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The biopsychosocial model. What is the biopsychosocial model?.
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What is the biopsychosocial model? • The biopsychosocial model (Engel, 1977) is a general model or approach that states that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors (abbreviated "BPS") all play a significant role in human functioning in the context of disease or illness. • This is in contrast to the traditional, reductionist biomedical model of medicine that suggests every everything which is psychological is first physical
Model description and application… • The biopsychosocial model implies that treatment of abnormal behavior for example depression, requires that the health care team address biological, psychological and social influences upon a patient's functioning. • In a philosophical sense, the biopsychosocial model states that the workings of the body can affect the mind, and the workings of the mind can affect the body. • The biopsychosocial model presumes that it is important to consider the biological, psychological and the social when explaining and treating abormal behaviour and empirical literature suggests that these factors all play a significant role in abnormal behaviour
Model description and application… • Practitioners of this model address the patients needs on the three levels – Biological/ Psychological and Social • There are theories that the mind directly effects the immune system – (we see this in the research on the stress response system) • Psychosocial factors can cause a biological effect by predisposing the patient to risk factors: An example is that depression by itself may not cause liver problems, but a depressed person may be more likely to have alcohol problems (an environmental risk), and therefore liver damage.
Evaluation • A plausible explanation because it takes into account three factors • Does not offer a clear cut explanation of abnormal behavior • has not been fully successful – the biomedical model still dominates in the treatment of abnormal behavior
Questions to check your understanding of the biopsychosocial model • What three factors does the biopsychosoical (BPS) model propose play a significant role in human functioning? • Why is the traditional biomedical model seen as reductionist? • What does the BPS model say about the workings of the mind and body? • Give an example of a connection between psychological factors and biological effects • Give two well developed evaluative points which relate to BPS (expand on the ones given in this packet)
What is the diathesis-stress model? • The diathesis–stress model is a psychological theory that explains behavior as both a result of biological and genetic factors ("nature"), and life experiences ("nurture"). • This model thus assumes that a disposition towards a certain disorder may result from a combination of one's genetics and early learning. • The term "diathesis" is used to refer to a genetic predisposition toward an abnormal or diseased condition. • According to the model, this predisposition, in combination with certain kinds of environmental “stress”, results in abnormal behavior. • This theory is often used to explain how mental disorders like schizophrenia are produced by the interaction of a vulnerable hereditary predisposition, with precipitating events in the environment. • It was originally introduced as a means to explain some of the causes of schizophrenia (Zubin & Spring, 1977).
Model Description and application… • In the diathesis–stress model, a biological or genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders. • The greater the underlying vulnerability, the less stress is needed to trigger the behavior or disorder. • Conversely, where there is a smaller genetic contribution greater life stress is required to produce the particular result. • Even so, someone with a diathesis towards a disorder does not necessarily mean they will ever develop the disorder. Both the diathesis and the stress are required for this to happen.
Evaluation • This model has had profound benefits for people with severe and persistent mental illnesses. It has stimulated research on the common stressors that people with disorders such as schizophrenia experience. • More importantly, it has stimulated research and treatment on how to mitigate this stress, and therefore reduce the expression of the diathesis, by developing protective factors. • Protective factors include psychopharmacology, skill building (especially problem solving and basic communication skills) and the development of support systems for individuals with these illnesses. • Even more importantly, the stress–vulnerability–protective factors model has allowed mental health workers, family members, and clients to create a sophisticated personal profile of what happens when the person is doing poorly (the diathesis), what hurts (the stressors), and what helps (the protective factors). This has resulted in more humane, effective, efficient, and empowering treatment interventions.
Questions to check your understanding of the diathesis stress model of abnormal behavior • What two factors does this model use to explain abnormal behavior? • What does the term “diathesis” mean? • What was this model initially used to explain? • In the diathesis stress model what is needed for abnormal behavior to occur? • What has this research stimulated an interested into? • What has the recent focus on protective factors enable health professionals to do?
The Dodo Bird Verdict • In Lewis Carroll's Alice's Adventures in Wonderland (1865), at a certain point a number of characters become wet. • In order to dry themselves, the Dodo decided to issue a competition. Everyone was to run around the lake until they were dry. Nobody cared to measure how far each person had run, nor how long. • When they asked the Dodo who had won, he thought long and hard and then said "Everybody has won and all must have prizes." "Everybody has won and all must have prizes."
The Dodo Bird Verdict • In psychological literature, Rosenzweig (1936) coined this phrase the "Dodo bird verdict", and it has been extensively referred to in subsequent literature as a consequence of the common factors theory. This is the theory that the specific techniques that are applied in different types of treatments for abnormality serve a very limited purpose (such as a shared myth to believe in), and that most of the positive effect that is gained from psychotherapy is due to factors that the schools have in common, namely the therapeutic effect of having a relationship with a therapist who is warm, respectful and friendly. Meta-analyses by Lester Luborsky (2002) show that the effect size that can be attributed to specific therapy techniques is only 0.2. Therefore, all therapies are considered equal and "all must have prizes". "Everybody has won and all must have prizes."
The Dodo Bird Verdict • On the other hand, scientists who believe in empirically supported therapies (EST) contend that it is not a fair picture of affairs. • Amongst many others Chambless (2002), for example, support the EST movement because there is much evidence that specific therapies are helpful to "specific people in specific situations with specific problems". • The significance of the figure of 0.2 is then an artifact of grouping problems and therapies in a non-meaningful way. "Everybody has won and all must have prizes."
The Dodo Bird Verdict • The "Dodo bird verdict" is especially important because policymakers have to decide on the usefulness of investing in the diversity of psychotherapies that exist. The debate has been very much heated since its re-inception in 1975 with a publication of Lester Luborsky. • Depending on what the outcome of the debate is held to be, many jobs and also the healthcare for many individuals are at stake. "Everybody has won and all must have prizes."
Questions to check your understanding of the dodo bird verdict in the treatment of abnormal behavior • Why is this called the dodo bird verdict? • Who was the person who came up with this concept? • What does the common factors theory propose? • What are ESTs? • What are the implications in terms of treating abnormal behavior if the dodo bird verdict is true?
