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.
Jarred Gallegos, Julie Lutz, Emma Katz, and Barry Edelstein
Faye F. Didymus
The cognitive–behavioral model of psychotherapy holds cognition at the core of psychological problems and disorders. The theoretical foundations of this model imply that dysfunctional thinking is common to all psychiatric disorders, psychological problems, and medical problems with a psychological component, and that changing an individual’s cognition results in causal changes in emotions and behaviors. In addition, when working with the cognitive–behavioral model, practitioners acknowledge that ongoing cognitive formulation is the basis of effective practice; that working with an individual’s beliefs about themselves, the world, and others results in sustained change; and that neurobiological changes occur following cognitive–behavioral therapy (CBT). The cognitive–behavioral model has been successfully applied in many domains (e.g., clinical, occupational, and sport psychology) where interventions are framed around the beliefs that characterize a presenting issue. Cognitive restructuring is one technique for implementing CBT that has been applied in sport and performance psychology. This technique is particularly relevant to performance domains because of the focus on cognitive formulation; the underpinning associations between cognition, emotion, and behavior; and the links between positively valenced emotions and superlative performance. Findings of sport psychology research extend the application of CBT beyond clinical populations and highlight the usefulness of cognitive–behavioral approaches for optimizing experiences of and performance in sport. Some would argue that the first scientifically testable paradigm that was built on the cognitive–behavioral model of psychotherapy, and came chronologically slightly before CBT, is rational emotive behavior theory (REBT). Because both CBT and REBT share cognitive–behavioral roots, they have many similarities in their underpinning assumptions and in the ways that they are applied. REBT, however, focuses on rational and irrational beliefs and the links between an individual’s beliefs and his or her emotions and performance. REBT has a more philosophical focus with motivational theoretical roots when compared to other CBT approaches. Distinguishing features of REBT also lie in the techniques used and, hence, the way in which the underlying principles of the cognitive–behavioral model are applied. Disputing is the applied foundation of REBT and is a method of questioning an individual’s beliefs that generate emotional responses. This technique aims to help an individual recognize and adjust flaws in his or her thinking to work toward a more functional philosophy. Research that has used REBT in sport and performance contexts is sparse but that which does exist highlights the approach as a promising one for optimizing athletes’ beliefs and their emotional, behavioral, and physiological responses.
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.