Competitive Memory Training for treating depression and rumination in depressed older adults: A randomized controlled trial Wilfried Ekkers a, * , Kees Korrelboom c , Irma Huijbrechts c , Niels Smits b , Pim Cuijpers b , Mark van der Gaag b a Department of Elderly Psychiatry, Parnassia Bavo Group Psychiatric Institute, Netherlands b Department of Clinical Psychology, VU University and EMGO Institute, Netherlands c Department of Research and Development PsyQ, Parnassia Bavo Group Psychiatric Institute, Netherlands article info Article history: Received 1 April 2010 Received in revised form 20 May 2011 Accepted 20 May 2011 Keywords: Rumination Depression Memory retrieval Treatment Older adults abstract Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged 65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET þ treatment-as-usual (TAU) versus TAU only. COMET þ TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults. Ó 2011 Elsevier Ltd. All rights reserved. Introduction Depression is a highly prevalent psychiatric disorder in later life (Beekman, Copeland, & Prince,1999) that is associated with substantial costs and burden (Murray & Lopez, 1997), and excess mortality rate (Cuijpers & Smit, 2002). The prevalence of depression is expected to increase, especially in older adults (Heo, Murphy, Fontaine, Bruce, & Alexopoulos, 2008). Rumination is one of the key cognitive aspects of depression (Papageorgiou & Wells, 2004). Rumination is defined as the tendency to experience intrusive, repetitive and negative cognitions about symptoms of depression, and the possible causes and conse- quences of these symptoms (Alloy, Ambramson, Metalsky, & Hartlage, 1988; Martin & Tesser, 1989, 1996; Nolen-Hoeksema, Morrow, & Fre- drickson, 1993). Rumination predicts the onset, duration, relapse and severity of depression (Just & Alloy, 1997; Kuehner & Weber, 1999; Lyubomirski & Nolen-Hoeksema, 1995; Nolen-Hoeksema, 2000). Furthermore, rumination has a negative impact on thought content (Lyubomirski, Tucker, Caldwell, & Berg, 1999), impedes problem- solving skills (Watkins & Baracaia, 2002) and mediates the predictive effect of other known risk factors of relapse (e.g., attributional style) (Alloy et al., 1988). Rumination is an important factor in late life depression (Erskine, Kvavilashvili, & Kornbrot, 2007; Von Hippel, Vasey, Gonda, & Stern, 2006) as well as in adult patients (see, for example, Smith & Alloy, 2009). Several treatments have been developed that target rumination, including meditation (Segal, Williams, & Teasdale, 2002), attention training techniques (Wells, 1990), acceptance and commitment therapy (Hayes, Luoma, Bond, Masuda, & Lillis, 2006), and rumination-focused cognitive behavior therapy (RFCBT) for residual depression (Watkins et al., 2007). Watkins, Bayens, and Read (2009) also developed concreteness training (CNT). Purdon (2004) reports that treating rumination is difficult, e.g. whereas meditation and attention training seem promising interventions, both have only moderate effects. Wells (2007) states that there appears to be a consistent positive effect of attention training for a range of disorders, but these data are preliminary. In the present study the effectiveness of a new, time-limited transdiagnostic training was adapted to treat depression by focusing on rumination in older patients. The supposed mechanism of change is by inhibiting access to dominant dysfunctional attitudinal styles and meanings by facilitating access to more functional attitudes and meanings. According to Brewin (2006), cognitive therapy does not directly modify negative information in memory but rather influences the relative retrievability of the different meanings that emotional * Corresponding author. Polanenhof 130, 2548 MC The Hague, Netherlands. Tel.: þ31 703918130; fax: þ31 703918131. E-mail address: w.ekkers@parnassia.nl (W. Ekkers). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2011.05.010 Behaviour Research and Therapy 49 (2011) 588e596