[HD 202] E01-T09-Biopsychosocial Formulation and Mental Health

• Mental health encompasses realizing abilities, coping with normal stresses, working productively, and contributing to the community.
• Mental illness involves distress, disability, or increased risk of suffering, death, pain, or loss of freedom.
• Positive psychology focuses on human strengths, building the best in life, and fulfilling normal lives.
• The biopsychosocial (BPS) model considers biological, psychological, and social dimensions of health and illness.
• Resilience involves the interplay of biological, psychological, social, and spiritual factors in overcoming adversity.

Mental Health

• Brain is the organ of the central nervous system, while the mind involves intellectual and psychological phenomena.
• Mental health is more than the absence of mental disorders and is integral to overall health.
• Mental health is a state of well-being in which individuals realize their abilities, cope with stress, work productively and contribute to their communities
• Mentally healthy: Awareness of one's self, ability to relate well with others, and actions are useful.
• APA developed the Diagnostic and Statistical Manual of Mental Disorders, similar to the International Classification of Disorders (ICD).

Positive Psychology

• Martin Seligman says the state of psychology is good, not good, and not good enough.
• Two victories of the disease model is that 14 disorders are treatable, and a science if mental illness is developed.
• Three costs of the disease model is that psychologists became pathologizers and victimologists, psychologists forgot about improving normal lives, and positive interventions were never developed to make people happier.
• Positive psychology aims to be concerned with human strength. building the best things in life, and making lives more fulfilling.
• Positive psychology studies what makes life worth living and measures happiness.
• Discovering the causation of positive states involves looking at the relationship between left and right hemispheric activity as a cause of happiness
• Happy people are extremely social, don't spend time alone, are in romantic relationships and have a rich repertoire of friends
• Seligman's group was able to manualize many of these and carry out random-assignment efficacy and effectiveness studies.

Three different "Happy" lives

• The pleasant life invites as much positive emotion ass you possibly can, and the skills to amplify it.
• Drawbacks of The Pleasant Life is that it is about 50% heritable and Positive emotion habituates rapidly.
• The Good Life invites Eudaimonian flow.
• The Recipe to The Good Life involves identifying signature strengths and recrafting work, love, play, etc.

The Meaningful Life

• Knowing your highest strengths and using them in the service of something larger than you
• Things that "drastically change lives" include Have a Beutiful Day, Gratitude Visit, Strengths Date.

The Full Life vs The Empty Life

• Life satisfaction is pleasure, engagement and meaning
• Matters is having both meaning and engagement

The Reason and The Charge

• Problems of psychology are parallel to the problems of technology, entertainment, and design.
• Skills to a happy life are different to the skills of relieving misery
• The final notes on positive psychology concern the scientific study of positive experience and positive individual traits, and the institutions that facilitate their development

BPS Model

• In 1977, internist George Engel(specializing in functional GI diseases) published the paper "The Need for a New Medical Mode: A Challenge for Biomedicine"
• He proposed the BPS as an alternative to the Biomedical Model, which focused exclusively on physical and biological factors.
• No illness, patient, or health condition can be fully understood by reducing it to a single domain.

Continuum of Natural Systems

• Individual personis at the center of the model

Domains of Influence

• Biological domain includes anatomy, physiology, genetics, neurochemistry, and immune function
• Psychological domain includes cognition, emotions, behavior, stress response, mental health, and coping mechanisms
• Sociocultural domain includes family structure, social support, cultural beliefs

Clinical Application: Myocardial Infarction (MI)

• Recovery from a Myocardial Infarction (MI) van affect a persons body biological
• Clincla focus typicaly includes restoration of cardiac function, preventing further infraction and stabilizing te patient physiologically
• Healing is not limited to physical recovery

Clinical Implications of the BPS Model

• Leads to better understanding and therapeutic alliance and Promotion of empathy and patient-centered care

Scientific Basis of the BPS Model

• Central and autonomic nervous system, psychoneuroimmunology and psychoneuroendocrinology

Epigenetics

• Epigenetic modifications of stress response genes, which code for neurotransmitters like serotonin, are associated with childhood trauma.
• Demethylation triggers the unwinding of DNA from the histones, promoting the expression of genes
• Patterns of DNA methylation can be passed onto the next generation.

Biopsychosocial Formulation

• BPS Model is most embraced in the field of psychiatry since causes of mental illness are multifactorial
• Used for organizing BPS with domains of biological, psychological and social
• The four factors are predisposing, precipitating, perpetuating and protective

Step-by-Step Guide to BPS Formulation

• Fill out all domains from predisposing to protective

Sample Case for BPS Formulation

• Patient Alex is a 64 year old filipino Chinese business man diagnosed with stage 4 lung cancer who refuse treatment
• Restorations of health is not the goal, but rather the means to enable the patient to find purpose and pursue meaningful goals

Healing Through Meaning

• Those who were oriented toward a meaning to be fulfilled were more likely to survive."
• Each person is a unique and irreplaceable human being whose existence is characterized by freedom of choice , personal responsibility and a human spirit
• Meaning can be found through creations, experiences and attitudes
• Frankl says we are called to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a triumph, to turn ones predicament into a human achievement