One of the most important questions many people have regarding mental-health is what influences it. Why does one person have good mental health while another person’s is poor? What triggers an episode of poor mental health and what are the root causes? The biopsychosocial model helps us understand all of this and more.
Background: The biomedical model
Before we dive into an explanation of the biopsychosocial model, you need to know a bit about something called the biomedical model of mental health. We won’t go into great detail here, but let’s take a quick look at the essentials.
The biomedical model
In the past, psychiatrists, who are trained as medical doctors, saw people who have mental health conditions as being ill in the same way that someone can be physically ill. They saw conditions as a result of disturbances in the brain to be treated with drugs, surgery or other physical means. They reasoned that if something was physically wrong with your brain, it needed a physical cure.
The biomedical approach was challenged in 1977 by George Engel because it didn’t take into account the many other factors that can influence mental health, and health in general. Factors such as upbringing, beliefs, coping skills, trauma and relationships did not enter the equation. It just didn’t seem right to Engel. So he proposed a new way of thinking about mental health that encapsulated social and psychological determinants to health as well as just simply a person’s biology. This was the biopsychosocial model.
The biopsychosocial model
Engel’s biospychosocial model went on to become very influention. Most medical professionals now consider mental health to be affected by three main areas that are encapsulated in the biopsychosocial model:
- Biological (e.g. genetics, brain chemistry and brain damage)
- Social (e.g. life traumas and stresses, early life experiences and family relationships)
- Psychological (e.g. how we interpret events as signifying something negative about ourselves)
These factors interact with each other in complex ways to produce the final result that is a person’s overall mental health. The graphic above is a simplified summary of how the factors work together. In reality, it is a complex web with many connections across the different areas. As we continue on in our lives, new events enter the model and impact on existing factors. It is in flux, not fixed.
Mental health conditions the complex result of several factors
According to the biopsychosocial model, mental health is the result of many forces occurring at different which have a cumulative effect on the individual. These forces can be positive or negative. If the negatives outway the positives then a person could develop a mental illness.
It’s unlikely to be one specific thing that causes mental ill-health, but rather a mixture of negative circumstances that have built up. There might be one thing that pushes a person too far, but it’s unlikely to be this alone that caused a disorder.
Negative factors add up
Imagine you’re having a bad day at work. You had a stressful morning at home, you’ve dealt with more problems than normal from clients and you have just got out of an exhausting meeting you had half forgotten about. You sit back down at your desk and promptly knock your coffee over.
This might bring you to tears, send you into a rage or make you feel that you hate your job. A colleague watching this scene might be justified in thinking that you are so emotional because you knocked your drink over. But it wasn’t knocking your drink over that was the real issue. It was all the other things that happened before that created a situation where, when you did knock your drink over, it was too much.
This is just a simple example. We’ve probably all been there though. Those days when nothing seems to go right come along now and then and it’s infuriating. But the point is that we can all recognise how events can add up to the point where something small can tip us over the edge.
In a similar way, biological, psychological and social factors can add up across a person’s life to lead to times of mental ill-health.
For example it is now well established that schizophrenia has a genetic component. However the condition can be triggered by certain traumatic or stressful life events, such as a pattern of poor and chaotic family relationships in childhood. It is more than one factor that caused the condition.
Depression may be caused by a mixture of life events (such as emotional abuse in childhood or traumas in adulthood such as divorce) and a person’s habitual ways of judging themselves and their experiences. Again, it is not one factor alone that caused the issue.
The biopsychosocial model applies to us all
The biopsychosocial model is great for helping us understand how mental health conditions might develop. However, we shouldn’t only think of it as being useful for people who are not mentally well. It applies to us all. We can its three areas as postive forces to improve our mental health.
Your mental health, mine, your friend’s, your family’s and your colleagues’ is created by an interplay of biological, psychological and social factors. This is important to understand. It means that ‘healthy’ people are not separate from ‘unhealthy’ people.
The mind of someone who has a mental health condition is not entirely different to yours. There’s just a different combination of factors that have come together to create a state where the person is mentally unwell.
As with the mental health continuum, we all have the potential to be mentally well or unwell. We cannot see people with mental health conditions as different in some fundamental way. This is one excellent way to confront the stigma surrounding mental health issues.
The biopsychosocial model in the workplace
The biopsychosocial model has another advantage. As well as being able to explain mental health in terms beyond the purely biomedical, it shows us there is potential to positively influence a person’s mental health in the workplace.
As a manager, you should use the biopsychosocial model to help you find ways you can positively influence your team.
For example, you could influence biological factors by creating lunchtime exercise habits. Or you could promote healthy eating initiatives. In this way, you can positively impact on another’s mental wellbeing.
You should also examine what can be done to improve the social and psychological aspects of your work. Some things will be beyond your control, but other small changes can be made. What training can be given to build resilience? Can you use praise to raise self-esteem? What can you do to foster strong relationships between colleagues?
The positives add up too
Remember, just like negative factors, positive factors add up. A day where you’ve had some positives such as enjoying going for a walk with colleagues over lunch, feeling good because you ate something healthy might mean that when you do knock that cup of coffee over, you are able to see it for what it really is. An annoying accident, but nothing more.
Again, if we apply this logic to our whole lives, then we see that to be more mentally healthy and resilient, we need to ensure we focus on increasing the positive factors in our lives.
What if you’re too busy to do all this?
There’s no getting away from the fact that it can be challenging and time-consuming to work through the biopsychosocial model and identify where changes can be made. But it will be time well spent. The long-term benefits far outweigh the short-term efforts. Check out this article to see why.
Conclusions from the biopsychosocial model
- The causes of mental health disorders are complex and varied. Biological factors have a role but they are not the only influence. Social and psychological factors are crucial too.
- We are all unique. Some people may be more disposed to develop a mental health issue than others, but we can all improve our mental health by seeing the biopsychosocial model as three positive forces for mental health.
- Focussing on the psychological aspects of the biopsychosocial model can empower people to take control of their thoughts and improve their mental health.
- Work is a social activity and it can be a positive or negative influence on a person’s mental health.
Learn more
If you’d like to learn more about mental health, you can get started with our bite-size Mental Health Awareness online course.
Delphis also offers on-site mental health workshops delivered and developed by highly educated business managers, academics and teachers. We guide companies along the path to creating mentally healthy, productive and rewarding working environments for their staff. The financial argument is compelling and caring for your employees is the right thing to do.
One major multi-national client says this about our workshops:
“Very relevant and informative with an engaging and inclusive style. Worth spending a whole day on. Loved the takeaway workbook, pretty much perfect, we need to roll out to whole company.”
Get in touch to discuss how we can provide customised mental health training for your organisation that fits your needs.
What Causes Anxiety?
So what causes anxiety and anxiety disorders anyway? According to Edmund Bourne (2000), author of the highly popular The Anxiety & Phobia Workbook, people often offer single cause explanations for anxiety disorders, including professionals. Many people will often offer simplistic explanations of anxiety disorders. Common "explanations" include: 1) brain imbalances, 2) traumatic episodes from childhood, or catchall blame…3) poor parenting. Each of these explanations does have some merit. However, anxiety disorders are much more complex. Anxiety disorders result from a multitude of biological, psychological, and social factors that all interact to create and maintain these disorders.
Anxiety experts usually explain anxiety and anxiety disorders using the biopsychosocial model. The biopsychosocial model proposes there are multiple, and inter-related causes of pathological anxiety. These causes can be roughly categorized into three main groups:
1. biological causes, 2. psychological causes, and
3. environmental or social causes.
When psychologists use the word "environment," they mean all the things that are happening around us. Used in this way, environment references our life experiences, particularly social interactions with other people, especially caregivers, family members, etc. Theoretically, people develop an anxiety disorder when they possess both biological and psychological "vulnerabilities," coupled with a social environment that set-off, or trigger these vulnerabilities.
The biological aspect of the biopsychosocial model refers to the body's physiological, adaptive responses to fear. It also refers to genetic traits, and the brain functioning that we "inherit." More specifically, what is passed down is a genetic vulnerability expressed as a "personality type" (Bourne, 2000). This personality type describes a person who is more reactive, more sensitive, and/or more easily excitable in the presence of stress.
Although we may be born with a biologically determined, heightened sensitivity to stress, this fact alone is insufficient to create an anxiety disorder. The psychological factors in the biopsychosocial model refer to our thoughts, beliefs, and perceptions about our experiences, our environment, and ourselves. These cognitive patterns affect our perceived sense of control over our environment. These cognitive patterns also influence how we assess and interpret events in our environment as either threatening or non-threatening.
These thoughts (cognitions) about our environment, and ourselves, play a key role in the formation of an anxiety disorder. For instance, one child's mother makes a correction to her son's homework. He interprets this as helpful and indicative of his parent's confidence in his ability to learn. Another child's mother makes a correction to her daughter's homework, and instead of interpreting this as helpful, the daughter interprets this as an indication of her limitations, and her parent's lack of confidence in her abilities. This furthers strengthens her own lack of confidence in herself.
Previously, we mentioned anxiety develops from the perceived gap between one's estimated ability to cope with a challenge, and the estimated difficulty of the task itself. From the example of the two children described above, you can imagine how the son might grow up to become a man who has confidence in his skills when faced with a challenging task. Thus, when estimating the perceived gap between his abilities and a challenging task, he will be less likely to experience anxiety. In contrast, the daughter may grow up to be a woman who lacks this self-confidence. When she is faced with a challenging task, she is more likely to experience anxiety. This is because she is likely to overestimate the perceived gap between her abilities and the task itself. Thus, because of these differences in their psychological make-up, the daughter would be at greater risk for developing an anxiety disorder.
According to Barlow (2002), once the biological and psychological vulnerabilities are in place, an individual may then "learn," from their social environment (such as their family), to focus their anxiety on specific objects, or situations in their environment. Thus, the social component of the model refers to environmental factors that may trigger, shape, and strengthen the biological and psychological vulnerabilities. Environmental factors can include stressors that commonly affect everyone, such as the tragic events of 9-11. They can also be more individualized stressors that may not be experienced by everyone. This might include financial stress, loss of a loved one, or pet loss.
Our social environment includes different role-models that can have a significant influence on any preexisting vulnerabilities. To illustrate the influence of role models in the formation of anxiety disorders, consider adolescent peer groups. These peer groups often contribute strong opinions about what behaviors will help, or hurt, someone's chances of gaining entrance into the "in crowd." Subsequently, by observing how their peers behave, adolescents learn what behaviors and attitudes will help them become accepted, or at least, not rejected by their peers. Although a certain amount of concern over peers' opinions is developmentally normal, some teens are particularly sensitive to their peers' opinions. They may have a tendency to become excessively preoccupied with their peers' evaluations. Ironically, this excessive preoccupation interferes with the very relationships and peer approval they are so desperately trying to obtain. Unfortunately for these youth, this preoccupation often results in clinical levels of worry, avoidance behavior, and feelings of anxiety.
Now let's examine the biopsychosocial model in more detail to more fully understand the biological, psychological, and social causes of anxiety disorders.