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 psychological disorder 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

existing conditions or traits of a person that increase their vulnerability to developing a disorder e.g. personality traits (perfectionism). this is different to risk factors as it focuses on existing traits while risk factors focuses on new influences

Precipitating factors

trigger the onset of a disorder (the immediate cause) e.g. a stressful event

Perpetuating factors

maintain or prolong 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.

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

Both affect mental health. Stress can lead to conditions like depression and memory loss, especially if it is ongoing and unmanaged. Impaired reasoning and memory can cause confusion, poor decision-making, and delusions, which are common in disorders like schizophrenia. Both can interfere with daily life and increase the risk of psychological disorders.

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.