Rethinking the biopsychosocial model of health: Understanding health as a dynamic system

The biopsychosocial model has dominated research and theory in health psychology. This article expands the biopsychosocial model by applying systems theories proposed by developmental scholars, including Bronfenbrenner's ecological models and Sameroff's transactional model, as well as contemporary philosophical work on dynamic systems. The proposed dynamic biopsychosocial model construes human health as a product of the reciprocal influences of biological, psychological, interpersonal, and macrosystem contextual dynamics that unfold over personal and historical time. The importance, or centrality, of these influences varies within a person over time. The model is explicated using two hypothetical case studies derived from existing interdisciplinary health research. Implications for health, theory, research, and policy are discussed.     

Philosophy,writing, and liberation

In responding to the three creative interpretive discussions in the symposium on my book Philosophy and the Art of Writing, this paper explores the different styles of philosophical discourse and their role in the practice of philosophy as a way of life that extends beyond the discursive and that combines self-cultivation with care for others in the ethical-aesthetic pursuit of living beauty. In advocating this aesthetic model of philosophical life over a purely therapeutic model, I suggest how the former can incorporate the latter's concerns for spiritual health and liberation. In developing my response to the symposiasts while elaborating on the themes of my book, I consider issues of ineffability, creative performance, embodiment, truth, heroism, vulnerability, possession, art, spirituality, love, and liberation.     

A Call for Interdisciplinary Collaboration to Promote Musculoskeletal Health: The Creation of the International Musculoskeletal Mental and Social Health Consortium (I-MESH)

Despite increasing recognition of psychosocial factors in musculoskeletal conditions, its impact on reducing the global toll of musculoskeletal symptoms has been only incremental. It is time to bring together clinicians and researchers with heterogeneous backgrounds, unified by a commitment to reduce the global impact of musculoskeletal illness by addressing mental and social health factors. In 2020, we initiated the International Musculoskeletal Mental and Social Health Consortium. Our current key priority areas are: (1) Develop best practices for uniform terminology, (2) Understand barriers to mental and social health care for musculoskeletal conditions, (3) Develop clinical and research resources. The purpose of this paper is to render a call to interdisciplinary collaboration on the psychological aspects of musculoskeletal health. We believe this international interdisciplinary collaboration is pivotal to the advancement of the biopsychosocial model of musculoskeletal care and has the potential to improve the health of individuals with musculoskeletal conditions globally.

     

The new philosophy of psychiatry: its (recent) past, present and future: a review of the Oxford University Press series International Perspectives in Philosophy and Psychiatry

There has been a recent growth in philosophy of psychiatry that draws heavily (although not exclusively) on analytic philosophy with the aim of a better understanding of psychiatry through an analysis of some of its fundamental concepts. This 'new philosophy of psychiatry' is an addition to both analytic philosophy and to the broader interpretation of mental health care. Nevertheless, it is already a flourishing philosophical field. One indication of this is the new Oxford University Press series International Perspectives in Philosophy and Psychiatry seven volumes of which (by Bolton and Hill; Bracken and Thomas; Fulford, Morris, Sadler, and Stanghellini; Hughes, Louw, and Sabat; Pickering; Sadler; and Stanghellini) are examined in this critical review.     

Redefining Ecological Ethics: Science,Policy, and Philosophy at Cape Horn

In the twentieth century, philosophy (especially within the United States) embraced the notion of disciplinary expertise: philosophical research consists of working with and writing for other philosophers. Projects that involve non-philosophers earn the deprecating title of "applied" philosophy. The University of North Texas (UNT) doctoral program in philosophy exemplifies the possibility of a new model for philosophy, where graduate students are trained in academic philosophy and in how to work with scientists, engineers, and policy makers. This "field" (rather than "applied") approach emphasizes the inter- and transdisciplinary nature of the philosophical enterprise where theory and practice dialectically inform one another. UNT's field station in philosophy at Cape Horn, Patagonia, Chile is one site for developing this ongoing experiment in the theory and practice of interdisciplinary philosophic research and education.     

The legacies of systemic and internalized oppression: Experiences of microaggressions,imposter phenomenon,and stereotype threat on historically marginalized groups

Previous literature has described how people of historically marginalized groups (namely people of color, women, queer and transgender people, people living with disabilities, immigrants, and people of religious minority groups) are likely to internalize negative, oppressive feelings about their identities (David, 2014; David, Schroeder, & Femandez, 2019). For example, studies have found that many women and people of color (and women of color, in particular) experience what has been labeled as imposter phenomenon, or the notion that they are not intelligent or adequate enough, despite evidence that confirms their success or worth. Similarly, people of color and people from other historically marginalized groups are known to experience stereotype threat, or anxiety about performance or behaviors that could confirm biases about a social group they belong to. Finally, previous literature shows that people of historically marginalized groups navigate various types of microaggressions, or subtle or covert biased statements and behaviors that negatively impact their self-esteem, academic performance, mental health, and physical health. While the terms microaggressions, stereotype threat, and imposter phenomenon have been discussed thoroughly in academic literature, less is written about the connections between these concepts. Utilizing intersectionality theory, the current paper will propose an interactional model between these constructs and aims to describe how cumulative effects of microaggressions exacerbate and contribute to internalized oppression. Based on this model, this paper will also provide recommendations for future directions in psychological research and practice.     

The progress and prospects of health psychology: tasks of a maturing discipline

Substantial research advances and professional articulation have brought the field of health psychology to a certain level of maturity. From a research standpoint, we are ready to meet the challenge of the biopsychosocial model. Professionally, the field must continue to demonstrate treatment effectiveness and cost-effectiveness, integrate basic science with applications, consider how best to market health psychology research, develop criteria for intervention, and agree on training standards for researchers and professionals in the field. Current trends toward complex, multidisciplinary programs of research, and lengthy training programs may, however, conspire to drive away talented young investigators. The field can anticipate and potentially solve some of these problems by drawing on the cooperative scientific vision that has characterized our field to date.     

The biopsychosocial approach to chronic pain: scientific advances and future directions

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.     

Ethical considerations and training recommendations for philosophical counseling

Philosophical counseling is a diverse and burgeoning type of mental health service delivery. Despite competing approaches to theory and practice, the field has largely strayed from an ethical critique of its methodology and counselor training requirements. This article outlines several ethical considerations and training recommendations that are proposed to bolster the quality and effectiveness of philosophical practice. As philosophical counseling gains increasing recognition in North America, recently established national organizations in philosophical practice may profit from revisiting their interim codes for professional conduct. Proposed training suggestions for counselor preparation my further assist institutions and board-regulated agencies in establishing competent and acceptable standards of client care.     

Objectivity,diversity, democracy: locating social theory in <Emphasis Type="Italic">Objectivity and Diversity</Emphasis>

Reprising and revising a question from Longino regarding an earlier phase of standpoint theory, I raise some issues regarding the place of a substantive normative social theory in the strong objectivity project in Harding’s recent book, Objectivity and Diversity. I offer reasons to think the issue needs to be reframed in the co-constructionist and pluralist setting of the new book but that interesting issues continue to arise in thinking about the philosophical resources feminist philosophies of science can or might rely on.     

Encompassing experience: Meanings and methods in health psychology

Abstract

Health psychology is limited by its almost exclusive use of a positivist quantitative research paradigm, and the adoption and use of qualitative methods by health psychologists will provide increased understandings of health and illness. Qualitative methods provide a means to incorporate the social world into our research, and furnish ways to investigate the meanings of health and illness experience. We present a brief consideration of the qualitative paradigm and some important underlying issues related to its use. We describe three qualitative approaches - grounded theory, narrative analysis, and discourse analysis - chosen for their relevance and diversity. We provide illustrations of the use of each in health research, and suggest how these approaches could be utilised by health psychologists to enrich understanding in the health field. We conclude that health psychologists have a great deal to gain from joining other social science health researchers in adopting qualitative approaches in their research.     

Current issues and new directions in Psychology and Health : Theory,translation, and evidence-based practice

Health psychology has at least two masters; cognitive behavioral theory and clinical and public health practice. We are expected to contribute to theory by creating new models and adding to existent models of human behavior, and to contribute to improvements in health outcomes for the public. In this brief note, we propose that translating concepts from practice into theory to create interventions that meet the standards of evidence-based practice will satisfy both masters. However, the integration will require a re-examination of our current understanding of how to use theory, the process of translation, and the development of pragmatic evidence-based practice.     

Evolution of the biopsychosocial model: prospects and challenges for health psychology.

Although advances have been made in specifying connections between biological, psychological, and social processes, the full potential of the biopsychosocial model for health psychology remains untapped. In this article, 4 areas that need to be addressed to ensure the continued evolution of the biopsychosocial model are identified and a series of recommendations concerning initiatives directed at research, training, practice and intervention, and policy are delineated. These recommendations emphasize the need to better understand and utilize linkages among biological, psychological, social, and macrocultural variables. Activities that facilitate the adoption of a multisystem, multilevel, and multivariate orientation among scientists, practitioners, and policymakers will most effectively lead to the kinds of transdisciplinary contributions envisioned by the biopsychosocial perspective.     

Counseling Theory: The Problem of Definition

It is proposed that (a) research in counseling and counseling practice do not generally make explicit their roots in counseling theory, (b) this lack of connectedness to theory may represent a weakness in our theories for failing to be useful, (c) this fault may be a function of our current definitions of theory, and (d) we should focus upon philosophical premises at this time. The philosophical premise of syntony is used to illustrate how many of the commonly accepted assumptions which set our standards are not necessarily so, and how the broadening of such assumptions may encourage more activity in theory development. Counseling approaches which do not qualify as theory must at least qualify in the realm of rationale by making explicit their philosophical or value premises.     

A Psychoeducational Approach to Hypochondriasis: Background,Content, and Practice Guidelines

Patients suffering from health anxiety are difficult to engage in a psychological treatment, although it has now been empirically established that cognitive behavioral treatments are beneficial for many of these patients. A first important step is to change their orientation from a biomedical to a biopsychosocial perspective. One way of promoting this change is to provide focused psychoeducation. A number of studies have shown that group psychoeducation for patients with health anxiety results in a reduction in anxious concerns, depression, and medical services utilization. The purpose of this paper is to describe the background, content, and implementation of a brief course entitled “Coping With Health Anxiety.” The empirical support as well as the potentially active ingredients of this approach are discussed.     

Community as practice: social representations of community and their implications for health promotion

Health promotion researchers and practitioners have increasingly turned to community-based approaches. Although there has been much work around the diverse understandings of the term in areas such as community psychology and sociology, I am concerned with how such understandings relate directly to community health research and practice. From a discursive perspective ‘community’ is seen as a socially constructed representation that is used variously and pragmatically. However, from a wider view, community can be seen as a matter of embodied practice. This paper draws on social representations theory to examine the shifting constructions of ‘community’, the functional use of those understandings in social life, and the practices that suggest that it is important to attend to their use in particular contexts. Accordingly, the paper argues that meanings of community in the health promotion or public health context must be seen as representations used for specific purposes in particular situations. Furthermore, the broader notion of embodied practice in social life has implications for community participation in health promotion. Copyright © 2007 John Wiley & Sons, Ltd.     

Quality of Life in Women Following Various Surgeries of Body Manipulation: Organ Transplantation, Mastectomy, and Breast Reconstruction

This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health.