María Oliva Márquez-González, Andrés Losada, and Rosa Romero-Moreno
Dementia caregiving is associated with negative physical and psychological health consequences. Multicomponent, behavioural, and psychotherapeutic interventions for reducing caregivers’ distress, particularly the cognitive-behavioural ones, present the greatest effect sizes, but nevertheless these effects are only moderate. The third wave of behavioural therapies and, specifically acceptance and commitment therapy (ACT), offers interesting therapeutic tools aimed at fostering the acceptance of aversive internal experiences and the commitment to personal values. Given the chronic nature of the caregiving situation and the unchangeability of many of its elements (e.g. feeling sadness or grief), ACT represents a promising and potentially helpful therapeutic approach to help dementia caregivers to decrease their emotional distress. Very few studies have so far analysed the efficacy of ACT or some of its components (e.g. mindfulness) in this population, but these provide some preliminary support for the utility of this approach in improving caregivers’ psychological well-being. Assuming the need for further research in order to consider ACT as an empirically validated therapy for dementia caregivers, in this chapter we analyse, in the context of caregiving, the psychological processes highlighted in the ACT model of psychopathology, such as experiential avoidance, describing examples of them in cases of caregivers we have assisted in our clinical work, and outlining ACT-based therapeutic strategies that we have found useful on a clinical basis for modifying them.
Kelly C. Allison and David B. Sarwer
Body image disturbances are common among women in the general population. Less is known about their prevalence and impact during pregnancy. This chapter examines the history of body image theory and research. Next, we examine issues related to body image during pregnancy, such as pregravid weight, gestational weight gain, and the unique ways women think about the changes to their body during pregnancy. The role of physical activity, mood, and eating disorders in relation to peripartum body image disturbance is also discussed. Finally, assessment of body image disturbance and existing treatments are presented. Future research is needed to develop peripartum-specific body image assessment tools and to assess the impact of psychosocial interventions during and after pregnancy on body image dissatisfaction.
Michelle Hamil and Alastair Gaskell
Later life can be a time when coping strategies are challenged by losses and transitions that can resonate with earlier experiences of distress and vulnerability. Pre-existing trauma and low self-esteem can also resurface to produce anxiety, depression, and self-destructive behaviours. Using case vignettes this chapter outlines the theory and breadth of application of cognitive-analytic therapy (CAT) to show how growth and development are possible when confronted with difficult states in later life including narcissistic and borderline personality traits, depression and dementia, and its use in consultation in residential care settings. By offering a lifespan model of socially and culturally mediated development CAT views a person as a ‘work in progress’, a culmination of events, experiences, and relationships that have resulted in the person in the here and now, with the hopeful possibility that regardless of age, transformation and change for the better may be obtainable (Hepple 2002).
Sara Honn Qualls
Family therapy interventions are useful in geropsychology when family structures and processes contribute to, or complicate well-being, or when family support is critical to the well-being of older adults. Although relatively early in development, therapy with ageing families draws from rich conceptual frameworks in family development, family systems, and medical family therapy. Family therapy interventions have been shown to add benefit in a limited set of studies. Care-giver family therapy, an emerging model that guides geropsychologists to organize evidence-based interventions, is illustrated with a case that demonstrates how family can be engaged to improve support and care for older adults and their care-giving family members.
Gregory A. Hinrichsen and Marie-Genevieve Iselin
Interpersonal Psychotherapy (IPT) is a time-limited treatment for depression; a substantial body of evidence supports its utility in adults. The focus of IPT is on interpersonally relevant events that are a precipitant or consequence of depression. The four problem areas that are the focus of IPT—grief, interpersonal role disputes, role transitions, and interpersonal deficits—encompass issues often seen among depressed older adults in clinical practice. Results of clinical studies and practice support the utility of IPT in the treatment of late-life depression. In this chapter, two clinical cases illustrate the use of IPT with older adults. The chapter authors share their experience in conducting an IPT training programme for medical centre-based psychology graduate students providing services to older adults, along with national efforts by the US Department of Veterans Affairs (VA) to build IPT competency among VA clinicians who serve a large population of older Veterans.
Childbearing women experience a host of emotional experiences and demands for adjustment. The past two decades have witnessed an abundance of research on pregnancy, lactation, and the transition to parenthood. This research cuts across many disciplines and often requires an understanding of biological and psychosocial processes outside the typical training for professionals in any one discipline. The Handbook of Perinatal Psychology was compiled to provide a comprehensive overview and evaluation of literature in the field, written by experts in a number of these disciplines to illustrate both typical and atypical experiences associated with childbirth. This Handbook includes chapters on typical psychological, biological, relational, and developmental experiences in women and newborns; an array of mental health problems associated with the transition to parenthood; approaches for screening, assessing, and treating adjustment problems in the transition to parenthood; other problems associated with childbearing; and special issues associated with childbearing.
Dana M. Litt, Jason R. Kilmer, Susan F. Tapert, and Christine M. Lee
This chapter reviews the extant literature surrounding adolescent marijuana use and abuse. Other than alcohol, marijuana is the most prevalent psychoactive substance used by adolescents. While recent progress has been made in understanding and identifying risk and protective factors of adolescent marijuana use, as well as short and longer term outcomes of use, the field is still in its infancy. The present chapter aims to summarize the prevalence, etiology, trajectories of use, motivations and reasons for use, and the physical and psychological consequences of marijuana use in adolescence. Finally, this chapter highlights the need for future research given the changing landscape of marijuana decriminalization in the United States and beyond.
Danielle Ramo and Christian Grov
Illicit drugs other than marijuana have a unique and important place in the picture of adolescent substance use and associated problems. Large, epidemiological studies have revealed that, although the use of individual drugs (other than marijuana) may fluctuate widely, the proportion of adolescents using any of them has been more stable in the decade between 2000 and 2010, compared to decades prior. In this chapter, we give an overview of illicit substance use in adolescence, including cocaine/crack, methamphetamine, heroin, ecstasy, MDMA, LSD, and GHB. We review epidemiological patterns of use among youth, including modes of use and common trajectories of use. We discuss cognitive, behavioral, and social contexts of other drug use in adolescence, and we review demographic patterns of use. We conclude by reviewing similarities and differences between substances.
Laura J. Miller
Becoming pregnant and giving birth can lead to considerable psychological, behavioral, and cognitive transformation. The nature and scope of change varies a great deal from woman to woman. This chapter summarizes qualitative and quantitative research on normal psychological adaptation to pregnancy, including recognition and acceptance of the pregnant state, experience of the boundary between self and fetus, and body image changes. It reviews research on internal representations of the fetus and fetal and neonatal attachment. Perinatal changes in stress reactivity and coping style are reviewed. The chapter explains the influence of women’s prenatal expectations about labor and delivery on subsequent experiences and reactions and describes normative postpartum mood reactivity. Perinatal effects on sleep, physical activity, sexual activity, and eating patterns are described. Controversies about the effects of pregnancy on cognition are examined. The chapter also covers topics related to the transition to motherhood, including influences on maternal self-esteem and self-efficacy.
Amy Wenzel, Scott Stuart, and Hristina Koleva
Psychotherapy is often the treatment of choice for perinatal women who wish to limit their fetus’s or infant’s medication exposure. The vast majority of empirical research that has examined psychotherapy for perinatal women has focused on depression. Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) have been examined in several studies to determine their efficacy in perinatal depression and anxiety. Recent research has begun to examine the manner in which psychotherapies can be delivered in alternative formats (e.g., teletherapy) in order to overcome problems with treatment retention and compliance. Suggestions for future research include large-scale randomized controlled trials that compare two active approaches to psychotherapy, mediation studies to uncover the mechanisms of change associated with the successful treatment of perinatal women, and randomized controlled trials evaluating the efficacy of psychotherapy for mental health disorders other than depression.
Sunil S. Bhar
Reminiscence therapy is an evidence-based treatment for geriatric depression. This chapter reviews the literature on the definition of reminiscence and its use as a therapy for older adults. It also reviews the evidence for the efficacy of various types of reminiscence therapies for older adults with dementia and depression. Two types of reminiscence therapy—life review and life review therapy—have compelling support as efficacious treatments for improving well-being and for reducing depression. Some support is available for the efficacy of reminiscence therapy for reducing problems associated with dementia, but more research is indicated. The chapter concludes with an overview of the purported mechanisms of reminiscence therapy and areas for further investigation.
Laura N. Gitlin
Depressive disorders are highly prevalent and among the most debilitating conditions in late life. If untreated, depression has profound effects on quality of life and health; it also increases the risk for dementia, other comorbidities, functional decline, and mortality. Although primary care is the principal setting for the detection and treatment of depression, older adults and particularly, minorities do not always receive evidence-based treatment guidelines. Thus, new care models are urgently needed. This chapter considers the role of community- and home-based approaches to depression care, their theoretical underpinnings and advantages, and exemplary programs. Twenty-three rigorously tested community- and home-based interventions with positive depression outcomes are identified, suggesting a robust and growing evidence base. Community- and home-based approaches may overcome persistent mental health disparities by reaching underserved populations, minimizing stigma by normalizing depression detection and delivering treatments at home, and increase access to nonpharmacological approaches—such as psychosocial and behavioral approaches—f or older adults who are at risk for or have late-life depression.