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.
Acculturation and Alcohol Use Among Hispanic and Asian American College Students: What Do We Know and Where Could We Go?
Byron L. Zamboanga, Cara C. Tomaso, and P. Priscilla Lui
Many college students, are susceptible to alcohol use and related problems, including Hispanic and Asian Americans. A potential factor contributing to this risk is acculturation, which can be defined as the process of psychological, behavioral, social, and cultural change and adaptation that occurs when individuals or groups from different cultural backgrounds come in contact. This chapter provides a narrative review of the literature examining acculturation and alcohol use among these populations. One key theme to emerge from this review is that the exact direction of the association between these variables is unclear and therefore should be considered with caution. While the existing evidence is relatively limited, gender and, to some extent, ethnic group membership appear to moderate the association between acculturation and alcohol use. Several methodological issues pertaining to the study of acculturation, future research directions, and implications for intervention and prevention are discussed.
Ana F. Abraído-Lanza, Karen R. Flórez, and Rachel C. Shelton
Despite the many health benefits of physical activity (PA), the majority of Latinos do not meet recommended levels of PA. This chapter provides an overview of research on acculturation and PA among adult Latinos in the United States. It identifies gaps in knowledge concerning the association between acculturation and different types of PA, the joint effects of socioeconomic position and acculturation on PA, and research on gender. It suggests several areas for further research related to acculturation and PA, including an exploration of norms, social networks, and broader social contexts. It concludes that although the bulk of evidence indicates that greater acculturation is associated with increased PA, more complex research designs and greater methodological and conceptual rigor are needed to move forward research in this area.
Kelly B. Haskard-Zolnierek and Summer L. Williams
This chapter outlines the ways in which depression and other mental health issues influence adherence and health-behavior change. Patient adherence and health-behavior change are defined and described. Common mental health issues including depression and anxiety are described as well as the prevalence of nonadherence to treatment for these conditions. Next, comorbidity of physical and mental health issues are discussed, such as depression co-occurring with various chronic diseases, providing evidence of the effects of mental health on adherence and health-behavior change. The mechanisms for the relationship of mental health to adherence and health-behavior change are discussed through the framework of the information-motivation-strategy model, with adherence being affected due to cognitive factors, motivational factors, and resource-related factors. The chapter concludes with a discussion of what health-care professionals can do to address and reduce this barrier to adherence and health-behavior change.
Adjustment to Chronic Illness and Disabilities: Theoretical Perspectives, Empirical Findings, and Unresolved Issues
Hanoch Livneh and Erin Martz
Chronic illnesses and disabilities (CID) are integral parts of life, and their likelihood of occurrence increases with one's age. The experience of CID invariably necessitates personal adaptation to both the individual's diminished functional capacities and their altered interactions with the physical and social environments. The field of psychosocial adaptation (PA) to CID has exponentially grown during the past 30 years and can be conveniently collapsed into two broad domains, namely, conceptual and empirical approaches to the study of PA to CID. The conceptual approach is mostly rooted in extensive clinical observations of individuals following the aftermath of CID onset and has led to the development of numerous theoretical frameworks of PA to CID and coping with CID. Here, we provide a review of the most influential conceptual models of PA to CID. The empirical literature is examined in this chapter by focusing on those studies that have directly sought to investigate the relationships (albeit not necessarily causal in nature) among a wide range of sociodemographic characteristics, CID-linked factors, personality attributes and coping strategies, and environmental influences (these four classes of variables are typically considered as predictors, mediators or moderators), and measures of PA to CID (the latter commonly regarded as outcomes). Due to space restrictions, our review of the empirical literature only focuses on certain types of CIDs, namely, spinal cord injuries, cancer, and multiple sclerosis. This chapter concludes with a discussion of those issues that need to be addressed by future researchers in the field of adaptation to CID.
Tammy Chung and Kristina M. Jackson
Alcohol is the substance most commonly used by youth. Problematic alcohol use can be considered a developmental disorder, which typically has its origins in an individual’s genetic liability, temperament, and experiences in childhood and adolescence. To provide a context for the emergence of alcohol use in adolescence, this chapter briefly reviews biological substrates of risk that include genetic liability and processes of developmental maturation (e.g., puberty, brain development). The chapter then addresses the prevalence of alcohol use and alcohol-related problems in adolescence, trajectories of youth alcohol use, and internalizing and externalizing behavior pathways associated with adolescent alcohol use. Risk and protective factors influencing adolescent alcohol use are discussed as targets to guide developmentally informed prevention and intervention.
Adolescent Cultural Contexts for Substance Use: Intergroup Dynamics, Family Processes, and Neighborhood Risks
Seth J. Schwartz, Sabrina E. Des Rosiers, Jennifer Unger, and José Szapocznik
This chapter reviews the role of cultural processes in substance use and other health problems among adolescents. The chapter focuses on Hispanics because of their status as both a minority group and an immigrant group, and because Hispanics have been a “lightning rod” for political discourse about immigration and US national identity. The core argument is that intergroup processes such as social dominance and system justification are responsible, at the population level, for unequal allocation of social resources—which, in turn, creates health disparities. These intergroup processes compound the effects of more proximal contexts such as individual, family, and neighborhood. It is argued that interventions to combat the social/cultural determinants of health disparities should be multilevel, including individual-, family-, community-, and population-level strategies.
Kenneth J. Sher, Julia A. Martinez, and Andrew K. Littlefield
Alcohol use disorders (AUDs), alcohol abuse and alcohol dependence, are among the most prevalent mental disorders in the United States and elsewhere. Controversy exists with respect to the optimal way of classifying these disorders and the boundaries between normal and abnormal drinking. Although AUDs can occur over much of the life span, from an epidemiological perspective it is largely a disorder of adolescence and young adulthood. Many who experience AUDs “mature out” of them as they age and acquire adult roles and, perhaps, as a function of normal personality. However, a significant minority of individuals fails to mature out, and some individuals develop AUDs later in adulthood. There are a number of etiological pathways associated with developing an AUD; foremost among them is a pathway shared with other externalizing disorders such as conduct disorder, adult antisociality, and other substance dependence. However, pathways associated with internalizing disorders and with individual differences in alcohol effects also exist. All of these pathways likely involve major genetic and environmental determinants. Given the etiological pathways that have been documented, it is not surprising that AUDs are often comorbid with other mental disorders. A number of approaches to the prevention and treatment of AUDs have been developed that are effective. Additionally, basic research is setting the stage for further advances in both behavior and drug treatments of AUDs.
This chapter provides an overview of the research into anxiety, stress, and worry during the perinatal period. It provides information on rates of disorders and of high levels of anxiety and their impact. Examples of the content of several anxiety disorders, both during pregnancy and the postpartum period, are given. Causes and risk factors for anxiety are discussed, together with its course over the perinatal period. Mention is made of specific perinatal studies looking at treatment for anxiety, and the author provides ideas on areas for future research. However, all of this information is tempered by an important caveat, in which the author suggests that much of the research that has been conducted in this area is, in fact, flawed.
Anastasia M. Raymer and Leslie J. Gonzalez Rothi
Neurologic damage affecting the left cerebral hemisphere leads to impairments in comprehension and expression of language in the verbal modality (aphasia) and in the written modality (dyslexia and dysgraphia). Impairment patterns take various forms, differing in the fluency/nonfluency of verbal output and integrity of auditory comprehension, repetition, and word retrieval abilities. The divergent classifications of aphasia allow reflection on neural and psychological correlates of specific aspects of language processing in verbal and written modalities. Neurologic damage affecting the right cerebral hemisphere can lead to changes in social and prosodic communication, speaking to the role of the right hemisphere in language processing. Patterns of language breakdown following neurologic injury have implications for assessment and intervention for affected individuals. Whereas perspectives vary on interpretation of the language breakdown across disciplines, this volume’s purpose is to facilitate interactions across disciplines to improve the lives of those with aphasia and related communication disorders.
Claude Richard and Marie-Thérèse Lussier
The clinical settings in which physicians and other healthcare providers must apply their scientific knowledge and technical expertise are diverse and require further adaptive capacities on their part. Thus, the science and the art, although often opposed, are in fact complementary and together define excellence in practice in which the art is not, as stated by Saunders, merely part of the medical humanities but it is integral to medicine as an applied science. This essay addresses those dimensions of medical talk described as the “art” of the medical encounter, how these impact the quality of information gathering and provision, and how, in turn, this influences patients’ understanding and recall. The notion of the “art of information exchange” is reframed as a “medical dialogue” using communication skills and dimensions not traditionally thought of when referring to the “art” of medical information exchange.
Leslie R. Martin
Nonadherence represents a significant challenge not only to personal health and well-being but also to the health-care system as a whole. The Information-Motivation-Strategy model, which forms the organizational framework for this volume, provides a simple yet comprehensive heuristic for addressing the significant and complex problem of nonadherence, emphasizing within each component the vital role of communication between the clinician and patient.
Beth A. Lewis, Eric Statt, and Bess H. Marcus
This chapter discusses three health behaviors that significantly impact public health. Specifically, physical activity behavior, weight loss, and smoking cessation are associated with many health benefits, including decreased risk of cardiovascular disease, type 2 diabetes, and cancer. These three health behaviors are important modifiable risk factors that can have a significant impact on health. Unfortunately, only half of Americans are physically active at the recommended levels. Additionally, 66.3% of Americans are overweight or obese. Finally, despite the health problems related to smoking, about one-fifth of Americans continue to smoke cigarettes. We provide an overview of the theoretical models commonly used in intervention studies and summarize the research evidence from randomized trials. Finally, we review three different intervention approaches for improving health behaviors, including an individual-level approach for physical activity, a community-level approach for weight loss, and a group-based approach for smoking cessation.
Michele G. Greene and Ronald D. Adelman
This chapter focuses on how communication is affected when, in addition to the physician and the patient, there is another individual present during the interaction. Although it is difficult to estimate the frequency with which triadic (three-person) encounters take place, they occur in a variety of medical situations, including pediatric, obstetric, geriatric, and oncology visits, visits in which an interpreter is present, visits in which health-care professional trainees participate, and a myriad of inpatient situations. Although estimates of the frequency of accompaniment to medical visits vary from study to study, we hypothesize that over the next decade there will be many more encounters in which a third person is present. This is likely to occur because of the rapid growth of the aging of the population (where there is frequent accompaniment in geriatric visits), the greater recognition of medical errors (and the potential role that accompanying third parties may play in reducing errors), the increasing size of the immigrant population that will need translating services, and the consumerist approach to health care. Of note, in recent empirical research, we have observed tetradic (four-person) and pentadic (five-person) medical visits. In this chapter, we briefly review the theoretical basis for understanding multiparty medical encounters (i.e., visits in which more than two interactive participants are present) and examine triadic interactions in four clinical areas: pediatric care, oncologic care, encounters with interpreters present, and geriatric care. We also provide an excerpt of a transcript from a visit to explore interactions in which more than three persons are present. An agenda for future research is suggested.
Pregnancy and postpartum recovery involve profound changes that affect nearly every aspect of a woman’s life. This chapter reviews the physical, hormonal, and physiological changes that occur in the course of normal pregnancy and the postpartum period. It describes the common symptoms and sensations associated with these changes and their implications in contributing to behavioral changes and psychopathology. It is important for health care providers to realize that, for a majority of women, somatic symptoms and some psychological symptoms represent normal physiological changes. The symptoms and complaints engendered by the changes of pregnancy are, in most cases, the natural consequence of bringing new life into the world. A familiarity with routine pregnancy-related changes will aid the mental health care provider in recognizing when behavioral patterns deviate from what is expected. Such understanding is key to assessing when such symptoms demand treatment and when they only call for reassurance and legitimization.
Biological Sensitivity to Context: A Framework for Understanding Relations Between Early Life Experiences and Problem Behaviors
Nila Shakiba, Elisabeth Conradt, and Bruce Ellis
It is now well established that early experiences of adversity play a central role in development of many mental health problems in adulthood. However, the effects are more pronounced and detrimental for some individuals compared to others. Informed by the biological sensitivity to context model, an evolutionary-developmental model of individual differences in stress responsivity, the present chapter highlights the role of stress response system as one moderating mechanism in the pathway between early life experiences and development of internalizing and externalizing behaviors. The model posits that the magnitude and integrated patterns of autonomic and adrenocortical responses to psychosocial challenges are indicators of the organisms’ level of susceptibility to both positive and negative environmental influences. The final part of the chapter focuses on the role of early life experiences in programming the functioning of stress response systems, development of adaptive stress responsivity patterns, and related behavioral profiles.
Simone Vigod and Meir Steiner
Much research has focused on understanding why women are at increased risk of serious mental health symptoms during pregnancy and the postpartum. Although psychosocial stressors play a major role in perinatal psychiatric disorders, not every woman who experiences adverse psychosocial circumstances develops a major psychiatric illness during this time. As such, attention has focused on exploring how biological factors might impact the development of perinatal psychopathology. This chapter reviews biological changes during pregnancy and the postpartum that may contribute to the onset and/or exacerbation of psychiatric symptoms and disorders in the perinatal period. It discusses heritability and genetics research suggesting that some women may have a biological predisposition to developing psychopathology in the perinatal period. Then, the chapter focuses on pregnancy- and childbirth-related biological changes in sex hormones; the neurotransmitter, endocrine, and immune systems; and sleep that may be contributing biological factors in perinatal psychopathology for women at risk.
Kathleen A. Martin Ginis, Rebecca L. Bassett-Gunter, and Catherine Conlin
Exercise has been shown to be an effective intervention for improving body image among both women and men. This chapter begins with a review of the meta-analytic evidence regarding the effects of exercise on body image. We then provide a comprehensive assessment of potential mechanisms underlying the effects of exercise on body image. Three mechanisms are discussed: objective changes in physical fitness, perceived changes in physical fitness, and changes in self-efficacy. An analysis of potential moderators of the exercise–body image relationship follows. Finally, we present a review of emerging topics in the exercise intervention and body image literature and provide recommendations for body image research within the field of exercise psychology.
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.
Svetlana Popova, Shannon Lange, Larry Burd, and Jürgen Rehm
Damage to the central nervous system is a unifying concept for nearly all of the diagnoses that fall under the Fetal Alcohol Spectrum Disorders (FASD) umbrella. Thus, FASD are an important public health and social problem worldwide that consumes a large amount of resources, both economic and societal by imparting a large burden on society through such sectors as the healthcare system, mental health and substance abuse treatment services, foster care, the criminal justice system, and the long-term care of individuals with intellectual and physical disabilities. Existing estimates of the economic impact of FASD demonstrate significant cost implications on the individual, the family and society. Many of the costs associated with FASD can be reduced with the implementation of effective social policies and intervention programs.