The Biopsychosocial Approach (VCE SSCE Psychology): Revision Notes

The Biopsychosocial Approach

What is the biopsychosocial approach?

The biopsychosocial approach is a comprehensive model used to understand both psychological development and mental wellbeing. Developed by George L. Engel in 1977, this model remains widely used in healthcare systems globally.

The approach recognises that human development and mental wellbeing are influenced by the complex interaction of three key dimensions:

• Biological factors (including hereditary influences)
• Psychological factors (internal cognitive and emotional processes)
• Social factors (environmental and relational influences)

Risk factors are influences that may increase one's chances of developing atypically or experiencing a mental disorder. Protective factors are influences that may prevent or decrease these chances.

Understanding mental wellbeing

Mental wellbeing refers to a state of emotional and social wellbeing in which individuals realise their own abilities, can cope with normal life stresses, work productively and contribute to their community.

The mental wellbeing continuum

A person's mental wellbeing exists on a continuum, or spectrum, ranging from high to low. An individual's position on this spectrum shifts throughout their life, depending on their experiences and coping abilities.

The continuum includes three main categories:

1. Mentally healthy (high wellbeing)

Mentally healthy individuals typically demonstrate:

• High levels of functioning in daily activities
• Ability to form positive relationships with others
• Capacity to manage feelings and emotions effectively
• Resilience to cope with normal daily stresses and manage change
• Logical thinking and problem-solving abilities
• Reasonable confidence and positive self-esteem

2. Mental health problems (moderate wellbeing)

Mental health problems represent relatively short-term disruptions affecting everyday functioning. These problems typically:

• Are not as long-lasting as mental disorders
• May result in mild and temporary impairment
• Cause some disruption to usual social and emotional wellbeing
• Often arise due to relationship or work stressors

Common characteristics include:

• Changes in sleep patterns and appetite (increased or decreased)
• Loss of energy and motivation
• Difficulty concentrating
• Difficulty completing work or study tasks
• Increased irritability
• Social withdrawal

3. Mental disorders (low wellbeing)

Mental disorders are long-lasting conditions that affect mood, thinking and behaviour. Approximately 20% of Australians experience a mental disorder in any given 12-month period. These disorders are typically diagnosed using set criteria and include conditions such as major depression and schizophrenia.

Mental disorders often involve the "three Ds":

• Distress: Unpleasant or upsetting emotions (e.g. sadness, anxiety, feeling overwhelmed)
• Dysfunction: Impact on ability to cope with everyday life and complete daily activities
• Deviance: Thoughts and behaviours that are inconsistent with cultural or societal expectations

Additional characteristics include:

• Reduced levels of day-to-day functioning
• Reduced ability to cope with change and uncertainty
• Impaired ability to engage in social relationships
• Substantial changes in thoughts, feelings and behaviours
• Apathy and lack of interest
• Serious or prolonged changes in typical character
• Impaired ability to function independently

Key characteristics of mental wellbeing

Three main characteristics define high levels of mental wellbeing:

High levels of functioning

High levels of functioning refer to the ability to carry out a wide range of daily activities, attend to self-care, maintain interpersonal relationships and demonstrate resilience when facing everyday challenges.

Areas of functioning include:

• Activities of daily living (e.g. self-care, personal hygiene)
• Work or occupational settings (e.g. productivity, achieving targets)
• School settings (e.g. participation, getting along with others)
• Interpersonal relationships (e.g. developing and maintaining friendships)

Resilience to life stressors

Resilience is the ability to 'bounce back' to previous normal functioning levels when faced with adversity.

Even people with high mental wellbeing experience challenges that may cause grief, anger or despair. However, through their capacity to adapt to or overcome stressful circumstances and continue with daily life, they demonstrate resilience.

The impact of a life stressor on mental wellbeing depends considerably on one's resilience. Resources that promote resilience include:

• Depth of social support
• Level of self-efficacy
• Problem-solving ability
• Ability to make and carry out plans

Social and emotional wellbeing

Wellbeing is the complex combination of a person's physical, social, emotional, mental and spiritual health, linked to happiness and life satisfaction. The Australian Psychological Society references six 'wellness' domains. Whilst wellbeing is holistic and difficult to separate into distinct areas, mentally healthy people typically display traits associated with social and emotional wellbeing.

Social wellbeing

Social wellbeing relates to the connections made with other people and the ability to get along with others in a community. It includes forming meaningful relationships with friends, family, co-workers and intimate partners.

Examples of high social wellbeing include:

• Developing positive relationships with family and friends
• Respecting and interacting appropriately with people from different ethnic and cultural backgrounds
• Working effectively as part of a team (workplace or sports)
• Contributing to society (e.g. through volunteer organisations)

Emotional wellbeing

Emotional wellbeing refers to the ability to feel a range of emotions and express these positively. Whilst all people experience varied emotions, the hallmark of good emotional wellbeing is the ability to manage these emotions and share them appropriately.

Examples of high emotional wellbeing include:

• Expressing a range of emotions relevant to the context
• Controlling varied emotions and responding positively
• Acting positively and having a positive affect
• Identifying emotions in others and responding appropriately
• Responding to setbacks with appropriate emotions

Aboriginal and Torres Strait Islander perspectives on mental wellbeing

Professor Helen Milroy, Australia's first Aboriginal psychiatrist, developed 'The Dance of Life' framework in 2006. This framework recognises the importance of healthcare professionals using a holistic approach when working with Aboriginal and Torres Strait Islander communities.

'The Dance of Life' is a multidimensional model combining paintings, narrative, theory and existing evidence. It identifies five dimensions of life and development:

The physical dimension

This dimension acknowledges that physical state cannot be separated from the land. It is represented by a human tree connected to the Earth, nurtured by Country and its plants and animals. The tree provides shelter and protection, existing in perfect harmony with the environment. At the end of its days, it returns to the Earth, providing continuity to existence.

The psychological dimension

This dimension acknowledges the rich connections made throughout life and the different stimuli experienced via all five senses simultaneously. The core of psychological life is alive and constantly evolving, supported and protected by collective layers of experience, knowledge and wisdom. This enables individuals to perceive the external world and be autonomous in their decisions. It also acknowledges that internal psychological struggles can be comforted by a collective consciousness.

The social dimension

This dimension acknowledges the importance of family and the presence of past generations. It recognises that family and children are linked together, part of a shared community that surrounds the family and keeps it safe from adversity. It represents the continuous and intimately connected sense of strength and wellbeing shared by a community and its enduring relationship to the environment.

The spiritual dimension

The tree of life represents the spiritual dimension connecting us to the Earth and the universe. It not only connects but also protects from all things outside our earthly existence. It recognises that life is rich and intricate, that humans are only a very small part of it, but that we are essential and irreplaceable nonetheless. This dimension is thought to be timeless, with an infinite capacity existing within, but also outside, our physical realm.

The cultural dimension

This dimension takes the form of three figures symbolising healing, ceremony and traditional law, which overrides all. These three aspects are intimately connected and weave a pattern throughout life that is vibrant and dynamic. A campfire symbolises community orientation, and the cleansing properties of smoke carry the burdens of life into the universe. The cultural dimension is grounded in the land, as much of the law, ceremony and healing comes from Country.

The three dimensions of the biopsychosocial approach

Biological factors

Biological factors refer to influences relating to the physiological functioning of the body. These are often called internal factors and are usually outside our control.

The body is complex, with systems working closely together to ensure daily functioning. However, some bodily aspects can make people more vulnerable to developmental differences (e.g. autism, ADHD) or mental disorders (e.g. anxiety, depression).

Biological factors affecting mental wellbeing and psychological development include:

• Genetics (heredity)
• Sex
• Hormones
• Immune function
• Nervous system activity
• Physical health
• Exposure to drugs or alcohol in the womb
• Nutrition
• Sleep

Genetic vulnerability

A biological risk factor for a mental disorder or developmental condition is called genetic vulnerability or genetic predisposition. This means an individual's DNA gives them an increased likelihood of developing a particular condition.

Biological protective factors

Healthy diet: Getting the right nutrients allows the body to carry out all processes required to maintain high physical and mental wellbeing. In childhood, certain nutrients (e.g. calcium and iron) are required for strong growth and development. A healthy diet provides energy for daily life and better equips individuals to overcome life stressors, contributing to resilience development and maintenance.

Adequate sleep: Quality sleep is a vital restorative process that helps prepare the body for daily activities. People who get enough sleep tend to be less irritable and less likely to get sick. When life stressors are encountered, well-rested individuals are better placed to overcome them. Therefore, adequate sleep contributes to resilience development and maintenance.

Psychological factors

Psychological factors refer to influences relating to the functioning of the brain and mind. This includes cognitive and affective processes such as thought patterns, memory and emotional responses. Like biological factors, psychological factors are considered internal.

Psychological factors affecting mental wellbeing and psychological development include:

• Ways of thinking
• Beliefs and attitudes
• Emotions and emotional responses, including stress
• Learning and memory
• Personality traits

Stress as a psychological risk factor

Stress occurs when an individual encounters a stimulus (e.g. a life event) that challenges their coping mechanisms. The stress response involves:

• Biological symptoms: Increased heart rate, muscle tension
• Psychological responses: Feeling overwhelmed, experiencing emotional pressure

The more adverse experiences in childhood, the greater the likelihood of:

• Developmental delays
• Later health problems (heart disease, diabetes)
• Substance abuse
• Depression

However, low exposure to stress due to supportive, responsive relationships with caring adults early in life can act as a protective factor against potentially damaging stress effects.

Social factors

Social factors refer to influences relating to the conditions in which people live and grow. This includes culture and social environment. These factors are considered external.

Examples of social factors include:

• Family dynamics and relationships
• Early life experiences
• Access to education
• Income level of the family
• Social supports
• Experiences of abuse or neglect
• Cultural values
• Social norms

Attachment as a social factor

Attachment refers to the very first relationship a baby forms with its primary caregivers.

Secure attachment: When a child is provided with consistent care and love, they form a secure attachment with their caregiver. This acts as a protective factor, providing a strong basis for forming solid, trusting relationships throughout life.

Insecure-disorganised attachment: If a child forms an insecure-disorganised attachment (due to lack of consistent care or emotional support), this can act as a risk factor for:

• Mental health problems
• Atypical emotional and social development
• Delayed achievement of cognitive milestones
• Difficulty trusting others and forming intimate relationships as adults

The cumulative effect of biopsychosocial factors

The biopsychosocial approach is holistic, recognising that factors from all three dimensions interact and can have cumulative effects on an individual's development and mental wellbeing.

When assessing risk, it is important to consider:

• The number of risk factors present
• The number of protective factors present
• How factors from different dimensions interact
• The overall balance between risk and protective factors