Positive Neuropsychology: Evidence-Based Perspectives on Promoting Cognitive Health.
Edited by John J. Randolph
New York, NY: Springer, 2013, 178 pp., ISBN 978-1-4614-6605-5, $59.95
Why should you read this book? Isn't that why people read book reviews, to see if it is worthy of their time? Positive Neuropsychology is a book that balances well the research findings from the field of neuropsychology with suggestions about how to translate such findings into strategies to improve clinical care. The problem is that the authors of this edited work all make the same disappointing point: Little is known about the effects of interventions based on Positive Neuropsychology. Historically the field of neuropsychology has focused on documenting pathology and the limitations of neurologically impaired individuals. The editors-authors do an excellent job of pointing to the promise of "positive psychology" and how it relates to the subfield of neuropsychology, yet most chapters apologetically conclude that positive neuropsychology is not yet evidencebased medicine.
The book should be required reading for neuropsychologists as it will likely spur them to consider more thoughtfully about how they may integrate into health care teams. It also highlights for neuropsychologists foci for future research. This book also has value for anyone working in collaborative care settings who seek to be inclusive of providers who may not usually be considered in the current team. Several chapters suggest unique patient cohorts and clinical conditions where a neuropsychologist could substantially contribute to care plans. Using positive psychology as the impetus for neuropsychology to increase its clinical relevance, most chapters offer ideas of how neuropsychologists can be part of routine clinical care, especially with the aging of the population and burgeoning field of cognitive neuroscience.
As a collaborative care clinician and leader I found myself pausing and reflecting on how care would be improved with the addition of a neuropsychologist to our team. For example, there is a chapter on coping with neuropsychological disorders in which the authors propose several intuitively appealing strategies to be used by therapists: Although the authors suggest appropriate caution given the lack of direct evidence showing the outcomes of such strategies, the reader is left optimistic and feeling creative on how such ideas and strategies can be applied. Many chapters provide examples of cognitive-enhancing interventions with evidence to support cautious optimism as to the growing arsenal of tools available to integrated health care teams, especially when there is a neuropsychologist as a team member.
One chapter in particular provides evidence and a rationale that cognitive impairment itself may limit a patient's use of active coping strategies so often seen as essential for well-being. The authors elegantly argue that neurological impairment may lead to a greater reliance on avoidance and emotion-focused strategies that are often associated with poorer outcomes, at least on the longer term, thus, to see that cognitive rehabilitation may be not only more complex but also more applicable to our work in collaborative care than before.
Another issue highlighted in a well-written chapter is that patients reporting short-term sleep restriction are similar to those reporting longer term sleep deprivation in terms of cognitive impairment, yet those with short-term deprivation tend to more severely underestimate the degree of their cognitive impairment. The reader is left more aware that perhaps patients seen in clinic may underreport impairment due directly to inadequate sleep.
There is also a very well-referenced chapter on lifestyle behaviors' impact on cognition, yet there were minimal suggestions of how neuropsychology can be used clinically in this regard. Again, research in neuropsychology has clearly helped identify deficits but has yet to produce data showing the benefits of "positive psychological" approaches or outcomes associated with preventive measures (i.e., active lifestyle, good nutrition).
The book is a good primer for behavioral health providers on neuropsychology and how they may play a role in collaborative care, but it falls short on presenting clear evidence for the impact of "positive neuropsychology" interventions. Another value of this compilation is its inclusion of such issues as the ecological validity of the assessment of executive functioning, that is there is little evidence for the validity of such tests to predict real-world functioning.
There is also information on the neuroscience of leadership development and a chapter on improving cognitive abilities in the older population, serving as a good example of gerontology and technology and other disciplines collaborating: technology and the cognitively impaired.
The books helps us to understand better the abilities and roles-activities we in collaborative care can expect from neuropsychologists and how best to collaborate with them. The book is more of a call to action that research needs to be done than it is a review of recent evidence on "positive neuropsychology."
Reviewed by William J. Sieber, PhD
University of California, San Diego