Abstract
The aim of this book is to ‘provide a comprehensive analysis of the nature, effects, measurement, and treatment of rumination’. However, while it may be comprehensive from the point of view of the clinical or research psychologist, it is found wanting in regard to the practising psychiatrist. Nevertheless, it provides a detailed description of various theories of rumination, albeit without any specific attempt to integrate the non-biological with the biological. Having noted that, there is a chapter on the physiological aspects of depressive rumination. There was also the observation by Matthews and Wells that ‘perhaps the most fundamental issue is whether rumination is a causal factor in emotional disorder and hence a potential target for intervention, as opposed to being merely a symptom of some more fundamental underlying process’. However, that ‘fundamental issue’ was not followed to any degree.
The book provides a number of useful conceptual frameworks. For example, Lyubomirsky and Tkach provide a credible theory of ‘a vicious cycle between rumination, negative affect, and multiple adverse consequences’, and the implication is clear that intervention at different points in that vicious cycle could be effective. However, intervention with medication is not addressed. Indeed, the words ‘antidepressant’, ‘medication’, ‘drug’, or ‘psychotropic’ are not included in the quite extensive index. This is unfortunate because, as clinicians appreciate, there is a challenging interaction between mental disorders and ruminations, and I imagine that the majority of psychiatrists would share my belief that psychotropic medication often plays a role in alleviating the distress of ruminations.
Tighter editing could also have made the book better. For example, a study of Nolen-Hoeksema and Morrow [1] demonstrated that students who had a tendency to ruminate in an assessment two weeks before the 1989 San Francisco earthquake were more dysphoric after the earthquake than those who had not had such ruminative tendencies, even though the levels of depressed mood before the earthquake were controlled for. That was first described on page 25; it was repeated on page 44, where it was referred to as the ‘Loma Prieta earthquake’; and it appeared a third time on pp. 108, 109, where the study was again described as an earthquake in the San Francisco Bay area, although on this occasion the earthquake was incorrectly stated to have occurred in 1987 rather than in 1989, as noted in the actual reference and in the earlier two chapters. It is indeed a fascinating study, but hardly worthy of description in three different chapters.
Notwithstanding these shortcomings, this book will be required reading for those who wish to pursue research in this area. For example, there is an excellent chapter on various psychological therapies for ruminations by Purdon, and this includes reference to the work of Davidson and Parker [2], whose meta-analysis demonstrated that eye movement desensitization retraining (EMDR) did not have any specific therapeutic component related to the eye movement per se, but that treatment gains were accounted for by exposure to traumatic events. There is also an excellent chapter on ‘cognitive therapy for depressive thinking’ by McMillan and Fisher. However, the dilemma remains that there is no attempt to integrate a pharmacological contribution to the exhaustively reviewed psychological approaches. For this reason alone, this book will be of limited value to the practising clinical psychiatrist.