One of the most important questions many people have regarding mental-health is what influences it. Why does one person have good mental health while another person’s is poor? What triggers an episode of poor mental health and what are the root causes? The biopsychosocial model helps us understand all of this and more.
Background: The biomedical model
Before we dive into an explanation of the biopsychosocial model, you need to know a bit about something called the biomedical model of mental health. We won’t go into great detail here, but let’s take a quick look at the essentials.
The biomedical model
In the past, psychiatrists, who are trained as medical doctors, saw people who have mental health conditions as being ill in the same way that someone can be physically ill. They saw conditions as a result of disturbances in the brain to be treated with drugs, surgery or other physical means. They reasoned that if something was physically wrong with your brain, it needed a physical cure.
The biomedical approach was challenged in 1977 by George Engel because it didn’t take into account the many other factors that can influence mental health, and health in general. Factors such as upbringing, beliefs, coping skills, trauma and relationships did not enter the equation. It just didn’t seem right to Engel. So he proposed a new way of thinking about mental health that encapsulated social and psychological determinants to health as well as just simply a person’s biology. This was the biopsychosocial model.
The biopsychosocial model
Engel’s biospychosocial model went on to become very influention. Most medical professionals now consider mental health to be affected by three main areas that are encapsulated in the biopsychosocial model:
- Biological (e.g. genetics, brain chemistry and brain damage)
- Social (e.g. life traumas and stresses, early life experiences and family relationships)
- Psychological (e.g. how we interpret events as signifying something negative about ourselves)
These factors interact with each other in complex ways to produce the final result that is a person’s overall mental health. The graphic above is a simplified summary of how the factors work together. In reality, it is a complex web with many connections across the different areas. As we continue on in our lives, new events enter the model and impact on existing factors. It is in flux, not fixed.
Mental health conditions the complex result of several factors
According to the biopsychosocial model, mental health is the result of many forces occurring at different which have a cumulative effect on the individual. These forces can be positive or negative. If the negatives outway the positives then a person could develop a mental illness.
It’s unlikely to be one specific thing that causes mental ill-health, but rather a mixture of negative circumstances that have built up. There might be one thing that pushes a person too far, but it’s unlikely to be this alone that caused a disorder.
Negative factors add up
Imagine you’re having a bad day at work. You had a stressful morning at home, you’ve dealt with more problems than normal from clients and you have just got out of an exhausting meeting you had half forgotten about. You sit back down at your desk and promptly knock your coffee over.
This might bring you to tears, send you into a rage or make you feel that you hate your job. A colleague watching this scene might be justified in thinking that you are so emotional because you knocked your drink over. But it wasn’t knocking your drink over that was the real issue. It was all the other things that happened before that created a situation where, when you did knock your drink over, it was too much.
This is just a simple example. We’ve probably all been there though. Those days when nothing seems to go right come along now and then and it’s infuriating. But the point is that we can all recognise how events can add up to the point where something small can tip us over the edge.
In a similar way, biological, psychological and social factors can add up across a person’s life to lead to times of mental ill-health.
For example it is now well established that schizophrenia has a genetic component. However the condition can be triggered by certain traumatic or stressful life events, such as a pattern of poor and chaotic family relationships in childhood. It is more than one factor that caused the condition.
Depression may be caused by a mixture of life events (such as emotional abuse in childhood or traumas in adulthood such as divorce) and a person’s habitual ways of judging themselves and their experiences. Again, it is not one factor alone that caused the issue.
The biopsychosocial model applies to us all
The biopsychosocial model is great for helping us understand how mental health conditions might develop. However, we shouldn’t only think of it as being useful for people who are not mentally well. It applies to us all. We can its three areas as postive forces to improve our mental health.
Your mental health, mine, your friend’s, your family’s and your colleagues’ is created by an interplay of biological, psychological and social factors. This is important to understand. It means that ‘healthy’ people are not separate from ‘unhealthy’ people.
The mind of someone who has a mental health condition is not entirely different to yours. There’s just a different combination of factors that have come together to create a state where the person is mentally unwell.
As with the mental health continuum, we all have the potential to be mentally well or unwell. We cannot see people with mental health conditions as different in some fundamental way. This is one excellent way to confront the stigma surrounding mental health issues.
The biopsychosocial model in the workplace
The biopsychosocial model has another advantage. As well as being able to explain mental health in terms beyond the purely biomedical, it shows us there is potential to positively influence a person’s mental health in the workplace.
As a manager, you should use the biopsychosocial model to help you find ways you can positively influence your team.
For example, you could influence biological factors by creating lunchtime exercise habits. Or you could promote healthy eating initiatives. In this way, you can positively impact on another’s mental wellbeing.
You should also examine what can be done to improve the social and psychological aspects of your work. Some things will be beyond your control, but other small changes can be made. What training can be given to build resilience? Can you use praise to raise self-esteem? What can you do to foster strong relationships between colleagues?
The positives add up too
Remember, just like negative factors, positive factors add up. A day where you’ve had some positives such as enjoying going for a walk with colleagues over lunch, feeling good because you ate something healthy might mean that when you do knock that cup of coffee over, you are able to see it for what it really is. An annoying accident, but nothing more.
Again, if we apply this logic to our whole lives, then we see that to be more mentally healthy and resilient, we need to ensure we focus on increasing the positive factors in our lives.
What if you’re too busy to do all this?
There’s no getting away from the fact that it can be challenging and time-consuming to work through the biopsychosocial model and identify where changes can be made. But it will be time well spent. The long-term benefits far outweigh the short-term efforts. Check out this article to see why.
Conclusions from the biopsychosocial model
- The causes of mental health disorders are complex and varied. Biological factors have a role but they are not the only influence. Social and psychological factors are crucial too.
- We are all unique. Some people may be more disposed to develop a mental health issue than others, but we can all improve our mental health by seeing the biopsychosocial model as three positive forces for mental health.
- Focussing on the psychological aspects of the biopsychosocial model can empower people to take control of their thoughts and improve their mental health.
- Work is a social activity and it can be a positive or negative influence on a person’s mental health.
Learn more
If you’d like to learn more about mental health, you can get started with our bite-size Mental Health Awareness online course.
Delphis also offers on-site mental health workshops delivered and developed by highly educated business managers, academics and teachers. We guide companies along the path to creating mentally healthy, productive and rewarding working environments for their staff. The financial argument is compelling and caring for your employees is the right thing to do.
One major multi-national client says this about our workshops:
“Very relevant and informative with an engaging and inclusive style. Worth spending a whole day on. Loved the takeaway workbook, pretty much perfect, we need to roll out to whole company.”
Get in touch to discuss how we can provide customised mental health training for your organisation that fits your needs.
The Biopsychosocial model was first conceptualised by George Engel in 1977, suggesting that to understand a person's medical condition it is not simply the biological factors to consider, but also the psychological and social factors [1].
- Bio (physiological pathology)
- Psycho (thoughts emotions and behaviours such as psychological distress, fear/avoidance beliefs, current coping methods and attribution)
- Social (socio-economical, socio-environmental, and cultural factors suchs as work issues, family circumstances and benefits/economics)
This model is commonly used in chronic pain, with the view that the pain is a psychophysiological behaviour pattern that cannot be categorised into biological, psychological, or social factors alone. There are suggestions that physiotherapy should integrate psychological treatment to address all components comprising the experience of chronic pain.
The diagram below shows an example of this model.
Diagram of the Biopsychosocial model. [2]
Physiotherapists must know how biopsychosocial factors interact in patients with chronic pain to explain the perpetuation of this condition and use it as a basis for planning the intervention program. The evidence has suggested a clinical biopsychosocial assessment for the physiotherapeutic management of patients with chronic pain in order to understand and explain the predominant mechanism of pain and psychosocial factors that may or may not be modified for the patient to improve their condition.[3]
This clinical evaluation is carried out during the data collection at the patient's entrance. A practical guide is proposed to take biopsychosocial data using the PSCEBSM (Pain–Somatic and medical factors–Cognitive factors–Emotional factors–Behavioral factors–Social factors–Motivation) model.[3]
P- Type of pain[edit | edit source]
Clinical identification and differentiation of the dominant pain mechanism:
Using the following tools:
- Classification criteria for differentiating predominant pain proposed by Nijs et al.
- Widespread pain index/Body Diagram : ≥ 7 score suggesting generalized pain, therefore, non-neuropathic pain of central sensitization
- Central Sensitization Inventory (CSI) : 40 score suggesting non-neuropathic pain of central sensitization
S- Somatic and medical factors[edit | edit source]
For physical therapist the physical examination is a very important part of his intervention - essential to:
- Be aware that some findings of clinical examinations such as mobility, strength, neurodynamics, coordination, etc. could be altered because there is greater sensitivity to mechanical stimulation and modified movement patterns in patients with non-neuropathic pain of central sensitization.
- Main goal in this stage is to evaluate the quality of movement, if the pattern of movement causes the pain to persist and if there is kinesiofobia
- Ask about current or previous health conditions, the disuse of body parts, changes in movement patterns, exercise capacity, strength and muscle tone during movement, the action of the drug in the CNS It is useful for data collection
C- Cognition / Perceptions[edit | edit source]
Both influence biologically on hypersensitivity in the brain by activating neuromatrix pain and also influence the emotional and behavioral factors. :
- Ask about perceptions: expectations of the intervention, expectations of the prognosis of their pain, understanding of their situation and the strategies they have available to face their situation, what the pain represents emotionally
- Brief Illness Perception Questionnaire (Brief IPQ)
- Pain Catastrophizing Scale (PCS)
E- Emotional factors[edit | edit source]
Ask if there is fear of specific movements, avoidance behaviors, psychological traumatic appearance of pain, psychological problems at work, family, finances, society, etc. It is also suggested to use the following scales:
- State-Trait Anxiety Inventory (STAI)
- Tampa-Scale of Kinesiophobia (TSK) and Fear Avoidence Belief Questionare
- Injustice Experience Questionnaire (IEQ)
- Patient Health Questionnaire-2 (PHQ-2), or Patient Health Questionnaire-9 (PHQ-9), or Center of Epidemiologic Studies Depression Scale (CES-D)
B- Behavioral factors[edit | edit source]
Can lead to avoid activity or movement due to fear, which in turn is presented as physical inactivity or disuse and, finally, disability. Therefore it is important to evaluate the behavior and adaptations that the patient has made due to the pain.
S- Social factors[edit | edit source]
It refers to the social and environmental factors in which the patient develops, which could be useful and supportive or harmful and stressful for the improvement of the patient's health condition. The data collection can be divided as follows:
- Housing or living situation
- Social environment
- Work
- Relationship with the partner
- Previous interventions
M- Motivation[edit | edit source]
Evaluating the motivation in the patient and his willingness to change is useful to modify his thoughts regarding the relationship pain-kinesiophobia, pain-disability, and acceptance-catastrophism. For this purpose, the following scale can be used
- Psychology Inflexibility in Pain Scale (PIPS)
Clinical Contribution[edit | edit source]
- The use of the biopsychosocial model as a clinical practice guide in physiotherapy allows the physiotherapist to be aware of all the factors that influence the patient's state of health. In addition, it allows laying the foundations of pain neuroscience education
- The psychosocial factors the patient deals with can mean the intervention of other health professionals besides the physiotherapist ie important to take into account the professional limits, as well as the ethical principles that ensure the comprehensive management of the patient.
The following videos emphasize the importance of using the biopsychosocial model to improve patient functionality and the problem that currently exists for physiotherapists in the use of this approach.
Criticisms of the model[edit | edit source]
- There is still minimal use of the biopsychosocial model in education, clinical care, and research. The biopsychosocial model cannot be consistently defined for an individual (data is not obtained systematically, making it untestable and non-scientific).
- Patient centered interview methods have been suggested to be used in practice, such that clinicians can identify a scientific BPS model specific to each patient with an agreed-upon, evidence-based patient-centered interviewing method can be more useful as these are reproducible and can elicit relevant patient information.[4]
References
- ↑ Gatchel, Robert J., Peng, Yuan Bo, Peters, Madelon, L.; Fuchs, Perry, N.; Turk, Dennis C. 2007 The biopsychosocial approach to chronic pain: Scientific advances and future directionsfckLR Psychological Bulletin, Vol 133(4), 581-624
- ↑ //savvywillingandable.wordpress.com/2013/09/25/the-biopsychosocial-model-explained/
- ↑ 3.0 3.1 Wijma, A. J., van Wilgen, C. P., Meeus, M., & Nijs, J. 2016 Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiotherapy theory and practice, 32(5), 368-384.
- ↑ Smith, Fortin, Dwamena, & Frankel. 2013. An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Education and Counseling, 91(3), 265-270.