Bio-Psycho-Social Model

1. Bio-Psycho-Social Model

2. George Engel (1977) • Rejected the biomedical model as dogma • As professions mature, they seem to learn that many approaches have a piece of the puzzle What treatment, by whom, is most effective for this individual with that specific problem and under which set of circumstances?”

3. Have we evolved past this notion of our approach being the right one? Why?

4. “Who is right and who is wrong” “What works best in a given situation”

5. The biopsychosocial model Biological and cellular processes Psychological processes Social processes and contexts

7. Medical Schools • 1980’s… patient-centered, problem-based interview skills • Open-ended questions • Reflection • Attending to non-verbal behaviour • Promoted yet not fully integrated (Zimmerman & Tansella, 1996)

8. Psychiatry • Some adoption of BPS • Multi Axial dimension to DSM IV • Focus still on Axes I&II (Biomedical)

9. psychology, social work, andcounselling • Interdisciplinary care

10. World Health Definition of Health (1948) “A complete state of physical, mental, and social well-being and not merely the absence of disease and infirmity.”

11. E.G.’s of BPS model application across disciplines: • Eating disorders(Ricciardelli & McCabe, 2004; Rogers & Smit, 2000) • pain management (Covic, Adamson, Spencer, & Howe,2003; Kellen, 2003; Truchon, 2001) • Chronic fatigue (Johnson, 1998) • Gastrointestinal illness (Drossman,1998) • Substance abuse (Marlatt, 1992) • HIV/AIDS (Markus, Kerns, Rosenfeld, & Brietbart,2000) • Schizophrenia (Kotsiubinskii, 2002; Schwartz, 2000) • Antisocial behavior (Dodge & Petit, 2003) • Racism (Clark, Anderson, Clark, & Williams, 1999) • Infertility (Gibson & Myers, 2000) • Gestational weight gain (Olson & Strawderman, 2003) • Spinal cord injury (Mathew, Ravichandran, May, & Morsley, 2001) • Diabetes (Peyrot, McMurry, & Kruger, 1999)

12. Encouraging Wide ranging • Not so encouraging Tends to be one or the other I.E. Biological or Psychosocial

13. Evolving view of diseases • Anatomical pathology • Belief that disease was localized in anatomy (16th to 18th Centuries) • Tissue pathology • Specific tissues could become diseased while others remain healthy (Late 1800s) • Cellular pathology • Belief that life resided in cells and so cells must be the place to look for disease (19th century)

14. Evolving view of diseases • Germ theory • Discovery that particles in the air that could not seen (e.g., bacteria) could cause disease. • Magic bullet • A specific cure could be found for every ailment that restore the person to perfect health. • Biopsychosocial model • Mind, body, and environment interact in causing disease.

15. Behavioural risk factors • Diet • Exercise • Smoking • Safe sex • Wearing seat belts in the car, etc. Biopsychosocial Model of Disease • Biology • Genetic variability • Anatomy • Physiology • Pathogens • Germs • Toxins • Social • Family • Society • Friends, etc.

16. Biopsychosocial Model • Psychological component • Behaviour (adoption and maintenance) • Emotional (feelings) • Cognition (thoughts, beliefs, and attitudes) • Personality – characteristic ways of thinking and feeling

17. Disease v. Illness • Disease is a diagnosable biological dysfunction or infection. • Illness is an individual’s unique experience of pain and suffering.

18. Aggression? Social pressures: Group think? Etiology Example: A Broken Bone Sensation seeking? Alcohol abuse? Role models? Risk taking? Competition? Sleep deprivation?

19. Why do people get sick? Biomedical Model: • Exposure to infectious agents or pathogens • Immune response either sufficient or insufficient

20. Why elsedo people get sick? • Previous exposure to virus • Health behaviors (sleep, nutrition, etc.) • Stress/emotions • Social relationships (support, conflict)

21. The Biopsychosocial Model BIO PSYCHO HEALTH SOCIAL

22. The Biopsychosocial Model BIO PSYCHO HEALTH SOCIAL

23. The Biopsychosocial Model BIO PSYCHO HEALTH SOCIAL

24. The Biopsychosocial Model: Why do college students get sick? health behaviors previous exposure to virus BIO PSYCHO immune reaction to virus personality HEALTH emotions SOCIAL social support social conflict

25. What are some psychosocial risk factors? • Depression • Social isolation • Romantic relationship stress • Socioeconomic status as a child Cardiovascular Disease

26. What are some psychosocial protective factors? Buffers reduce the negative effects of a risk factor (i.e. stress). social support self-efficacy optimism

27. How do different risk factors and protective factors interact to influence health?

28. Unemployment is a risk factor for cardiovascular disease

29. Multiple Pathways of Causality What might explain this relationship? Cardiovascular Disease Unemployment

30. Multiple Pathways of Causality:Mediation Cardiovascular Disease Unemployment Stress

31. Multiple Pathways of Causality:Mediation Unemployment Stress Cardiovascular Reactivity Cardiovascular Disease

32. Multiple Pathways of Causality:Mediation Loss of Income & Health Care Cardiovascular Disease Unemployment

33. Multiple Pathways of Causality: Mediation Loss of Income & Health Care Unemployment Unable to pay for blood pressure meds Cardiovascular Disease

34. Multiple Pathways of Causality • Moderation: The presence of one factor modifies the relationship between another factor and an outcome. • What might change this relationship? Cardiovascular Disease Unemployment

35. Multiple Pathways of Causality:Moderation X Cardiovascular Disease Unemployment + Social Support

36. Multiple Pathways of Causality: Moderation Cardiovascular Disease Unemployment + Type A Personality

37. Multiple Pathways of Causality:Moderation Cardiovascular Disease Unemployment + Type A Personality

38. John Hopkins School of Medicine Combining pharmacological and behavioural interventions in community based clinics for persons with severe dependence to multiple substances

40. John Hopkins School of Medicine Combining pharmacological and behavioural interventions in community based clinics for persons with severe dependence to multiple substances Motivated Stepped Care Approach Brooner and Kidorf

41. Research supports a combination of: • Behavioural incentives • Pharmacological treatments • Utilization of family or significant other support • Skills-based group counselling • MI based individual counselling • Medical and psychiatric treatment

42. Evidence base: • Retention rates at least as good (mostly better) than other programs • Urine positive rates: about 50% less than other model programs on the east coast of the US with similar treatment populations

43. Concept Careful combination of all known effective elements into a system that achieved a delicate balance between motivating patients to change vs. irritating them to the point of dropping out of treatment simultaneously supportive, motivating, and confronting/challenging

44. Evidence based practice • Very costly treatment approach • Very strong results and evidence base

45. U.S. News & World Report's Best Hospitals The Johns Hopkins Hospital has once again — for the 18th consecutive time — earned the top spot in U.S.News & World Report’s annual rankings of American hospitals