Biopsychosocial model

The biopsychosocial model (BSP) is a method of looking at all biological, psychological, and social influences on human health and the body’s ability to respond to and recover from various diseases. The model examines a continuum of influences that begins with the biosphere and encompasses society, culture, community, family, and the individual and analyzes their impacts on all the systems that make up the human body. The biopsychosocial model has become part of the medical mainstream; clinicians are taught to examine biological, psychological, and social factors when diagnosing and treating all kinds of health problems and use BSP to treat a wide range of conditions that include but are not limited to cancer, HIV/AIDS, depression, personality disorders, pediatric illnesses and traumas, post-traumatic stress disorder (PTSD), chronic fatigue syndrome, dementia, chronic pelvic pain, and lower back pain. The model has also been used effectively by emergency room physicians and acupuncturists.

Background

In the twentieth century, the foundation for the biopsychosocial model evolved from conflicts between biological reductionism, which reduced biological explanations to their simplest forms, and traditional psychoanalytic theories, based on the teachings of Sigmund Freud, the Austrian neurologist. The first American to attempt a more comprehensive understanding of the ways in which the body and the environment influenced one another was Adolf Meyer of Johns Hopkins University. Roy Grinker of the University of Chicago built on Meyer’s work and is credited with coining the term "biopsychosocial."

The two individuals most closely associated with the biopsychosocial model are the psychiatrists George Engel and John Romano of the University of Rochester in New York. After suffering the loss of his twin brother, Engel became interested in the high correlation between the loss of a loved one and the onset of various diseases. In 1977, that discovery led Engel to develop the biopsychosocial model that is still used in the twenty-first century. In addition to contributing to the understanding of the biopsychosocial model, Romano, who had founded the university’s Department of Psychiatry in 1946, was a major influence on the overall development of psychiatry in the United States.

Implementations of the biopsychosocial model have focused on patient-centered health care, and it has been endorsed by various professional organizations as well as the World Health Organization.

Overview

Patient interviews have become one of the most important tools used by physicians as a means of understanding biological, psychological, and social impacts on a patient’s health. A group of physicians at the Centre for Studies in Family Medicine at the University of Western Ontario built on the biopsychosocial model to develop a patient-centered model that remained in use throughout the world. In a 2000 study conducted at the Centre by Moira Stewart and colleagues, the researchers discovered that Engel’s emphasis on patient interviews held up over time because it continued to be integral to successful outcomes in medical treatment. They found that patient-centered communication was effective in speeding up recovery time, improving mental health, and reducing the need for follow-up medical treatment and referrals to specialists.

In the early twenty-first century, though the extent of its implementation has varied, the biopsychosocial model has been used in treating chronic illnesses such as cancer and HIV/AIDS. In a 2010 study, Scott M. Debb and David L. Blitz noted that the biopsychosocial model is significantly more effective than traditional methods in treating such diseases because it takes biological predispositions, psychological stressors, socioeconomic factors, physiological characteristics, and patient-generated appraisals of all these factors into account. In their examination of chronically ill patients in Atlanta, Chicago, and San Juan, Puerto Rico, Debb and Blitz found that Black people recovered more slowly from cancer and HIV/AIDS than White people and received poorer health diagnoses. This was assumed to be partly due to greater access to the health-care system by White people. However, Black people expressed more optimism about their health, a fact that researchers posited was linked to higher levels of ethnic identity.

Within the field of physiotherapy, the United Kingdom's National Institute for Health and Care Excellence has established guidelines for using the biopsychosocial model in conjunction with traditional methods of therapy. The new paradigm calls for increased attention to the overall environment of patients. However, many physiotherapists have lacked sufficient training in implementing the model.

The biopsychosocial model also has significant potential for dealing with issues presented by diverse ethnicities that make up the client base of community counselors throughout the world. In 2009, British clinical psychologist Waseem Alladin offered a nine-dimensional model for community counseling based on the biopsychosocial model that recognizes respect for human dignity as articulated in the United Nations Declaration of Human Rights. For example, understanding social and religious perceptions associated with particular ethnicities is integral to treating individual patients successfully.

Most medical schools teach both the biomedical and biopsychosocial models. When training physicians, the biopsychosocial model emphasizes the need to acknowledge the role that relationships play in an individual’s health; take a patient’s own impressions of their health problems into account; mandate detailed life histories from patients; attempt to identify the most relevant biological, psychological, and social factors in particular cases; and offer treatment based on a multidimensional perspective. For instance, understanding how a person perceives health problems and identifying levels of support available to them may determine how well they recover from an illness. Some psychiatrists and psychologists have criticized the biopsychosocial model for various reasons, one of which is that one of the biological, psychological, or social aspects of diagnosis may be underrepresented depending on patients' subjective experiences or doctors' own biases. Some have argued that the blurring of physicians' boundaries of expertise required by the method could be detrimental to treatment or could demand overwhelming extra training. Nonetheless, it continued to be used, to some extent, across the medical spectrum.

After the COVID-19 pandemic was declared in early 2020, some proponents of the biopsychosocial model argued that though the model was not regularly or widely used across patient care, it was especially beneficially suitable to rehabilitation efforts for those infected with the disease. Experts who shared this perspective argued that once people with COVID-19 were recovering following appropriate biomedical treatment, they would need biopsychosocial model support to rehabilitate fully due to the pandemic's heavy psychological and social impacts as well as physical. As surveys had shown that virus control measures such as lockdowns and physical distancing measures had affected many people's psychological health as they attempted to adjust to new ways of living, working, and socializing, biopsychosocial model supporters believed that this model could be crucial to managing negative effects such as increased stress and anxiety. Others pointed to the need to address the disparate sociological and psychological impacts of the pandemic on people from communities of color and lower socioeconomic statuses.

Bibliography

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Silk, Kenneth R. Biology of Personality Disorders. APA, 1998.

Stewart, Moira, et al. “The Impact of Patient-Centered Care on Outcomes.” Journal of Family Practice, vol. 49, no. 9, 2000.

Wainwright, Thomas W., and Matthew Low. "Why the Biopsychosocial Model Needs to Be the Underpinning Philosophy in Rehabilitation Pathways for Patients Recovering from COVID-19." Integrated Healthcare Journal, vol. 2, no. 1, Sept. 2020, doi:10.1136/ihj-2020-000043. Accessed 20 Dec. 2021.

Williamson, Simon. "The Biopsychosocial Model: Not Dead, but in Need of Revival." BJPsych Bulletin, vol. 46, no. 4, 2022, pp. 232–34, doi.org/10.1192/bjb.2022.29. Accessed 17 July 2024.