This post is based off an article was originally published here for clinicians, but since it may be beneficial & helpful for some of our patients and readers, I’ve included it on this site so you have an idea of how we approach healthcare here at Proactive Rehabilitation & Wellness. I hope you find it a quick and insightful read. 

What is a Biopsychosocial Approach?

Simply put: humans are incredibly complex (tell me something I don’t know, right?)

In the past, a biomedical model of practice placed symptoms, diagnoses, and physiological issues at the forefront of clinician’s mind. While these factors are important, they represent only a fraction of the whole person, the individual patient, sitting in front of us. You are a unique individual with unique situations and factors; not just a diagnosis out of a textbook.

We understand how physical, psychological, and social/environmental factors interact throughout your experience of a disease, injury, or illness. We also understand that there are too many factors at play for rigid treatment protocols or “cookie-cutter” treatment programs.

We don’t simply rely on a diagnosis or symptoms to determine which treatment option, assessment tool, or outcome measure will be most effective for you. We look at your whole person, not just the aches and pains you’re currently feeling now.

Defining the Biopsychosocial Model

The biopsychosocial model is not really a treatment plan or technique. In fact, the biopsychosocial model can really be thought of as both as a philosophy of clinical care and a guide for clinical practice [1]. That’s why we say that we take a biopsychosocial approach to healthcare.  We don’t necessarily follow a standardized biopsychosocial treatment; because, again, every person is different, so every treatment should be tailored to each person.

Now, the biopsychosocial model proposes that suffering, disease, or illness involve a host of factors from biological (tissues, structures, molecules) to environmental (social, psychological). Each of these factors affect a your subjective experience, clinical outcomes, and effective treatment throughout the treatment process or course of a disease. Taking this approach to providing care involves taking into account the physical, psychological, and social factors of the disease or injury and promoting an integrated approach to treatment [2]. This topic has become a rather popular and regularly studied topic over the past several years, especially in the world of pain management and treatment.

It would seem apparent, especially in instances of chronic pain, that a simple explanation like “arthritis” can not adequately explain what is truly going on with your specific situation or limitation. While there very well may be biomechanical and physical issues like joint degeneration, to simplify a your suffering or pain to this one diagnosis seems misguided. And what about people who are experiencing real debilitating pain, but have no physical or biomechanical issues that can explain it? Are these people simply “making it up”? Is it “all in their head”?

Basic Principles of the Biopsychosocial Model

I’d say that the answer to those questions above is a resounding, “No”. But in order to understand why, we have to understand a few basic principles about all of the biopsychosocial factors that affect our health and well-being:

1. The relationship between psychological and physical factors of health can be extremely complex. A patient’s subjective experience can result from physiological factors, but it can’t simply be reduced to them [1].
2. These different factors affect each individual differently, since we are dealing with this individual’s subjective experience.
3. Changes in one of these factors (biological, psychological, or social/environmental) potentially create real and notable changes in the other factor(s) [3].

As you can see, there’s often more to any diagnosis or limitation than a simple answer like “arthritis” or “degenerative joint disease”.  So many other factors influence your experience of pain, your limitations, and your ability to manage that pain or limitation.

What About Treatment?

Here’s a short video of Rafi explaining a bit about the biopsychosocial model and how it influences what we do in the clinic:

Since we take a biopsychosocial approach, we understand that there are too many factors at play for rigid treatment protocols or “cookie-cutter” treatment programs. Even if two patients are referred to our clinic with the same diagnosis, they each differ physically, socially, or even psychologically. Because of all these factors, which can be different with every patient, throwing patients into the same exact treatment program will likely result in suboptimal outcomes [4]. So we don’t do that here.

Here’s a story: When I was just starting out in the world of outpatient orthopedic rehabilitation, I remember an older and more seasoned therapist telling me in my first week at the clinic that “a shoulder is a shoulder is a shoulder.” I operated under that assumption for a while, achieving mediocre or average outcomes with my patients. I wondered why some patients got better very quickly, while others with the same diagnosis struggled to make even modest progress towards their treatment goals. It wasn’t until I began to explore the application of a biopsychosocial approach to treatment, that I began to see and experience the results both my clients and I wished for.

By addressing not simply the physical symptoms and issues with the patient’s tissues, joints, and posture —and taking a broader look at each individual’s context and situation— I was able to deliver a higher standard of care. This became most evident in treating patients who had been experiencing chronic pain for years. And that is the approach we take at ProActive Rehabilitation & Wellness.

References

[1] Borrell-Carrio, F. (2004). The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. The Annals of Family Medicine, 2(6), 576-582. doi:10.1370/afm.245

[2] Covic, T. (2003). A biopsychosocial model of pain and depression in rheumatoid arthritis: A 12-month longitudinal study. Rheumatology, 42(11), 1287-1294. doi:10.1093/rheumatology/keg3

[3] Moseley, L. (2002). Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of Physiotherapy, 48(4), 297-302. doi:10.1016/s0004-9514(14)60169-0

[4] Gatchel, R. J., & Howard, K. J. (n.d.). The Biopsychosocial Approach. Retrieved from https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach