Seeing the patient (their fears and hopes) as part of the healing model is imperative to treating a patient. I strongly suggest the inclusion of a basic understanding of developmental psychology to understand the cognitive abilities of patients as to what they can verbalise and understand.

Regards

Nico 

If I understand your question correctly:

Yes I do believe the shift towards the biopsychosocial model is important to give people optimal assessment and treatment based on their needs. Most diseases are affected or complicated in some ways by other factors, which might affect treatment succsess. The patients can have needs that affect the ordinary treatment , and by adding and individualising services to fit their needs with a broader approach can raise treatment succsess.  

I have written about this theory in my PhD which you can find here:

http://hdl.handle.net/11250/283543 

One of the first advocates for this approach within the medical world was George L. Engel

(Engel, 1977). He challenged the biomedical thinking by showing other significant factors

affect the disease and its course. He stated that the biomedical approach did not answer the

scientific and social challenges that medicine and psychiatry were facing and he was referring

to the effect of treating patients with placebo medicine – showing the influence of

psychosocial factors on many biological treatments. Study results have shown that medicine

alone cannot treat patients with substance use disorders, but a combination of medicine and

psychosocial treatment does have a positive effect on patients (Volpicelli, Pettinati, McLellan

& O’Brien, 2001). The medication should have been effective by itself if the biology of

humans was the predominant factor. Engel’s biggest contribution to the field was challenging

and broadening clinical views and understanding of the disease by applying a broader medical

approach to meet patient needs. The weakness of earlier approaches is that they are

insufficient and not broad enough to give comprehensive and satisfying explanations on their

own. A combination of ideas from different perspectives can address the limitations of

individual theories.

Dear Mohan, Nico and Marianne,

Thank you for revisiting these important issues!

I say this because the overlapping fields of psychosomatic medicine, behavioral medicine, health psychology and psychiatric epidemiology have evolved so much since I began my work many years ago. Engel was a pioneer who influenced all of these research areas. Indeed, Marianne's comments are very spot on.

Albee is another pioneer whom you may want to research. I like his work because he originally developed a model that I have found useful in my work on stress in medical students, spouse caregivers of persons with either Alzheimer's disease or schizophrenia, disasters, etc.

Albee formed a simple model that characterizes

Distress as a response to not only stressors, but also a person's unique vulnerabilities and resources.

Distress = (Exposure to Stress + Vulnerability)/Resources

I have found it useful, statistically, to multiply Exposure by Vulnerability because, the product makes it easier to use statistically than the addition.

I am not saying that this is a perfect model, but that it provides a theoretical framework for research in terms of identifying groups at high risk for deleterious responses to varying types of stressors. I do believe, as did Albee, that vulnerabilities are more hard wired (race, gender, developmental illnesses, personality, early trauma) than are resources, which are more flexible (coping, social supports, income).

My experience has been that Health Psychology embraces the other disciplines mentioned above and that it has focused on empirical analyses of theoretical models. Having gone to numerous conferences on psychosom medicine, behavioral medicine, health and physio psychology, I can tell you that it is difficult to talk about health psych in isolation without referencing its cousins. .

Health is much more than not being ill (the latter definition is rather a common sence concept but it is also associated with medical approach focusing on deficits, sickness and negative diagosis to much extent).

Firstly, today  I was wondering about this question and thought there are some concepts within health and positive psychology that one may find interesting in explaining why people maintain health, recover faster and generally how they response to the demanding situations. Here are only some of them, which are well known:

1) Lazarus and Folkman transactional model of stress and coping (Lazarus, Folkman 1984) has been an inspiration to many other researchers who developed new concepts in theory of coping with stress i.e. Hobfoll's conservation of resources theory, Aspinwall's proactive coping (1997 Psychol Bull)

These concepts explain quite much about how the person may adjust i.e. to chronic illness and emphasise the importance of cognitive processes.

2) Seligman's style of explaining failures and success. What I like about this concept are the three dimensions in which the attributional/explanatory style  is framed (internal vs external, stable or unstable, local vs global).

This concept has many applications in counseling and CBT therapy.

3) Spiritual dimension of health (Ewles, Simnet, 1992). It emphasises not only the religious aspects but mainly the dignity, authonomy, freedom, the ideas that correspond strictly to self-development of the individual. Recent studies confirm that people in many situations, including critical events, may benefit from using religious or spiritual efforts to deal with problems (i.e. positive religious coping strategies developed in questionnaire RCOPE, Pargament, 1997).

4) Schwarzer's concept of self-efficacy (1992) - To put it simple, it has been empirically confirmed  that self-efficacy predicts better adjustment.

5) ... despite there are more of them, I wish they were more recognised by National Healthcare Services across the countries. That would be beneficial for example in developing successful multi-level suicide prevention programmes.

Dear friends thanks for answering my question which has little bit  improve my concept regarding the health psychology it is a very new subject for me.

In my younger days, I taught 2nd year medical student a semester called Emotions and Health. On day one, I offered lunch at a fancy restaurant to any student who could name a human health condition that did not have a psychological component in cause, course of cure. Lost once over several years when I could not find a reference soon enough.

Of course psychology is required to understand all the layers of all of the factors involved in both disease and wellness. Take a look at the "will to live" research, for examples. Or resilience as a factor in psychoneuroimmunology...

psychology is sure an important component in understanding health and disease. most behavior change model has a psychological component. in fact preventive perspective of health is better than cure. understanding psychology behind the disease and embracing psychological ways to prevent and treat it is a golden chance to abundant living. yes psychology is important and necessary in health and disease. research show that patients who are psychologically well heal faster physically.

Health psychology is important since mind and body interact continually in all physical states. Affecting one affects the other. The more "psycho-educated" we are about these mechanisms and their consequences, the more equipped we become in promoting health or accepting the lack of it. 

Absolutely it is important but it doesn't matter how important it is to those of us who study PNI if those driving the car don't want to hear the message. If we become the same as those that have had all the answers for the years past then we loose the value of what we have studied and what makes the blood course through our veins. It's not what we do it is how we do it that counts and how we are is the only way to change the worn out model that doesn't work. The proof is obvious by the amount of disease that continue--heart disease, obesity, cancer and autoimmune disease. Recently I read a great article that said we can't move into the future if we fail to let go of the past. How many people really are willing to do that? The old guard is unwilling to let go of what they know and they are still in control.

Dear Mohan,

Indeed to understand health psychology fully, the inclusion of biopsychology and social model is appropriate.

Biopsychology enlightens us on the patients health issues and more - anatomy, disease, diagnosis and drugs included. Even biopsychology is divided into 6 divisions - 1) Physiological Psychology 2) Psychopharmacology 3) Neuropsychology 4) Psychophysiology 5) Cognitive Neuroscience and 6) Comparative Psychology

The social model may point towards the social economic status (SES) the patients are facing whether the patients are economically stable or poorly displaced.

All affect the patients health directly one way or another - thus making health psychology more meaningful because the health professionals are now equipped with full knowledge of their patients medical and social background. This makes the information more useful and complete.

Best regards - Mariam

The biopsychosocial model is essential in health psychology and it should be in medicine but isn't -- mainly biochemical  (xray, blood test) and drug dependent.

Is there a way to integrate the biopsyschosocial model in regular health care and medical practice? 

Not only is there a way but Holistic Nursing has been trying to nudge this forward for 36 plus years.  Functional Medicine has also been trying to nudge this forward for a number of years, as has Holistic Medicine.  Holistic Medicine has been on this path for approximately 36 years if history serves me right.  The problem or challenge, which ever you prefer is that insurance companies stop us in our tracks.  If you want care that goes to the core or examines and treats by assessing the patient from a root-cause perspective then the patient has to pay for it themselves. Insurance will not pay for it.

Functional medicine doctors are so tired of dealing with the insurance companies that they no longer take insurance.  Frankly, when I go into practice I will not take anything but private pay.  I don't have the time to spend all day trying to deal with the insurance companies.  It's negative, it wears on the provider, and it becomes more expensive mentally, physically and financially for the practitioner and patient.  It is not about what is best for the patient it is what is the most financially profitable for big business.  My question is how do we encourage insurance companies to support assessing and treating from the root-cause perspective where it will make a real difference instead of the constant band aide approach that we all know doesn't work.  History is the proof.  In addition to that Pharmaceuticals are also part of the driving force in this because they want to sell pills and medication and they are large contributors to educating physicians.

Once the pharmaceutical companies started advertising it drove the price of care up even further. That action dis-empowered the population and sold them on a quick fix.  Now they don’t want to take the self-responsibility because it takes work. I believe the tide is beginning to turn, at least a little bit.  What will do the most good is if the population takes their power back and that is going to take work on the part of those of us who are care providers—psychologist, psychiatrists, medical doctors, and nurses (which btw are not part of the medical field, they are a separate profession in and of themselves).

The bottom line is that it is a multi-layered issue and care providers must collaborate to make the changes in the system.

Not only is there a way but Holistic Nursing has been trying to nudge this forward for 36 plus years.  Functional Medicine has also been trying to nudge this forward for a number of years, as has Holistic Medicine.  Holistic Medicine has been on this path for approximately 36 years if history serves me right.  The problem or challenge, which ever you prefer is that insurance companies stop us in our tracks.  If you want care that goes to the core or examines and treats by assessing the patient from a root-cause perspective then the patient has to pay for it themselves. Insurance will not pay for it.

Functional medicine doctors are so tired of dealing with the insurance companies that they no longer take insurance.  Frankly, when I go into practice I will not take anything but private pay.  I don't have the time to spend all day trying to deal with the insurance companies.  It's negative, it wears on the provider, and it becomes more expensive mentally, physically and financially for the practitioner and patient.  It is not about what is best for the patient it is what is the most financially profitable for big business.  My question is how do we encourage insurance companies to support assessing and treating from the root-cause perspective where it will make a real difference instead of the constant band aide approach that we all know doesn't work.  History is the proof.  In addition to that Pharmaceuticals are also part of the driving force in this because they want to sell pills and medication and they are large contributors to educating physicians.

Once the pharmaceutical companies started advertising it drove the price of care up even further. That action dis-empowered the population and sold them on a quick fix.  Now they don’t want to take the self-responsibility because it takes work. I believe the tide is beginning to turn, at least a little bit.  What will do the most good is if the population takes their power back and that is going to take work on the part of those of us who are care providers—psychologist, psychiatrists, medical doctors, and nurses (which btw are not part of the medical field, they are a separate profession in and of themselves).

The bottom line is that it is a multi-layered issue and care providers must collaborate to make the changes in the system.

I have also been involved in integrative medicine going back to1964 when I developed biofeedback and published applications and also on meditation and relaxation and  more recently on yoga for depression, anxiety, and Irritable Bowel Syndrome.  I have collaborated with MDs.  Not much progress. 

It's not a question of antinomy.  All processes are taking place in the body.  Psychological variables like anger and anxiety are taking place in the body as are other variables like vagal tone and baroflex sensitivity and blood pressure and they can and do interact (different degrees) with respect to disorder or pathology or potential treatment.

Ah, yes Dr Shapiro, now I know why I knew you name. It's an honor to be exchanging ideas with you. ...and for that matter everyone else as well. The more we collaborate in discussion the closer we become to collaborating with other peers and helping to creat the change that we want to see. Thanks.

Thanks, Ann, for your kind words.  Be interesting to know what these interchanges lead to.  David