What is a Biopsychosocial Approach?

What is a biopsychosocial Approach?

• An approach to behavioural health treatment, based on the General Systems Theory, which requires an integration of biological, psychological and sociocultural factors (Melchert, 2011).
• It uses a holistic perspective to achieve positive health and functioning within the chosen areas of significance in the individual’s life (Melchert, 2011).
• This approach encourages the objective of clinical practice as treatment provided to a person and not just a body (Saraga, Fuks,& Boudreau, 2014).
• “No one lives in a vacuum, and obtaining a full bio-psycho-social evaluation is the best way to ensure proper diagnosis and treatment” (Amen &Routh, 2004, p.101).

Assessment Process

• An assessment is a critical step before treatment planning due to significant information pertaining to biological, psychological, and sociocultural aspects of a client's life (Melchert, 2011).
• Aims of psychiatric evaluation according to American Association Practice Guides for the Treatment of Psychiatric Disorders (2006) (Melchert, 2011):
• to establish if any behavioural health problem are present
• to collect further data that can potentially support a different diagnosis and comprehensive clinical formulation
• to encourage collaboration with the client to create a treatment plan that will pay considerable attention to any potential safety issues that involve the client and others. This can also be a method to revise treatment plans based on new perspectives gained from a former evaluation if a long term plan is being reassessed
• to identify long term issues that must be considered in follow up care

Assessment Process

3 Methods of Maximizing Treatment Effectiveness

Treatment effectiveness

• Prioritizing needs (Melchert, 133)
• Overall Complexity of needs (Melchert, 135)
• Integrating assessment information (Melchert, 136)

Maslow's Hierarchy of Needs

bPS Approach to Treatment Planning

Treatment Planning

• The next step after assessment

To Intervene or not to intervene

• Considering the optimum approach to the problem/concern at hand
• 4 options after assessment: (Melchert, 2011)

1. No intervention: the problem or concern does not warrant clinical intervention

2. Intervention: approach with clinically significant concerns and problems

3. Postponement: a decision about intervening, but observe and monitor the problem in the meantime ("watchful waiting")

4. Second opinion: Reference to another professional for more assessment or to provide the needed intervention

Addressing the severity and complexity of needs

• Treatment plans are based on the results of the conducted assessment (Melchert, 2011).

Level of Care decision making

• Level of care is another significant aspect of treatment planning because it is essential to ensure that a counselor is providing an appropriate level of care that will be sufficient for the client's needs (Melchert, 2011).
• Should not provide too much care because it can be a waste of resources that can be allocated to another individual requiring particular attention (Melchert, 2011).
• Should not provide too little care because the purpose of intervention is to maximize the chances of positive outcomes (Melchert, 2011).

Graduated "stepped" models of intervention

• Developed to address mental health issues or behavioral health needs of the population in general (Melchert, 2011).
• Various models of intervention created to accommodate common behavioral health issues (Melchert, 2011).
• This is a necessary task that can be complicated in comparison to various preferred theoretical orientations when conceptualizing cases (Melchert, 2011).

Collaborative care

• Involving multiple human service professionals is essential to biopsychosocial treatment, especially in complex cases (Melchert, 2011).
• This can include social workers, physicians, psychologists, psychiatrists, lawyers, etc.
• Family and friends are another potential group that can facilitate beneficial collaboration.
• One limitation would include its costliness

Contextual factors

• Involving various stakeholders in the client's life can maximize external and internal supports (Melchert, 2011).
• This is an ideal but cannot always be achieved as a result of contextual factors pertaining to each individual.
• It is essential to take all aspects of a client's life into consideration when treatment planning (Melchert, 2011).
• Common contextual factors include (Melchert, 2011, p.158):

-Co-occurring medical, psychiatric, and substance use disorders

-Stability of patients psychosocial environment

-Client's level of family, peer, and other supports

-Client's decision making capacity is questionable

Ongoing care and follow up

• Particular clients require on-going monitoring support and care in order to maintain their treatment (Merchert, 2011).
• This is typically essential in cases of severe and chronic conditions, nonetheless, it can still be significant in mild and moderate cases (Melchert, 2011).
• Essential to consider in BPS treatment

Range of alternative interventions

• There are numerous types of therapies that can be implemented into BPS treatment.
• Mastering this treatment planning requires extensive study and clinical experience (Melchert, 2011).

Levels of care recommended for anxiety

Case Study (Pinel, 2018, p.460):

M.R. was a 35-year-old woman who developed a pathological fear of leaving home. The onset of her problem was sudden. Following an argument with her husband, she went out to mail a letter and cool off, but before she could accomplish her task, she was overwhelmed by dizziness and fear. She immediately struggled back to her house and rarely left it again, for about 2 years. Then, she gradually started to improve.

Her recovery was abruptly curtailed, however, by the death of her sister and another argument with her husband. Following the argument, she tried to go shopping, panicked, and had to be escorted home by a stranger. Following that episode, she was not able to leave her house by herself without experiencing an anxiety attack. Shortly after leaving home by herself, she would feel dizzy and sweaty, and her heart would start to pound; at that point, she would flee home to avoid a full-blown panic attack.

Although M.R. could manage to go out if she was escorted by her husband or one of her children, she felt anxious the entire time. Even with an escort, she was terrified of crowds--crowded stores, restaurants, or movie theaters were out of the question.

Level of Care decision making for m.r.

Considering M.R.’s particular situation, where would you categorize this client in terms of her severity of need on the chart provided?

Melchert, 2011, p.154

Collaboration

AND

CONTEXTUAL

Factors

Ongoing Care and Follow-Up

• Anxiety can range from mild to severe needs and ongoing care and follow ups can be beneficial depending on the person and context.
• It would consist of scheduled visits with various health care professionals to keep-up with treatment.
• Examples of typical follow up:

Medication

Potential brief counseling sessions

Relationships and support systems

Potential treatment method:

mindfulness meditation

• Studies show that mindfulness can decrease anxiety and an individual's negative self perception, which, in turn, promotes healthy and acceptable social skills (Beauchemin et al., 2008).
• Depending on clinical context, "mindfulness impacts symptoms of depression and anxiety through both distinct and common emotion regulatory mechanisms" (Desrosiers, 2013, p.16).

Limitations to the BPS approach

• It is not a scientific model, derived from empirical testing (Van Oudenhove & Cuypers, 2014).
• "It fails to provide a conceptual (i.e.metaphysical/ontological) account of the nature of the interaction between the three heterogeneous groups of processes, the biological, psychological and social ones, despite the fact that this interaction is the core constitutive element of all illness according to the model itself" (Van Oudenhove & Cuypers, 2014, p.5).

Limitations continued

• Not all patients are in need of treatment based on all three domains introduced by the biopsychosocial model.

• Treatment has varying benefits; some may benefit from intensive psychosocial treatment while others may rely on more biological treatments, without the involvement of the other (Richter, 1999).

References

• Amen, D., & Routh, L. (2004). Healing Anxiety And Depression. Penguin Group US
• Beauchemin, J., Hutchins, T. L., & Patterson, F. (2008). Mindfulness meditation may lessen anxiety, promote social skills, and improve academic performance among adolescents with learning disabilities. Complementary Health Practice Review, 13(1), 34-45.
• Desrosiers, A., Vine, V., Klemanski, D. H., & Nolen-Hoeksema, S. (2013). MINDFULNESS AND EMOTION REGULATION IN DEPRESSION AND ANXIETY: COMMON AND DISTINCT MECHANISMS OF ACTION. Depression and Anxiety, 30(7), 654-61. doi:http://dx.doi.org/10.1002/da.22124
• Melchert, T. (2011). Foundations of professional psychology: The end of theoretical orientations and the emergence of the biopsychosocial approach. Waltham, MA: Elsevier.
• Pinel, J. P. J., & Barnes, S. J. (2018). Biopsychology (10th ed.). New York, NY: Pearson Education.

References Continued

• Richter, D. (1999). Chronic mental illness and the limits of the biopsychosocial model. Medicine, Health Care, and Philosophy, 2(1), 21-30. Retrieved from https://search.proquest.com/docview/220889688?accountid=142373
• Saraga, M., Fuks, A., & Boudreau, J. D. (2014). GEORGE ENGEL'S EPISTEMOLOGY OF CLINICAL PRACTICE. Perspectives in Biology and Medicine, 57(4), 482-494. Retrieved from https://search.proquest.com/docview/1728137634?accountid=142373
• Systems Theory/Therapy (2017). Retrieved from https://www.goodtherapy.org/learn-about-therapy/types/systems-theory-therapy
• Van Oudenhove, L., & Cuypers, S. (2014). The relevance of the philosophical 'mind-body problem' for the status of psychosomatic medicine: A conceptual analysis of the biopsychosocial model. Medicine, Health Care, and Philosophy, 17(2), 201-213. doi:http://dx.doi.org/10.1007/s11019-013-9521-1