UNIT 2 - TOPIC 3

Biopsychosocial approach

it promotes a holistic, three-pronged, collaborative approach to understanding, assessing and treating psychological disorders. It offered a holistic alternative to the traditional biomedical model, which separated mind and body.

Who and when was the biopsychosocial approach developed?

George Engel in 1977

What did Engel believe?

that to truly understand and treat a person’s mental and/or physical illness, it was important to consider their condition in terms of biological, psychological and social influences.

Biomedical model

focused only on physiological aspects (biological and physical factors) and often ignored emotional distress.

How do biological factors help with the biopsychosocial approach

helps us understand how physical health and brain function can impact a person’s mental health and behaviour.

• Focuses on how the body affects behaviour.

• Looks at the brain, nervous system,
  chemicals in the brain, and inherited traits
  (genetics).

• Explains behaviour using physical and
  biological processes.

Biological factors included in biopsychosocial approach

body and physical health - physiology, anatomy, neurology, genetics, gender, age, and ethnicity.

Types of assessment for biological factors

neuroimaging (EEG, PET, MRI, fMRI) and neuropsychological testing (IQ tests, questionairres)

Types of treatment for biological factors

onset of illness: medication and medical procedures

management phase: regular symptom monitoring and adjustment of medication/procedures

long-term strategies: ongoing meds, less frequent monitoring

How do psychological factors help with the biopsychosocial approach

helps us understand how a person’s mental
processes and emotional traits influence their behaviour and wellbeing.

Psychological factors included in biopsychosocial approach

mind and emotions - personal perceptions (their individual opinions based on past experiences), personality traits, cognition (how they think, learn etc.), attention (what they focus/ignore), motivation (what drives them?) and behaviours (are they aware of their actions and how it affects others?).

Types of treatment for psychological factors

onset of illness: calm environment, emotional support

management phase: wellness recovery planning, promote self-care and independence (resilience)

long-term strategies: ongoing counselling, maintaining relationships

How do social factors help with the biopsychosocial approach

highlights how a person’s social surroundings and support systems affect their health and recovery.

• These factors can help build resilience or
  contribute to poor health.

• Strong social support networks are just as
  important as medical care for recovery.

• A caring, professional relationship
  between the patient and clinician is
  essential for better outcomes.

Social factors included in biopsychosocial approach

people, environment, and social conditions - school or work pressures, level of education, access to medical/support services, socioeconomic status, cultural background and values

Types of treatment for social factors

onset of illness: hospitalisation to receive treatment, home support, address cultural influences

management phase: access to rehab (e.g. therapy, counselling), monitor cultural beliefs (making sure treatment meets culture)

long-term strategies: continued support, gradual reduction of rehab so individual adjusts

Difference between biopsychosocial approach and biomedical approach

biomedical model focuses only on physical or biological factors only. It views illness as a result of physical pathology (study of diseases). Biopsychosocial approach focuses on biological, psychological and social factors. It views illness as a result of a combination of mind, body and social factors. In summary, The biomedical model takes a narrow view of health by looking only at the body - It simplifies health to physical causes. The biopsychosocial model is holistic - It integrates the mind, body, and social context to not only treat health conditions but to understand them on a deeper level.

Difference between biomedical and biopsychosocial approach using an example

Chronic pain:

Biomedical model: Seeks physical damage or inflammation as the cause and prescribes medication.

Biopsychosocial model: Considers how stress, beliefs about pain, job dissatisfaction, or lack of support might contribute — and treats with a
combination of physical therapy, counselling, and medication.

What did Engel emphasise on clinician behaviour?

He emphasised the importance of the clinician’s empathy and compassion in the recovery process. A clinician perceived as uncaring could negatively impact treatment and recovery.

Risk factors

conditions or factors that increase the likelihood of a person developing a disorder/condition or experiencing a relapse (getting worse after getting better) They often interact, and their impact depends on their number, type, and persistence.

Types of risk factors

biological, psychological, sociocultural, environmental

Protective factors

They help prevent the onset or relapse of an illness by supporting wellbeing and reducing stress e.g. good coping strategies. It builds resilience and helps people cope with adversity (challenges).

Multidimensional model

It recognises that multiple, ongoing risk factors are more harmful than a single one. It is supported by practitioners and the World Health Organization (WHO).

Difference between risk and protective factors

Risk factors increase the chance of developing a psychological disorder while protective factors decrease this chance. Risk factors make a person more vulnerable to mental health issues while protective factors build resilience and help a person cope with stress and challenges.

The four P’s

factors that increase or decrease the risk of psychological disorders. There is predisposing, precipitating, perpetuating, and protective factors.

Predisposing factors

a type of risk factor that refers to existing conditions or traits of a person that increase their vulnerability to developing a disorder e.g. personality traits (perfectionism).

Precipitating factors

a type of risk factor that refers to triggering the onset of a disorder (the immediate cause) e.g. a stressful event

Perpetuating factors

a type of risk factor that refers to maintaining or prolonging the disorder and prevent recovery e.g. lack of support

Biological factors for psychological disorders

can make someone more vulnerable to mental illness. It includes genes, medication, sleep and substance abuse.

Genes as a biological factor

it is the genetic vulnerability to specific disorders. It increases the risk of developing psychological disorders. Genes influence how proteins are made in the body, but genetic mutations can result in abnormal protein function such as neurotransmitter imbalances. This does not guarantee a disorder, it only increases susceptibility.

Medication as a biological factor

it is poor response to medication due to genetic factors. Genetics can affect the effectiveness and dosage needs of the medication.

Example of neurotransmitter imbalance

low serotonin, which is linked to depression. SSRI (Selective Serotonin Reuptake Inhibitors) like Zoloft and Prozac increases serotonin levels. The individual’s response to SSRI’s varies due to differing serotonin levels and other underlying factors. Or, it could be ineffective if the depression’s root cause is not serotonin-related or due to genes.

Five stages of medication response as a biological factor

it is influenced by genetics.

1. Absorption

2. Distribution

3. Target interaction

4. Metabolic processes

5. Excretion

Sleep as a biological factor

sleep and mental health can influence each other. Common disorders include anxiety, depression, ADHD, and bipolar disorder. Sleep deprivation can impair emotional regulation, making individuals react more intensely to negative emotions. Mental dysregulation from lack of sleep can increase vulnerability to mental illnesses. Benzodiazepines can treat sleep problems by enhancing GABA, which helps with relaxation and emotional control. Long-term use of benzodiazepine can cause worsening depression and dependence.

Substance abuse as a biological factor

it is linked to various psychological disorders. Addictive substances can alter brain function by interfering with neurotransmission. It can also worsen existing mental health conditions or trigger symptoms in genetically vulnerable individuals.

Example of long-term substance abuse

nicotine stimulates acetylcholine receptors and raises dopamine levels, creating feelings of pleasure.

Psychological factors for psychological disorders

affects how someone handles stress or trauma. It includes rumination, impaired reasoning and memory and stress.

Rumination as a psychological factor

obsessive thinking and worrying about negative past, present, or future situations. It can harm mental health if the cycle is not broken, preventing the ability to generate solutions or shift focus. The more long-term the rumination, it becomes a cognitive habit and becomes more harder to break.

What does rumination lead to?

fewer positive memory connections. This causes anxiety and depression.

What is the cause of rumination?

the brain’s tendency to link related memories - negative thoughts trigger more negative memories. This process involves neural networking, where brain areas for negative thinking become more active.

Treatments for rumination

CBT, which helps to reframe negative thoughts and encourages new emotional and thinking patterns.

Examples of rumination

1. constantly replaying past conversations, trying to understand what went wrong

2. feeling anxious about upcoming events and obsessing over them

Impaired reasoning and memory as a psychological factor

difficulties in thinking clearly and remembering information. It interferes with everyday life, work and relationships.

Impaired reasoning on its own

struggling to think logically and make decisions based on available information where people may jump to conclusions or have trouble solving problems step-by-step.

Impaired memory on its own

having trouble remembering information, which can affect recall (short-term or long-term).

What conditions does impaired reasoning and memory occur in?

schizophrenia, depression, dementia, bipolar disorder and PTSD

Stress as a psychological factor

causes the body to release hormones. Too much stress that is ignored can harm the mind and body.

Example of stress

Excess cortisol increases the chance of mental disorders like depression. It can also make it harder to remember and learn things.

What is the cause of stress?

tough life events like losing someone, health worries, or break-ups.

What does stress lead to?

feeling sad, memory troubles, a weak immune system, and mental illness.

Compare the effects of stress and the effects of impaired reasoning and memory on mental health

Stress → Your body and mind reacting to pressure or demands (e.g., deadlines, conflict). Can cause physical symptoms (headache, fast heartbeat) and emotional ones (worry, irritability).

Impaired reasoning and memory → Trouble thinking clearly, making decisions, or remembering things. This is not a reaction to a challenge — it’s a problem with how your brain processes and stores information.

Social factors for psychological disorders

impacts a person’s emotional wellbeing and support system. It includes disorganised attachment and significant relationships.

Disorganised attachment as a social factor

People with disorganised attachment struggle to express feelings and connect with others. This makes it harder for people to cope with life’s challenges in a healthy way, increasing their chances of developing psychological disorders.

What does disorganised attachment lead to?

social isolation, poor emotional regulation, relationship difficulties, high stress levels, aggressive or unpredictable behaviour, and negative parenting styles.

Significant relationships as a social factor

relationships that are considered highly important, such as with family, friends, romantic partners, or housemates. They often involve love and affection. The loss of a significant relationship can lead to gried. Prolonged grief can lead to psychological disorders such as anxiety or depression.

Grief relating to loss of a significant relationship

a multi-faceted response to loss that activates the limbic system - physical, emotional, cognitive, behavioural and spiritual. It can even cause risky behaviours such as substance use, complicated bereavement disorder (in severe cases) etc.

Prevalence meaning

how common a disorder is in the population

Symptoms meaning

common signs or behaviours seen in the disorder

Perceived causes meaning

factors believed to cause or contribute to the disorder

What type of medical professional diagnoses disorders and how?

a mental health professional (psychologist, psychiatrist) uses guidelines like those in DSM-5

When is someone diagnosed with an anxiety disorder?

When their fear, worry, or nervousness

Phobia

an irrational and intense fear of a specific object or situation that lasts at least 6 months and is out of proportion to the actual threat. Phobias fall into three main categories - agoraphobia, social phobia, or specific phobia

Stress

the physical and psychological response to pressure or challenges (called stressors).

Anxiety

includes symptoms like heart palpitations, muscle tension, trembling, dry mouth, and stomach upset—similar to the fight-flight-freeze response.

Prevalence of specific phobias

affect about 11% of Australians, with children being the most commonly affected group. It's normal for children to have fears at different ages, and most grow out of them. The age of onset varies depending on the type of phobia, but most begin in childhood. If a specific phobia persists into adulthood, it usually does not go away without treatment.

Symptoms of specific phobias

there is four broad categories of symptoms - healthy, reacting, injured and disorder. Disorder symptoms include excessive anxiety and fear, inability to fall or stay asleep, isolation and inability to perform duties.

Perceived causes of specific phobias

refer to the factors believed to contribute to the development of phobias. These causes are not always the same for everyone, but they usually fall into the biopsychosocial approach (biological, psychological and social/environmental factors).

Biological causes of specific phobias

genetics, brain function, and flight-fight-freeze response.

Psychological causes of specific phobias

classical conditioning (a direct experience causing a general phobia - association), observational learning and cognitive biases.

Social/environmental causes of specific phobias

parenting styles, life experiences (traumatic general events often out of person’s control) and cultural influences.

Generalised Anxiety Disorder (GAD)

involves constant, excessive worrying that affects daily life for at least six months. Unlike specific phobias, GAD’s anxiety is not tied to a particular situation and can cover worries about work, school, health, family, finances, and more. Worries often shift from one topic to another, causing ongoing distress.

Prevalence of GAD

Anxiety disorders affect about 17.2% of Australians aged 16–85. Women are more affected (21.1%) than men (13.3%). From this same sample, around 3.8% of Australians have GAD (higher in women by 2 percent - 4.8% in women and 2.8% in male). GAD often occurs alongside other disorders like depression, complicating diagnosis and treatment. In Australia, about 6.9% of young people (4-17 years old) have an anxiety disorder, with 2.2% having GAD.

Symptoms of GAD

persistent worrying that is hard to control, restlessness, muscle tension, fatigue, difficulty participating in everyday activities. In children, they may show perfectionism traits and often seeking constant approval from others and asking “what if…?” questions.

Perceived causes of GAD

falls into the biopsychosocial approach (biological, psychological and social/environmental factors).

Biological causes of GAD

flight-fight-freeze response, the neurotransmitters GABA (calming) and glutamate (excitatory), and genetic predisposition and inherited vulnerabilities.

Psychological causes of GAD

Individual perceptions such as behavioural factors, how behaviour is influenced by the environment; and cognitive factors, how thought processes influence feelings and behaviours. Thoughts and beliefs play a MAJOR role.

Social/environmental causes of GAD

environmental triggers (life events, substances, exposure), parental modelling (children observing parents) and transmission of threat information (e.g. people mentioning threats frequently).

Stigma

Mental illness could be stereotyped, making people with that illness seem “crazy” or “dangerous”. This leads to a negative social attitude or belief that leads to discrimination, disapproval or exclusion of a person because of a condition, behaviour or trait - causing them to feel ashamed, isolated and rejected. It prevents them from seeking help or receiving proper support. There are three types of stigma - public/social stigma, self-stigma, and institutional stigma.

Public/social stigma

when society holds negative beliefs (stereotypes) about people with a mental illness. It may lead to rejection or judgement from others, discouraging acceptance of treatment.

Self-stigma

when individuals internalise these beliefs and feel ashamed of their condition (low self-esteem and poor self-efficacy). This causes feelings of embarrassment and shame, making them less likely to seek help.

Institutional stigma

when systems or policies disadvantage people with mental health issues. They restrict opportunities such as access to support and services or these people. For example, fewer available services compared to other health services and reduced funding for mental health research.

Effect of stigma on treatment (general)

Embarrassment and shame (self-stigma) can mean that people with psychological disorders are less likely to seek, accept (social stigma) or find (institutional stigma) help, and will often go untreated for years. This not only affects themselves, but also their family and friends - for example, financial stability due to expensive healthcare.

What are the main types of treatment for psychological disorders?

psychotherapy, pharmacotherapy, electroconvulsive therapy (ECT) and psychosurgery.

What is psychotherapy?

a type of psychological disorder treatment. It is the use of psychological techniques (like CBT, psychodynamic, and systematic desensitisation) by trained professionals to change thoughts, emotions, and behaviours.

What disorders is psychotherapy used for?

It’s used for a range of disorders

What is the effectiveness of psychotherapy?

It is effective for many people and often improves quality of life and emotional functioning.

Side effects of psychotherapy

they are minimal but may involve emotional discomfort when exploring distressing thoughts.

Is psychotherapy used alone or in combination?

It can be used alone or combined with medication (pharmacotherapy), especially for moderate to severe conditions.

What is pharmacotherapy?

a type of psychological disorder treatment. involves treating mental health disorders with medication, such as antidepressants (SSRIs), antipsychotics (e.g. clozapine), or medication for substance use (e.g. methadone).

What disorders is pharmacotherapy used for?

It’s used for depression, anxiety, schizophrenia, and addiction.

What is the effectiveness of pharmacotherapy?

It is effective at reducing or managing symptoms but may not fully cure the disorder.

Side effects of pharmacotherapy

dependency, physical effects (like weight gain), and possible non-compliance.

Is pharmacotherapy used alone or in combination?

It can be used alone, but is often more effective when combined with psychotherapy.

What is electroconvulsive therapy (ECT)?

a type of psychological disorder treatment. it is a medical treatment where seizures are electrically induced in the brain to relieve severe mental health symptoms

What disorders is ECT used for?

It’s used especially for depression and bipolar disorder

What is the effectiveness of ECT?

It is highly effective, with 50–80% remission in some cases, and works quickly.

Side effects of ECT

confusion and memory loss, particularly around the time of treatment.

Is ECT used alone or in combination?

It is usually only used when other treatments like psychotherapy and pharmacotherapy have failed, or when fast relief is needed (e.g. in suicidal depression).

What is psychosurgery?

a type of psychological disorder treatment. it involves physically altering the brain (e.g. removing brain tissue or using Deep Brain Stimulation)

What disorders is psychosurgery used for?

It’s used rarely, for severe, treatment-resistant disorders like OCD, depression, and schizophrenia.

What is the effectiveness of psychosurgery?

Its effectiveness is limited — fewer than half of patients significantly improve — but DBS is more precise and less damaging than older traditional surgeries.

Side effects of psychosurgery

serious side effects like memory loss, personality changes, brain bleeding, and death.