Biomedical and biopsychosocial models of health compared

¶ … Biomedical and Biopsychosocial Models of Health

Prior to 1977, the biomedical model was the key model used by physicians to explain the causes of illness and disease. It postulates that illness is a consequence of abnormalities/malfunctions in the physiological body processes, and that social and psychological factors are not in any way related to the disease process (Taylor, 2009). In addition to this single-cause aspect, the biomedical model was driven by three other major assumptions; i) the mechanical metaphor -- that the body works as a machine; ii) mind-body dualism -- that our values, beliefs, and ideas, which are matters of the mind, play a significant role in the physiological/biological processes of the body; and iii) the discounting emotion factor -- that physicians could not rely on the patient's opinion when making a diagnosis because patients are likely to be biased about their health.

The biopsychosocial model, on the other hand, recognizes disease as a consequence of the interaction of various social, psychological, and biological factors (Taylor, 2009). It takes into account the entire scope of a patient's well-being and recognizes the effect of such factors as strain and stress, emotion, and environmental surroundings on the occurrence of illness and disease (Taylor, 2009).

The biomedical model is the traditional model of health and offers a number of crucial benefits in the study of illness and disease, particularly in relation to the effect of germs on biological processes. However, it also had its own share of liabilities, and it is these liabilities that led scientists to develop the new biopsychosocial model of health. To begin with, its assumption of mind-body dualism wrongly portrayed the body and the mind as two separate entities. Additionally, the model appeared to place more emphasis on the causes of illness as opposed to the conditions that promote health (Taylor, 2009). Moreover, its 'body as a machine approach' was thought to be a wrong oversimplification of reality that failed to recognize the fact that factors external to the human body such as inadequate food supply, domestic abuse, and dangerous neighborhoods also had an effect on a person's health (Taylor, 2009). Of crucial significance, however, was its emphasis on the single-cause aspect of illness and disease. The model assumed that disease was caused solely by germs; however, this assumption began to gradually lose relevance after it was established that most modern illnesses are largely associated with lifestyle factors and stress and cannot be associated with a one single cause (Taylor, 2009).

The biopsychosocial model of health essentially addresses the shortcomings of the biomedical model. First, by recognizing the possible effect of external environmental factors on biological processes, the model is able to explain why, for instance, out of ten people who are exposed to measles, only five would actually develop the disease (Taylor, 2009). Moreover, by appreciating the effect of somatic factors, the model provides a more realistic framework for explaining the leading causes of death in modern society including diabetes, cardiovascular diseases, and high blood pressure, which are largely associated with lifestyle factors. Further, the model is able to clearly explain how social and psychological factors influence the effectiveness of treatment (Taylor, 2009). It is because of these relative strengths that that biopsychosocial model has been increasingly adopted by practitioners and researchers.

Clinical Implications: under the biomedical model, physicians were expected to make diagnoses by considering only the effect of biological factors such as biochemical imbalances, and how these could have contributed to the reported malfunctions. In contrast, however, the biopsychosocial model requires physicians to "consider the interacting role of biological, psychological, and social factors in assessing an individual's health or illness" (Taylor, 2009, p. 7). Moreover, a physician must ensure that his treatment recommendations involve all the three factor sets, and that consequently, target therapy is designed as to fit the unique health statuses of individual patients, and to deal appropriately with multiple health problems (Taylor, 2009).

Part Two: Risk and Resilience Factors for Stress and Disease

Max faces quite a number of risk factors that predispose him to stress and disease.

Job stress - he works in an auto parts factory, where he is most certainly exposed to unfavorable levels of noise, hostile working conditions that he has very little control over, and a demanding work schedule that requires him to work in the evenings and on weekends. He has very little time to rest and the fact that his body is constantly in a state of activation predisposes his biological systems to higher levels of wear and tear. Ultimately, the risk of disease increases as the body gets increasingly fatigued, and its ability to repair damaged tissues and defend itself from harm is seriously compromised.

Relationship problems -- he is unable to negotiate higher wages given that he has little control over the terms of his employment. As a result, he faces financial constraints and is under constant pressure from his wife, who perhaps feels that he is not giving enough, in terms of time and finances, to support his family. He also faces the pressure of being a good employee, and at the same time, a family man. The combined effect of these pressures places him at a very high risk of suffering a psychological breakdown.

Smoking and unhealthy eating habits - his frequent intake of fatty diets increases the levels of cholesterol in his blood, and causes a plaque build-up in his coronary arteries. This places him at a high risk of cardiovascular disease. Smoking increases this risk, as well as that of lung cancer.

Unfavorable surroundings/neighborhoods - he lives in a crime-prone neighborhood and is under intense pressure to protect his hard-earned assets. He also faces additional pressure from not having enough time to guide his children from being influenced into engaging in crime. These factors make him more predisposed to stress and mental disease.

Resilience Factors

These include those factors that enhance his ability to cope with the aforementioned risk factors.

Strong social network -- he has a strong social network of caring family members and good friends, who offer assistance in the form of financial and friendly advice, essentially helping him deal with his financial constraints and psychological pressures.

Regular exercise -- he exercises regularly, which essentially helps him burn excess cholesterol and boost his levels of 'good' cholesterol, essentially minimizing the risk of heart disease. Further, regular exercise reduces the risk of psychological breakdown as it provides an emotional lift, making one feel happier and more confident.

Part Three: HIV-Prevention Plan

The Center for Disease Control and Prevention (CDC) estimates that approximately 29% of persons living with HIV in America today are women (Morokoff, et al., 2011). It is further estimated that women have a 12% likelihood of getting infected through heterosexual contact, whereas men have a 4% risk of exposure to the same (Morokoff, et al., 2011). Injection drug use has been found to be the greatest cause of HIV infection among women, with approximately 46% of the current population of women living with AIDS having been exposed through this medium (Morokoff, et al., 2011). Moreover, 38% of this population was exposed through unprotected intercourse with an infected person. This plan seeks to reduce the rates of HIV infection among women in Franklin County, New York. The CDC recently named New York as the second-leading state in terms of HIV infections among women. The plan will focus on educating women in Franklin on how to reduce their exposure to HIV. It will emphasize three major areas -- infections through injected drug use, infections through sexual behavior, and mother-child transmissions during birth and breastfeeding.

Injected Drug Use -- the CDC identifies amphetamines, cocaine, and heroine as the most commonly injected substances among women. Sharing of injection paraphernalia such as needles exposes women to the risk of HIV infection. This infection could also occur through water used to unclog equipment, cotton used for drug filtration, and drug cookers for melting heroine, all of which come into contact with blood at some point during the injection process (Morokoff, et al., 2011). Majority of women who get infected with HIV through this medium do so from a relational context -- sharing injection equipment with their IDU sex partners. This form of transmission can be prevented through educating women on how to use bleach to clean their drug injection paraphernalia. Further, needle exchange programs (NEPs) can be initiated. However, unlike in other programs, where women are required to travel physically to the distribution center to exchange their equipment for new ones, this program will emphasize a door-to-door distribution mechanism so that child care responsibilities do not bar women from benefiting from the program.

Sexual Behavior: although the rate of women-to-women transmission is not as high as that of men-to-men, the CDC estimates that homosexual sexual behavior still accounts for a significant percentage of HIV transmission among women (Morokoff, et al., 2011). Oral sex is the most common form of transmission in this regard. Condoms have been found to be an effective mechanism for preventing STD transmission during sexual activity. To reduce the rates of transmission between heterosexual partners, this plan, unlike past programs, which have focused on educating women on how to use and how to obtain condoms, will teach women how to "be sexually assertive with respect to declining unwanted sex or initiating condom use" (Morokoff, et al., 2011, p. 276). Specific strategies will include empowering women to gain control over sexual activity through the use of the female condom as the male condom has been found to be largely male-controlled.

Prenatal HIV Transmission: under the proposed plan, counseling will be offered in all settings that offer care facilities to women - including drug abuse treatment facilities, mental health clinics, STD clinics, prenatal clinics, family planning clinics, and primary care facilities. Practitioners will be trained on how to provide voluntary testing programs as well as universal counseling services. Further, care and information providers will be educated on how to use sensitive strategies to asses patients' exposure risks by, for instance, examining their drug use and sexual risk behaviors (Walker, 2003). They will be taught how to design their strategies so that they are client-centered, linguistically-specific, developmentally-appropriate, sensitive to sexual identity issues, culturally-competent, and confidential. Women will be educated on, among other things, "how the administration of zidovudine (ZDV)…early in pregnancy can substantially reduce the rate of perinatal (sic) HIV transmission" (Morokoff, et al., 2011).

I estimate that the effective implementation of this plan could reduce the rates of HIV transmission among women in Franklin County by more than 3% annually.

Part Four: the Psychology of Drug Use and Addiction -- Presentation

Health Hazards of Addiction

Drugs are psychoactive substances capable of altering behavior, cognition, and mood. They are classified into three major groups, depending on their effect on the central nervous system (CNS) -- i); depressants such as heroine and alcohol, which slow down CNS activity, creating feelings of reduced anxiety as well as relaxation' ii) stimulants such as cocaine and caffeine, which speed up CNS activity, causing paranoia, as well as increased feelings of well-being, confidence, and energy; and iii) hallucinogens, such as ketamine and PCP, which cause alterations in the perception of time and sensory experiences. This text focuses on the depressants category, which are associated with a number of health hazards, including the risk of permanent brain damage and sustained mental confusion; strokes and seizures; liver damage or failure; abdominal pain and vomiting, and a weakened immune system that is highly susceptible to infections.

Psychology-Based Treatments for Addiction

Addiction to drugs in the depressant category (alcohol and heroine) is treatable using psychological techniques, particularly because thoughts play a significant role in an individual's decision to engage in the same. Cognitive-behavioral therapy can be used to alter the way an individual thinks about these drugs. Through such therapy, the individual would be able to anticipate health problems associated with drug use, and to consequently develop appropriate coping mechanisms. Specific treatment techniques would include exploring the consequences of continued substance abuse and initiating self-monitoring strategies for recognizing and dealing with cravings and risk factors.

Part Five: Case Study: Eating Disorders

Carrie is at risk of developing bulimia nervosa, an eating disorder where one, having no control over their eating habits, experiences bingeing and purging episodes, where they overeat and then try to rid themselves of the extra calories through induced vomiting or excessive exercising (Mayo Clinic, 2014). Often times, this disorder is driven by an unhealthy obsession to maintain 'good' weight, and an attractive body shape (Mayo Clinic, 2014). Carrie's obsession in this case is driven by two crucial factors; i) her admiration for clothes and fashion magazines, and the thought that fashion suits thin and shapely people better than fat ones; and ii) the negativity of friends and family members about overweight and shapelessness.

Below are some of the red flags that the family/doctor ought to look out for to ascertain whether Carrie has indeed developed an eating disorder (Mayo Clinic, 2014):

Skipping meals or preferring to eat in secret

Food hoarding

Use of herbal products or dietary pills to facilitate weight loss

Frequent checking in the mirror to note the slightest gain in weight

Repeated complaints about being fat or overweight even after the doctor has acknowledged that they are of normal weight

Persistent worry about losing weight and staying in shape

Social withdrawal

Funny eating rituals

Eating only 'safe' foods more often those low in calories and fat

In diagnosing the disorder, the physician will check whether the patient meets the diagnostic criteria outlined in the Diagnostic and Statistics Manual of Mental Disorders (DSM), after which he/she will recommend one or more of these three treatment options:

i) Psychotherapy -- cognitive behavioral therapy, where the patient is taught how to substitute unhealthy eating habits for healthier ones, is quite common with bulimia nervosa (Mayo Clinic, 2014). Specific treatment strategies could include teaching the patient how to monitor their moods, how to deal with stressful situations, and how to keep their eating patterns in check (Mayo Clinic, 2014).

ii) Nutrition education -- giving the patient information on how to establish healthy eating habits, how to develop an eating plan, and how to eat healthy so as to maintain a healthy weight (Mayo Clinic, 2014).

iii) Medication -- anti-anxiety and anti-depressant medications could be administered to deal with anxiety and depression, and to consequently help the patient control any urge to binge (Mayo Clinic, 2014).

Part 6: Literature Review on the Psychology of Addiction

Effect of Addiction on Individual and Family

Researchers contend that addiction to substances such as alcohol and cocaine affects not only the individual, but also their family, their colleagues at work, and the society in general (Alavi, et al., 2012). Repeated substance use causes damage to the frontal cortex of the brain, affecting key vital functions including sleep, metabolism, appetite, and the body's ability to respond to stress. As a result, the individual is more at risk of falling into depression, having erratic energy levels, or experiencing a state of emotional imbalance. Addiction to alcohol causes extensive damage to the liver, making it more prone to failure. The burden of addiction extends beyond the individual -- families are forced to face legal and financial problems, as well as the risk of divorce and high exposure to violence. Cigarette smokers additionally expose their families, particularly children, to high risks of developing breathing complications and lung infections. Then there is the additional risk of such children developing feelings of ambivalence or anxiety, and lacking family and parental support necessary for effective development.

Psychological Theories of Addiction:

Psychologists have differed on what the exact cause of addiction is. One faction postulates that addiction, particularly substance addiction, is driven by some kind of abnormality/psychopathology that presents itself as a mental illness (Horvath, et al., 2014). Another group tends to think that people are influenced to engage in harmful behaviors by their external environments (Horvath, et al., 2014). However, another section of researchers opposes this claim, arguing that people engage in harmful behaviors primarily because their thoughts and beliefs drive them to. These three psychological theories have been discussed in the subsections that follow.

Addiction under the Psychopathological Model: under this model, addiction is perceived to be a consequence of mental disorders such as mental illness, mood disturbances, and cognitive difficulties. In this regard, addiction is believed to occur together with a mental disorder, and psychotherapy will, therefore, be administered to identify and address the underlying disorder. Specific treatment strategies could include improving the individual's emotional and cognitive functioning or restructuring their personality.

The Learning Theory of Addiction: the learning theory portrays addiction as a learned behavior (Horvath, et al., 2014). This kind of learning could take either of two forms -- classical conditioning (learning based on paired association) or operant conditioning (consequence-based learning). According to the authors, when a person pairs the 'benefits' they derive from smoking with cues from their environment, they are said to have learned the addictive tendency of smoking through classical conditioning. Towards this end, if a person creates or establishes a culture of taking alcohol after work every day, they make 'after work' their cue for drinking, and addiction is deemed to come about because any time they get off work, they develop strong cravings for alcohol (Horvath, et al., 2014). The authors note that addiction learnt through this king of conditioning can be corrected through the process of unlearning -- the individual in the example above can, for instance, get over his addiction by repeatedly engaging in a different activity, say playing football, after work (Horvath, et al., 2014).

Operant conditioning is the second form of learning. In this case, the individual learns through rewards and punishments. Thus, a person becomes addicted to a substance because they perceive their experience with the same as rewarding, or rather, because they have not experienced any negative consequences in their use of the same (Horvath, et al., 2014). Treatment in this regard would basically involve reinforcing the negative consequences of addiction -- for instance, family members could let an addicted member become homeless or lose their job. According to Horvath and his colleagues (2014), these negative consequences would make addictive behavior less appealing, and the individual would consequently be more willing to abstain from the same. Accordingly, a reward could be administered, say allowing the individual to return home after they have demonstrated improvement as a way of reinforcing the positive effects of not engaging in harmful behavior (Horvath, et al., 2014).

Issues of Concern Identified in the Literature: researchers focus in regard to addiction appears to be shifting from substance addiction towards internet addiction. The internet is increasingly becoming an integral part of society, and we all appreciate its role in facilitating communication, improving trade, increasing consumer mobility, and bettering everyday life. However, for psychologist, the diffusion of the internet poses a whole new level of risk -- the risk of stress and depression resulting from internet addiction (Akin & Iskender, 2011; Chebbi, et al., 1997; Razieh et al., 2012; Khan, et al., 2014). Studies have increasingly pointed to a direct relationship between internet addiction and stress/depression. In their study involving 300 university students, for instance, Akin and Iskender (2011) found that people who used the internet more were more likely to develop emotional breakdowns or fall into depression. Their results were replicated by Chebbi and his colleagues (1997), who, studying the effect of internet usage and addiction on employee relations, found that employees who used the internet more had more problems interacting positively with their colleagues. Internet addiction in his study was defined as the use of the internet for more than eight hours daily (Chebbi, et al., 1997). In yet another study, Kan and his colleagues (2014), after examining the behavioral tendencies of 300 university students, concluded that there was a strong and direct relationship between internet addiction and stress/anxiety. What remains unclear, however, is how the two -- internet addiction and depression/stress are related. Future research could thus focus on showing the actual physiological mechanisms involved in this relationship.

Psychology-Based Treatments for Addiction: there is consensus that motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) are effective in treating substance as well as internet addiction (McHugh, et al., 2010). CBT can be used to alter the way an individual thinks about these drugs, such that they are able to anticipate health problems associated with drug use, and to consequently develop appropriate coping mechanisms (McHugh, et al., 2010). MET, on the other hand, drive behavioral change by evoking internally-motivated responses. One common technique is to appeal to the people that an individual cares about - for instance, their families, in a bid to evoke that internal motivation to change.