Sleep health is understood as a key factor in lifelong health and for social participation, function, and satisfaction. In later life, insomnia and other sleep disturbances are common. Insomnia is experienced as poor, disrupted, or insufficient sleep associated with significant daytime impairments including increased fatigue or reduced energy, impaired cognitive function, and increased mood disturbance. Poor sleep is associated with negative outcomes across a range of dimensions that impair quality of life, increases risk for other diseases, and may interact negatively with the progression and treatment of other disorders. Evidence for effective psychological interventions to improve sleep in later life, specifically cognitive behavioral therapy for insomnia, is robust and well described. Good sleep should be understood as a substrate for psychological health and a reasonable expectation in later life.
Article
Insomnia and Clinical Sleep Disturbance in Later Life
Simon Smith
Article
Intergenerational Transmission of Risk for Behavioral Problems Including Substance Use
Deborah M. Capaldi, David C. R. Kerr, and Stacey S. Tiberio
Intergenerational studies are key to informing research, preventive intervention, and policy regarding family influences on healthy development and maladjustment. Continuities in family socialization and contextual risks across generations, as well as genetic factors, are associated with the development of psychopathology—including externalizing problems in children—and with intergenerational associations in the use of marijuana, alcohol, tobacco, and other drugs; these continuities are reflected in the low-to-moderate associations generally found in prospective studies. Until recent years, estimates of intergenerational continuities in problem behaviors and the processes explaining such associations (e.g., parenting behaviors) have been based largely on retrospective reports by adults about their own parents’ behaviors. Now there are some long-term prospective studies spanning as many as 30 years that can assess linkages between behaviors in one generation and the next. Whereas such studies have considerable design and implementation challenges, and are very expensive, it is of critical importance to examine the magnitude of associations of behaviors across generations. For example, a modest association across generations suggests either that genetic factors have a limited influence on that behavior or that they are subject to considerable moderation by environmental factors. These prospective studies relate to theoretical developments regarding intergenerational influences that are reviewed—for example, individual differences in genetic sensitivity to environmental influences. The theoretical approach employed in the Oregon Youth Study—Three Generation Study is a Dynamic Developmental Systems (DDS) model of continuous feedback across systems throughout development. A new hypothesis encompassed by DDS is developmental congruence of intergenerational associations in problem behaviors. As used in geometry, congruence refers to figures of a similar shape and size. This term has been adapted to refer to the expectation that ages of onset and patterns of growth in key behaviors will show similarity across generations. This is based on the theory that genetic and temperamental factors increase an individual’s risk when these factors are expressed at sensitive developmental periods. Thus, the timing of these manifestations (e.g., susceptibility to deviant peer influences) is expected to be similar across generations. Developmental similarity is also likely due to continuities in social-risk context and family mechanisms, such as parenting.
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International Perspectives on Residential Aged Care
Nasreen A. Sadeq and Victor Molinari
The need for facilities that provide residential aged care is expected to increase significantly in the near future as the global population ages at an unprecedented rate. Many older adults will need to be placed in a residential care setting, such as an assisted living facility (ALF) or nursing home, when their caregivers can no longer effectively manage serious medical or psychiatric conditions at home. Although the types of residential care settings worldwide vary considerably, long-term care residents (LTC) and staff benefit from environmental and cultural changes in LTC settings. Unlike traditional medical models of LTC, culture change advocates for a shift toward holistic, person-centered care that takes place in homelike environments and accounts for the psychosocial needs of residents. Carving out a role for family members and training professional caregivers to address behavioral problems and quality-of-life issues remain a challenge. In LTC settings, preliminary research indicates that implementing person-centered changes addressing resident and caregiver needs may lead to better health outcomes, as well as increased satisfaction among patients, families, and staff. With the burgeoning world population of older adults, it is incumbent that they be provided with optimal humane culturally sensitive care.
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Internet-Based Methods in Managing Alcohol Misuse
Stuart Linke and Elizabeth Murray
Alcohol-use disorders are widespread and associated with a greatly increased risk of health-related and societal harms. The majority of harms associated with consumption are experienced by those who drink above recommended guidelines, rather than those who are alcohol dependent. Brief interventions and treatments based on screening questionnaires and feedback have been developed for this group, which are effective tools for reducing consumption in primary care and in other settings. Most people who drink excessively do not receive help to reduce the risks associated with excessive consumption. Digital versions of brief and extended interventions have the potential to reach populations that might derive benefit from them. Digital interventions utilize the same principles as do traditional face-to-face versions, but they have the advantages of availability, confidentiality, flexibility, low marginal costs, and treatment integrity. The evidence for the feasibility, acceptability, costs, and effectiveness of digital interventions is encouraging, and the evidence for effectiveness is particularly strong in studies of student populations. There are, however, a number of unresolved questions. It is not clear which components of interventions are required to maximize effectiveness, whether digital versions are enhanced by the addition of personal contact from a facilitator or a health professional, or how to increase take up of the offer of a digital intervention and reduce attrition from a program. These questions are common to many online behavior-change interventions and there are opportunities for cross-disciplinary learning between psychologists, health professionals, computer scientists, and e-health researchers.
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Interpersonal Psychotherapy for Older Adults
Gregory A. Hinrichsen
In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.
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Melancholia and Depression
Åsa Jansson
Depression is defined in diagnostic literature as a mood disorder characterized by depressed mood, loss of interest or pleasure in activities, significant changes in weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and suicidal ideation and/or attempts. Research suggests a link between depressed mood and monoamine depletion, elevated cortisol, and inflammation, but existing laboratory evidence is inconclusive. Current treatments for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle changes; however, more severe forms of the disorder can require other medication, sometimes in combination with electroconvulsive therapy (ECT).
Disagreement persists over how to define and classify depression, in part due to its ambivalent relationship to melancholia, which has existed as a medical concept in different forms since antiquity. Melancholia was reconfigured in 19th-century medicine from traditional melancholy madness into a modern mood disorder. In the early 20th century, melancholia gradually fell out of use as a diagnostic term with the introduction of manic-depressive insanity and unipolar depression. Following the publication of DSM-III in 1980 and the introduction of SSRIs a few years later, major depressive disorder became ubiquitous. Consumption of antidepressants have continued to rise year after year, and the World Health Organization notes depression as the leading cause of disability worldwide.
At present, internationally recognized systems of classification favor a single category for depressive illness (alongside a circular mood disorder, bipolar I and II), but this view is challenged by clinicians and researchers who argue for the reinstatement of melancholia as a separate and distinct mood disorder with marked somatic and psychotic features.
Article
Memory Rehabilitation in Healthy Aging
Nicole D. Anderson
Healthy aging is accompanied by decrements in episodic memory and working memory. Significant efforts have therefore been made to augment episodic and working memory in healthy older adults. Two principal approaches toward memory rehabilitation adults are restorative approaches and compensatory approaches. Restorative approaches aim to repair the affected memory processes by repeated, adaptive practice (i.e., the trained task becomes more difficult as participants improve), and have focused on recollection training, associative memory training, object-location memory training, and working memory training. The majority of these restorative approaches have been proved to be efficacious, that is, participants improve on the trained task, and there is considerable evidence for maintenance of training effects weeks or months after the intervention is discontinued. Transfer of restorative training approaches has been more elusive and appears limited to other tasks relying on the same domains or processes. Compensatory approaches to memory strive to bypass the impairment by teaching people mnemonic and lifestyle strategies to bolster memory performance. Specific mnemonic strategy training approaches as well as multimodal compensatory approaches that combine strategy training with counseling about other factors that affect memory (e.g., memory self-efficacy, relaxation, exercise, and cognitive and social engagement) have demonstrated that older adults can learn new mnemonics and implement them to the benefit of memory performance, and can adjust their views and expectations about their memory to better cope with the changes that occur during healthy aging. Future work should focus on identifying the personal characteristics that predict who will benefit from training and on developing objective measures of the impact of memory rehabilitation on older adults’ everyday functioning.
Article
Neuroimaging
Chelsea Ekstrand
The growing field of neuroimaging has offered exciting insights into the inner workings of the human brain in health and disease. Structural neuroimaging techniques provide detailed information about the physical properties and anatomy of the brain and nervous system, including cerebrospinal fluid, blood vessels, and different types of tissue. The most commonly used structural neuroimaging techniques are computed tomography (CT) and structural magnetic resonance imaging (MRI). CT uses X-rays to create a two-dimensional representation of neural tissue, whereas MRI quantifies differences in tissue density by manipulating molecules using magnetic fields, magnetic field gradients, and radio waves. Functional neuroimaging techniques provide a measure of when and where activity is occurring in the brain by quantifying underlying physiological processes. Functional neuroimaging techniques fall into two broad categories: measures of direct brain activity, including electroencephalography (EEG) and magnetoencephalography (MEG), and measures of indirect brain activity, such as positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). Different functional neuroimaging techniques can be used to examine different physiological changes, including electrical activity, magnetic field changes, metabolic and neurotransmitter activity, and indirect measures of blood flow to offer insight into cognitive processing. Structural and functional neuroimaging have made a profound impact on understanding the brain both during normal functioning and in clinical pathology. Overall, neuroimaging is a powerful tool for both research and clinical practice and offers a noninvasive window into the central nervous system of humans in both health and disease.
Article
Obsessive-Compulsive Disorder
Jonathan S. Abramowitz
Obsessive-compulsive disorder (OCD) is one of the most destructive psychological disorders. Its symptoms often interfere with work or school, interpersonal relationships, and with activities of daily living (e.g., driving, using the bathroom). Moreover, the psychopathology of OCD is seemingly complex: sufferers battle ubiquitous unwanted thoughts, doubts, and images that, while senseless on the one hand, are perceived as signs of danger on the other hand. The thematic variation and elaborate relations between behavioral and cognitive signs and symptoms can be perplexing to even the most experienced of observers. Cognitive-behavioral models of OCD explain these phenomena and account for their heterogeneity. These models also have implications for how OCD is treated using exposure and response prevention, which research indicates are effective short- and long-term interventions.
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Personality Assessment in Clinical Psychology
Katy W. Martin-Fernandez and Yossef S. Ben-Porath
Attempts at informal personality assessment can be traced back to our distant ancestors. As the field of Clinical Psychology emerged and developed over time, efforts were made to create reliable and valid measures of personality and psychopathology that could be used in a variety of contexts. There are many assessment instruments available for clinicians to use, with most utilizing either a projective or self-report format. Individual assessment instruments have specific administration, scoring, and interpretive guidelines to aid clinicians in making accurate decisions based on a test taker’s answers. These measures are continuously adapted to reflect the current conceptualization of personality and psychopathology and the latest technology. Additionally, measures are adapted and validated to be used in a variety of settings, with a variety of populations. Personality assessment continues to be a dynamic process that can be utilized to accurately and informatively represent the test taker and aid in clinical decision making and planning.
Article
Physical Activity, Physical Fitness, and Depression
Felipe B. Schuch and Brendon Stubbs
Depression is a leading cause of global burden affecting people across all ages, genders, and socioeconomic groups. Antidepressants are the cornerstone of treatment, yet treatment response is often inadequate. While some psychological interventions such as cognitive behavioral therapy can also help alleviate depressive symptoms, alternative and complimentary treatment options are required. In particular, therapeutic interventions that also address the greatly increased levels of obesity and cardiovascular disease among people with depression may offer added value. With the rising burden of premature mortality due to cardiovascular disease in people with depression and promising evidence base for physical activity to improve depressive symptoms, it is important to review the role, benefits, and underlying neurobiological responses of exercise among people with depression.
There has been a growing body of evidence to suggest that higher levels of physical activity reduce a person’s risk of incident depression. It appears that lower levels of cardiorespiratory fitness increase an individual risk of depression, suggesting that physical activity and physical fitness have a key role in the prevention of depression. Moreover, exercise can improve depressive symptoms in those with subthreshold depressive symptoms and major depressive disorder. Despite the effectiveness of exercise, the optimal dose and frequency are yet to be fully elucidated. Nonetheless, exercise appears to be well accepted by people with depression, with relatively low levels of dropout from interventions, particularly when supervised by qualified professionals with expertise in exercise prescription. Various barriers to engaging in exercise exist and motivational strategies are essential to initiate and maintain exercise. A number of hypotheses have been postulated to determine the antidepressant effect of exercise; however, most are based on animal models or models elucidated from people without depression. Therefore, future representative research is required to elucidate the neurobiological antidepressant response from exercise in people with depression. Physical activity interventions targeting fitness should be a central part of the prevention and management of depression. In particular, physical activity interventions offer a viable option to prevent and address cardiometabolic abnormalities and cardiovascular disease, which account for a significant amount of premature deaths in this population and are not addressed by standard pharmacological and psychological therapies.
Article
Potentially Harmful Treatments
Scott O. Lilienfeld
Although psychotherapy is on balance effective for a broad array of psychological problems, a relatively small but steadily accumulating body of evidence suggests that at least some psychological interventions are harmful. Until recently, however, relatively little research attention has been paid to the identification of harmful psychological treatments. Although it has long been recognized that a nontrivial minority of people become worse following therapy, this finding does not necessarily mean that they have become worse because of therapy. Nevertheless, recent research has homed in on a small subset of interventions that may produce psychological harm, physical harm, or both. In addition, there is growing interest in pinpointing potential mechanisms of deterioration effects in psychotherapy, as well as in distinguishing harmful therapies from harmful therapists.
Article
Prevalence, Measurement, and Experience of Eating Disorders in Sport and Retirement
Trent A. Petrie
Although the specific prevalence rates may vary, eating disorders (ED) affect male and female athletes regardless of sport type and competitive level. Generally, rates of subclinical disorders are much higher than clinical ones, with the most frequent clinical classification being Eating Disorders Not Otherwise Specified. Further, EDs occur not only among active athletes, but are also found in samples of retired athletes as well. Existing research on the prevalence of EDs in athletes, however, has been limited due to its reliance on out-of-date diagnostic criteria, sometimes small samples, and a focus on point prevalence to the exclusion of examining how rates might change over time. Central to prevalence research and clinical assessments is the ability to accurately assess EDs in athletes. Although structured clinical interviews represent the most valid approach, they are time consuming and not often used in determining prevalence. Researchers have relied on self-report measures instead. Such measures include those developed initially in nonathletes, but used to study athletes (e.g., Questionnaire for Eating Disorder Diagnosis; Mintz, O’Halloran, Mulholland, & Schneider, 1997), and those specifically for athletes (e.g., Athletic Milieu Direct Questionnaire; Nagel, Black, Leverenz, & Coster, 2000). Most of these measures, though having adequate psychometric properties, are based on diagnostic criteria that are no longer in use, so additional research that employs prevalence measures that reflect DSM-5 criteria is needed with athletes. Most ED research in sport has used samples of active athletes; few studies have considered how the transition out of sport might affect athletes’ perceptions of their bodies, their relationship to food, and their approaches to exercise and being physically active. Retirement from sport generally is considered to be a developmental stressor and thus may exacerbate ED symptoms and body image concerns in some athletes. Yet, for other athletes, retirement may represent a positive transition in which they emerge from a sport culture, focused on weight and appearance, to reclaim themselves and their bodies. Initial qualitative findings appear to support each hypothesis in part, though longitudinal quantitative studies that track athletes from active competition through retirement are needed to understand the changes athletes experience in relation to their bodies, food, and exercise, and when such changes are most likely to occur.
Article
Progressive Neurological Conditions and Their Impact on Psychological Well-Being in Later Life
Nadeeka N. Dissanayaka
Progressive neurological disorders are incurable disorders with gradual deterioration and impacting patients for life. Two common progressive neurological disorders found in late life are Parkinson’s disease (PD) and motor neuron disease (MND). Psychological complications such as depression and anxiety are prevalent in people living with PD and MND, yet they are underdiagnosed and poorly treated.
PD is classified a Movement Disorder and predominantly characterized by motor symptoms such as tremor, bradykinesia, gait problems and postural instability; however, neuropsychiatric complications such as anxiety and depression are common and contribute poorly to quality of life, even more so than motor disability. The average prevalence of depression in PD suggest 35% and anxiety in PD reports 31%. Depression and anxiety often coexist. Symptoms of depression and anxiety overlap with symptoms of PD, making it difficult to recognize. In PD, daily fluctuations in anxiety and mood disturbances are observed with clear synchronized relationships to wearing off of PD medication in some individuals. Such unique characteristics must be addressed when treating PD depression and anxiety. There is an increase in the evidence base for psychotherapeutic approaches such as cognitive behavior therapy to treat depression and anxiety in PD.
Motor neuron disease (MND) is classified a neuromuscular disease and is characterized by progressive degeneration of upper and lower motor neurons is the primary characteristic of MND. The most common form of MND is Amyotrophic lateral sclerosis (ALS) and the terms ALS and MND are simultaneously used in the literature. Given the short life expectancy (average 4 years), rapid deterioration, paralysis, nonmotor dysfunctions, and resulting incapacity, psychological factors clearly play a major role in MND. Depression and suicide are common psychological concerns in persons with MND. While there is an ALS-specific instrument to assess depression, evaluation of anxiety is poorly studied; although emerging studies suggesting that anxiety is highly prevalent in MND. Unfortunately, there is no substantial evidence-base for the treatment of anxiety and depression in MND.
Caregivers play a major role in the management of progressive neurological diseases. Therefore, evaluating caregiver burden and caregiver psychological health are essential to improve quality of care provided to the patient, as well as to improve quality of life for carers. In progressive neurological diseases, caregiving is often provided by family members and spouses, with professional care at advanced disease. Psychological interventions for PD carers addressing unique characteristics of PD and care needs is required. Heterogeneous clinical features, rapid functional decline, and short trajectory of MND suggest a multidisciplinary framework of carer services including psychological interventions to mitigate MND. A Supportive Care Needs Framework has been recently proposed encompassing practical, informational, social, psychological, physical, emotional, and spiritual needs of both MND patients and carers.
Article
Prospective Memory and Cognitive Aging
Simon J. Haines, Jill Talley Shelton, Julie D. Henry, Gill Terrett, Thomas Vorwerk, and Peter G. Rendell
Tasks that involve remembering to carry out future intentions (such as remembering to attend an appointment), and the cognitive processes that enable the completion of such tasks (such as planning), are referred to as prospective memory (PM). PM is important for promoting quality of life across many domains. For instance, failures in remembering to meet social commitments are linked to social isolation, whereas failures in remembering to fulfill occupational goals are linked to poorer vocational outcomes. Declines in PM functioning are of particular concern for older adults because of the strong links between PM and functional capacity. The relationship between age and PM appears to be complex, dependent on many factors. While some aspects of PM appear to hold up relatively well in late adulthood, others appear to show consistent age-related decline. Variability in age differences appears to partially reflect the fact that there are diverse types of PM tasks, which impose demands on a range of cognitive processes that are differentially affected by aging. Specifically, the level and type of environmental support associated with different PM task types appears to be a meaningful determinant of age-related effects. Given the worldwide changing age demographics, the interest in age-related effects on PM will likely intensify, and a primary focus will be how to optimize and maintain PM capacity for this population. This is already reflected in the increasing research on interventions focused on enhancing PM capacity in late adulthood, and points to important future directions in this area of study.
Article
Psychoanalysis and Psychosomatics in Europe
Silvia Degni
Psychosomatics concerns those physical disorders not caused by an organic event but caused by psychological events. These disorders, called “psychosomatic,” may involve different organs and systems and it is possible a wide range of cases of possible psychosomatic disorders.
The term psychosomatics itself represents all the complexity and tension of this discipline. It contains a dualism that contrasts with the theory at the heart of psychosomatic medicine—the functional and synergistic unitary nature of soma and psyche.
The psychosomatic problem represents the original nucleus at the inception of the psychoanalytic movement that concerns itself precisely with the physical disorders devoid of an anatomopathological substratum. With the development of the libido theory and the resulting hypotheses on the development of neurosis, Freud proposed a model that integrates the somatic, psychic, and social component, and it represents in a convincing way physical diseases that occur as a result of psychological events. Freud created two distinct approaches in the explanation of psychosomatic disorders: the first makes use of a system of conversion of the psychic into the somatic, and the second raises problems of biological nature, in the sense that a psychological factor (anxiety) would directly activate the sympathetic system and therefore the organic functions it controls.
The conflict theory was the first major paradigm of psychosomatic medicine, and most efforts by the first generation of psychosomatists aimed to test this hypothesis and identify psychological conflicts that were typical of patients suffering from diseases considered psychosomatic in nature. Some scholars—such as Federn, Goddeck, Deutsch, Dumbar and Alexander, Schultz-Hencke, von Weizsäcker, Schilder, Schur, de Mitsherlich, de Boor—starting from the Freudian psychoanalysis, emphasize a particular psychoanalytic mechanism interpreted as a cause of psychosomatic disorders. The panorama of contemporary psychosomatics is certainly much more varied than the classical one, and new proposals and conceptions have emerged alongside the psychoanalytic model. The main contemporary models aim to integrate the knowledge of medicine and psychoanalysis into a coherent and unitary theoretical whole. The goal is therefore the unification of the ontological and scientific dualism that sees the body of medicine as opposed to the psyche of psychoanalysis. The contemporary theories all converge in the analysis of the original mechanisms of formation and development of subjectivity that is named according to the search to address ego, self, or identity.
Article
Psychodynamic Psychotherapies
Mary V. Minges and Jacques P. Barber
Psychodynamic psychotherapies (PDP) is an umbrella term for a variety of therapeutic modalities that have evolved out of the psychoanalytic/psychodynamic tradition, each theorizing a trajectory of human development that includes an etiology of and treatment for psychopathology. PDPs have in common the belief that people have an unconscious mind that influences thoughts and behaviors outside of the individual’s awareness. These processes operate from birth till death and are responsible for adaptive and maladaptive functioning at the level of interpersonal relationships and daily living.
The psychodynamic therapist creates a case formulation for the individual seeking treatment, which incorporates a formal diagnosis with an understanding of the underlying dynamic factors contributing to the individual’s suffering. From this case formulation a treatment plan is created specific to the individual. During treatment, the therapist develops a strong working alliance while utilizing psychodynamic-specific techniques targeted at bringing insight into these unconscious thoughts and behaviors. Greater self-understanding enables greater choice ability and flexibility in functioning.
In contrast to prevalent views, empirical research has found support for the efficacy of PDP in the treatment of mental disorders, including but not limited to: depression, anxiety disorders, somatic disorders, and personality disorders. In general, PDP was found more effective than control conditions and not different from active treatments. PDP effects have been shown to remain stable post treatment.
Article
Psychological Assessment of Older Persons
Jarred Gallegos, Julie Lutz, Emma Katz, and Barry Edelstein
The assessment of older adults is quite challenging in light of the many age-related physiological and metabolic changes, increased number of chronic diseases with potential psychiatric manifestations, the associated medications and their side effects, and the age-related changes in the presentation of common mental health problems and disorders. A biopsychosocial approach to assessment is particularly important for older adults due to the substantial interplay of biological, psychological, and social factors that collectively produce the clinical presentation faced by clinicians. An appreciation of age-related and non-normative changes in cognitive skills and sensory processes is particularly important both for planning the assessment process and the interpretation of findings. The assessment of older adults is unfortunately plagued by a paucity of age-appropriate assessment instruments, as most instruments have been developed with young adults. This paucity of age-appropriate assessment instruments is an impediment to reliable and valid assessment. Notwithstanding that caveat, comprehensive and valid assessment of older adults can be accomplished through an understanding of the interaction of age-related factors that influence the experience and presentation of psychiatric disorders, and an appreciation of the strengths and weaknesses of the assessment instruments that are used to achieve valid and reliable assessments.
Article
Psychological Treatments for Social Anxiety Disorder
Simona C. Kaplan, Michaela B. Swee, and Richard G. Heimberg
Social anxiety disorder (SAD) is characterized by fear of being negatively evaluated by others in social situations. Multiple psychological interventions have been developed to treat SAD. The most widely studied of these interventions stem from cognitive-behavioral, acceptance-based, interpersonal, and psychodynamic conceptualizations of SAD. In cognitive-behavioral therapy (CBT), patients learn to identify and question maladaptive thoughts and engage in exposures to feared situations to test the accuracy of biased beliefs. Mindfulness and acceptance-based approaches to treating SAD focus on mindful awareness and acceptance of distressing internal experiences (i.e., psychological and physiological symptoms) with the ultimate goal of behavior change and living a meaningful life based on identified values. Interpersonal psychotherapy links SAD to interpersonal problem areas and aims to reduce symptoms by targeting interpersonal difficulties. Psychodynamic psychotherapy for SAD focuses on identifying unresolved conflicts that lead to SAD symptoms, fostering insight and expressiveness, and forming a secure helping alliance.
Generally, CBT is the most well-studied of the psychological treatments for SAD, and research demonstrates greater reductions in social anxiety than pill placebo and waitlist controls. Results from randomized controlled trials (RCTs) suggest that mindfulness—and acceptance-based therapies may be as efficacious as CBT, although the body of research remains small; four of five RCTs comparing these approaches to CBT found no differences. RCTs comparing CBT to IPT suggest that CBT is the more efficacious treatment. Two RCTs comparing CBT to psychodynamic psychotherapy suggest that psychodynamic psychotherapy may have efficacy similar to CBT, but that it takes longer to achieve similar outcomes. RCTs examining CBT and pharmacotherapy suggest that the medications phenelzine and clonazepam are as efficacious as CBT for treating SAD and are faster acting, but that patients receiving these medications may be more likely to relapse after treatment is discontinued than patients who received CBT. Research generally does not indicate added benefit of combining psychotherapy with pharmacotherapy above each monotherapy alone, although this body of research is quite variable. Effectiveness studies indicate that CBT is equally effective in community clinics and controlled research trials, but studies of this nature are lacking for other psychological approaches.
Article
Resilience in Later Life
Nancy A. Pachana, Nicola W. Burton, Deirdre McLaughlin, and Colin A. Depp
Research on healthy aging has begun to address mental health issues in later life. Despite the debates about exactly what constitutes healthy aging and which are the most useful or valid determinants of this construct to study, there is substantial evidence for several determinants of successful aging, including physical activity, cognitive stimulation, and social networks. All three of these determinants support mental health, including cognition, in later life. Resilience is another construct that plays an important role in healthy aging, but it has not received as much research attention at the end of life as in earlier periods. Factors that reduce the risk of mental distress or promote resilience with respect to mental health in the face of challenges in later life remain fruitful areas for further investigations.
