients whose appointments were later in the day, mainly around lunchtime. Via the telephone interview we found that most of the 'no-shows' still had felt unwell and blamed themselves for not turning up. They still wanted to be given professional help. CONCLUSION: No-show at intake appears to be less of a problem than expected. It seems a good idea to approach patients after they have missed appointments, because 'no-shows' still have serious symptoms and are still eager to receive professional help. It will probably be worthwhile conducting a similar investigation among 'no-shows' once they have begun to receive treatment.