Biopsychosocial Model and Cultural Health Approaches Notes

Biopsychosocial model: overview

Health and illness arise from the interplay of biological, psychological, and social factors (the biopsychosocial model).
Core idea: these factors can contribute to, cause, or predict the onset of health issues; they also influence each other and can be shaped by the experience of health and illness.
The model emphasizes interconnected pathways rather than a single cause.

Pathways and directions in the biopsychosocial model

Direction 1: factors predict onset of illness
- Biological, psychological, and social factors can contribute to or predict the onset of health problems.
- Examples and mechanisms include genetics, stress, health beliefs, and social support.
- Upstream focus: diagnosis and prevention (e.g., screening, genetic testing) to reduce worst outcomes.
- Example discussed: breast cancer
- Biological: genetic predispositions to breast cancer.
- Psychological: health anxiety affecting willingness to pursue screening; beliefs about screening effectiveness.
- Social: social support and family prompting to seek screening; encouragement from family to see a doctor.
Upstream/prevention emphasis: early attention to these factors can improve diagnosis and preventive efforts (e.g., more targeted screening when genetic risk is known).
Genetic testing as a preventative medicine example: knowing predisposition can drive increased screening and early intervention.
Direction 2: health/illness changes biology, psychology, and social relationships
- Illness experience itself can alter biological processes, psychological states, and social dynamics.
- Example: cancer (breast cancer)
- Biological changes: cancer progression or treatment effects on physiology.
- Psychological changes: depression, anxiety, fear of the unknown, body image concerns, identity shifts related to appearance changes from treatment.
- Social changes: shifts in social roles (work, parenting, friendships); altered social support; new relationships with medical providers; potential for positive social connections through shared experiences.
- These changes can create new mediators that influence subsequent health trajectories (midstream factors).
Direction 3: factors influence recovery, outcomes, and long-term health (downstream effects)
- Illness-related biological, psychological, and social changes affect recovery, treatment navigation, risk of comorbidity, and susceptibility to further illness.
- Example dynamics:
- Isolation or loss of social roles may hinder recovery.
- Strong social support and connectedness can promote faster or more successful recovery.
- Negative social experiences (isolation) can impede recovery; positive social networks can facilitate it.
- Downstream outcomes include morbidity (diseases), mortality (death), and cure, and also the trajectory of long-term health.
Health psychologists study mechanisms: how and why these factors influence health and illness through mediators and pathways.
- Mechanism = mediator (the process or psychological/biological process that explains how a factor affects health).
- Example mechanism (stress pathway): high stress can lead to maladaptive coping (e.g., increased smoking, alcohol use) which then worsens health outcomes.
- Direct pathways also exist (e.g., stress triggering sympathetic nervous system activity directly affecting health).
- Mediation model (X -> M -> Y) with direct effect X -> Y:
- Let X be a health-related factor (e.g., stress), M a mediator (e.g., maladaptive coping), and Y a health outcome (e.g., illness progression).
- Equations (conceptual):
  - M = aX + e_M
  - Y = c'X + bM + e_Y
  - Total effect: c = c' + ab
- These ideas underpin framing of stress and health, including future lectures on stress pathways.

Exercise: using biological, psychological, and social factors

Activity described for class: in pairs, choose one of four health experiences and list contributing factors in each category (biological, psychological, social).
Example themes students discussed (summarized):
- Biological: genetics (e.g., predisposition to cancer), hormones, immune function, physical activity, body type, preexisting conditions (e.g., arthritis), medications with side effects, infectious agents (e.g., germs).
- Psychological: chronic pain, stress, mental illnesses (anxiety, depression), psychological distress, self-image and self-esteem changes (esp. with skin cancer or appearance changes), executive function impacts (memory, attention).
- Social: social support, isolation/is alienation, socioeconomic status (costs of prevention and exposure to risk), exposure to environmental risks (e.g., chemicals at work), family and social networks encouraging or hindering care seeking, impact on roles (parent, worker, friend).
Purpose of the exercise: brainstorm factors across the three domains and build a larger list; slides will be updated with contributions.
Note on process: discussion included real-time examples (e.g., sunscreen costs, workplace chemical exposures, the role of family encouragement) and reflections on how culture shapes symptom presentation and health beliefs.

Cultural approach to health: key idea and TED Talk by Dr. Faye Parks

Core metaphor: culture is the water we swim in; we are not always aware of how culture shapes our health beliefs and practices.
Conventional medical model vs healing traditions:
- Healing involves a patient’s connection to belief systems that promote good thoughts, feelings, and behaviors.
- Conventional medicine often overlooks culture’s role; healing traditions can be legitimate partners with conventional care.
- Integrated practice combines Western medicine with local cultural practices for healing and recovery.
Brain-immune connection and mindfulness: research suggests brain-immune communication and brain changes associated with positive affect among meditators, supporting the idea that culture and mind states can influence physiology.
Four structural elements/themes of African American healing traditions (identified in Dr. Parks’ study): 1) Spirituality: awareness of an otherworldly dimension; spirituality as a foundation that awakens personal strengths (love, compassion, creativity, hope, gratitude, justice).
- Personal anecdote: grandmother’s emphasis on being good (character, service, and self-care) used to illustrate spiritual practice as an everyday guiding principle.
  2) Ritual: prescribed actions that create belonging and social support; examples include limpia (cleansing) and sweat lodge ceremonies; collective rituals like the ring shout in Gullah Geechee culture.
- Ring shout: a circular, counterclockwise movement with rhythm that historically supported social bonding and collective resilience. 3) The power of words: speech as a source of power; intent behind words shapes outcomes; prayers and spoken phrases can influence health outcomes.
  - Data point: Pew Research Center reports about daily prayer; prayers linked to health outcomes and coping.
    4) Dreams: dreams as a connection to the unconscious mind; dream content carries metaphorical meaning and guidance.
- Examples include dream interpretations (eagle totem in Native American culture; flight as rising to a new level).
Cross-cultural evidence and examples:
- Tibetan care projects in exile in Dharamsala (Northern India) mixed Western psychological approaches with local cultural and religious practices; relaxation techniques complemented with cultural practices.
- Insights from other cultures (Senegal, Brazil, China, Tibet, Thailand) show shared elements like spirituality, ritual, words, and dreams as a blueprint for healing traditions.
Takeaway: the best practice bridges conventional medicine and cultural healing traditions, aligning health care with local life and agency, and recognizing healing traditions as legitimate partners in recovery.

Implications and connections

Practical implications:
- Health care should consider patients’ beliefs, cultural practices, and social contexts when designing prevention, treatment, and recovery plans.
- Integrative approaches can improve adherence, satisfaction, and outcomes by aligning medical recommendations with cultural practices.
- Address social determinants of health (e.g., SES, access to care, environmental exposures) as essential components of prevention and recovery.
Ethical considerations:
- Respect for diverse healing traditions and patient autonomy in choosing culturally meaningful care.
- Avoiding stereotypes about “superstitions” or “myth” in healing practices; acknowledge culturally grounded forms of agency.
Real-world relevance:
- Understanding how social support, stigma, and cultural norms influence screening uptake and treatment adherence.
- Recognizing how culture shapes health beliefs—impacting when and how people seek care and comply with recommendations.
Foundational terms and concepts to remember:
- Biopsychosocial model: health results from biological, psychological, and social factors interacting.
- Upstream vs midstream vs downstream processes:
- Upstream: prevention and early detection; reducing onset of illness.
- Midstream: treatment and management during illness.
- Downstream: recovery, outcomes, and long-term health trajectories.
- Mediator (mechanism): a variable that explains how a factor affects an outcome; mediation model example: X → M → Y with a direct path X → Y.
- Mediation equations (conceptual):
- M = aX + e_M
- Y = c'X + bM + e_Y
- Total effect: c = c' + ab

Quick synthesis: how the transcript frames health psychology

The transcript highlights that health psychology seeks to understand not just whether factors influence health, but how they do so (the pathways and mechanisms).
It emphasizes the importance of culture in shaping health beliefs, practices, and recovery processes, advocating for integrative approaches that honor patient contexts.
It grounds abstract concepts in concrete examples (breast cancer risk, screening behavior, social support, body image, stigma) and an interactive classroom exercise to surface diverse factors across biological, psychological, and social domains.
It ends by introducing a culturally grounded lens that complements conventional medical practices, arguing for healing that incorporates spirituality, rituals, language/words, and dreams as part of the healing process.

References to numbers and explicit details from the transcript

TED Talk length used for planning: $10 ext{ minutes}$ .
Time since initial observation of cultural patterns: $ext{15 years}$ ago (approximately the study referenced by Dr. Parks).
Prayer prevalence in the U.S.: $55\%$ of Americans pray every day.
Class size reference: mentions more than $60$ participants in the room.
Specific health illustration discussed: breast cancer (genetic predisposition, health anxiety, screening, preventive testing).
Concepts introduced: upstream/midstream/downstream framing; mediators/ mechanisms; brain-immune connections; cross-cultural healing practices.

Note for revisiting

Slides post-lecture will include additional lists and examples from student contributions; the content here captures the major ideas and the illustrative examples discussed in class and the accompanying TED Talk.