Bio-psycho-social model

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Mods: although this is not a plea for support, it relates heavily to some threads that have been posted in the Haven in recent weeks, and I'm asking you to let it remain in the Haven for at least a couple weeks. (Also I don't know where it would be more appropriate and yet still reach its intended audience.)

A basic tenet in clinical psychology is that psychopathology is usually determined by not a single factor, but rather a context of contributing factors. This was true when I first encountered the perspective in the 1980s and it remains true today.

The bio-psycho-social model is quite helpful and illustrative in depression. The "bio" part refers to genetic loading, but also factors that occur after birth, and these can include learned helplessness, CPTSD, hormonal changes (postpartum, anybody?), brain damage (some regions of the brain are more likely to cause depression than others), drugs of abuse as well as medications, and adequate nutrition, sleep, and exercise.

The "psycho" part means psychological factors, such as cognitive styles that lean towards spotting the negatives (and ASD, I'm talking to you, here), inaccurate beliefs about others that may come from family-of-origin as well as schooling, and also learned helplessness (notice that I included it in the bio part, as well).

The "social" part means the moderating effects of social support, as well as the detrimental effects of bullying, ostracism, and blocks to purposeful efforts such as advancing in work or education. It also includes too many social demands, which for us with ASD can mean trying to mask in a complex environment, as well as conflicting pressures from work, partner relationships, and parents and children.

A nuanced view of causation as well as treatment of depression and related disorders (anxiety, PTSD, etc.) takes all these factors into account. When we encounter a description that says "your depression is caused by [single factor] so do this [single action] and you will be cured," we need to remember the bio-psycho-social model and how it applies to us. Keeping up an exercise routine can be facilitated with social support. Cutting off all social ties or rejecting all emotional support, while seeming to simplify the picture, can cause other problems. Etc.

That reads like a course description for "Clinical Psychology 101".  Can you cite a few references?  I am not challenging your post; it just seems like a topic worth studying more deeply.

Yeah, part of this nuanced view is understanding of hierarchy and priority of these factors.

Biological factor is your brain, it's like your car.
Psychological factor is your consciousness and rational thinking, this is driver of your car.
Social factor is like traffic rules, road infrastructure and drivers in other cars.

If you don't get enough sunlight, physical activity, sleep, healthy food, water, etc. your car has flat tires, flat battery, empty gas tank, rusty engine, worn out break pads, clogged fuel pump, etc.

Driver behind the wheel fundamentally limited by condition of his car.

If you car is broken you are just not going anywhere. Without working car you can't improve your driving skills, it doesn't matter if you know traffic rules.

It means if you are depressed and you are not intentional about covering these basic needs, all other factors like therapy, medications, social support just fundamentally will not work. This should be general knowledge.

When we encounter a description that says "I'm glad that maintaining pressure in your tires helped you, but it's not for everyone" we need to remember the bio-psycho-social model and how it applies to all of us.

Moderators should really make salad's post "Hard intense training is the best cure for a lot of problems" sticky. Depressed people seeking for help really need this knowledge.

These are not hierarchical. That's a misinterpretation of the theory.

@Fnord: https://en.wikipedia.org/wiki/Biopsychosocial_model This model is so widely accepted that there is no need for a journal article and even if I had one, it would probably be from three decades ago. Wikipedia ought to do you. Or any Abnormal Psychology textbook.

They are hierarchical.

Where does you consciousness exist? In some abstract astral plane? No. It is function of your brain.

How do you experience emotions? Is it some abstract astral plane magic? No, it is result of chemical conductivity in synapses of neurons in your brain, physiological organ of your body.

How do you have motivation? Is it some abstract trait of your personality? No, it is result of biochemical processes, reward system of your brain, physiological organ of your body.

You don't understand the theory.

Thanks, Bea!  I went straight to the references section, before reading the article itself (good write-up, though).

The BPS model is non-hierarchical, although some who favor hierarchical models may try to bend and twist BPS into their personal belief systems.  BPS is more like a three-dimensional volume within which various vaguely-defined loci may be found.  Each locus represents a unique set of parameters that give rise to the individual personality.  Even then, other factors not within the BPS volume may influence the outcome.

(Reading those papers took me back to the days of my own Masters' Thesis.)

That's a way better wording of the general idea that I have in mind when I condemn the 'just do burpees until your depression goes away' sounding positions. They're way too oversimplified to be helpful and the black and white thinking used to reach those conclusions often doesn't lend itself to very meaningful discussions, just a lot of bluster and needless hostility.

Yeah, kinda like trying to do CPR when you do not even know what the initials stand for.  Even those of us with good intentions often do more harm than good when we do not know what to do.

Are you guys serious? Is this the first time you hear of this model?

This is literally the first document linked in references:
biopsychosocial-model-approach.pdf

Please, tell me why does the title of the first illustration says "HIERARCHY OF NATURAL SYSTEMS"?

Biological, psychological, and social factors exist along a continuum of natural systems, as depicted in the diagram above.

It explains the tendency towards defensiveness in some people; they're only genuinely trying to help.

It just means that someone who's describing literally being unable to get out of bed and who's main factor delaying intentional self-harm is struggling with the motivation and executive function required to perform those acts probably needs more than just to be told to do burpees until they puke.

They almost certainly need more than anyone on this board is qualified to provide.

The last sentence is quoted for truth.

Sadly, for the people seeking help, they are likely better off obtaining that help elsewhere.

This person unable to get out of bed due to screwed tryptophan metabolism and build up of quinolinic acid as a result of lack of physical activity among other things.

What would solve this problem, clear neurotoxic compound from their brain and allow tryptophan to cross blood-brain barrier to synthesize serotonin?

Positive affirmations? Emotional support? No, doing burpees until they puke.

I don't understand what kind of harm can this advice, this awareness cause this person?

One of the things I like about the biopsychosocial perspective is that it not only can account for different types of causality of depression; but it also can account for the various therapies known to be effective. For instance, CBT (cognitive behavioral therapy) combines mental changes - examining cognitions that can cause depression - and social support from a competent therapist; the behavioral part of CBT may use factors that are both mental and physiological, such as breathing exercises, physical exercise, and even snapping a rubber band on one's wrist each time a target cognition is found. So CBT is multifaceted. Psychodynamic therapies put a lot more focus on interpersonal learned experiences and current social experiences, with a lot of social support from the therapist. ECT (electroconvulsive or "shock" therapy) probably is primarily biological, in that it directly affects brain electrochemical functions, as do anti-depressant drugs. But surprisingly, there is a documented place for each of these treatment approaches in depression treatment.

Puking has not been shown to be necessary or sufficient in treatment of depression.

CBT doesn't treat depression. Do some research. Independent trials over and over demonstrate very small treatment effects for MDD, and those effects by design are just coping strategies for symptoms of depression, not treatment of condition.

This is the reason why institutions practicing CBT now combine it with physical activity. Because there is solid scientific evidence of physical activity being effective treatment for depression as condition.

You're fixated on the chemical side of it as though there's nothing beyond that and that approach is flawed no matter how condescending you act about it.

Yes actually, emotional support can contribute to helping change someone's mindset and improve how they can approach other advice. Just take this positive step is useless when one isn't focused on improving their depression but instead on just avoiding it further.

Becoming belligerent when your advice isn't accepted doesn't help either and it ends up appearing like bullying to the person being 'helped' because it often resembles patterns of bullying they've experienced before. (as reported by a poster who has been subjected to the pile-on of belligerent advice before) It contributes to their negative state, it doesn't help with their negative state. You can argue until you're blue in the face but you won't change how the behaviour is received.

There's nothing wrong with mentioning how important exercise is but when it's repeated over and over again as though it's the only viable solution and everyone else is actually harming the person by taking any other perspective you should expect that eventually that attitude will get called out as not helpful.

Repeating the same thing over and over again after it's been rejected by the person asking for help makes it no longer help, even if the message might genuinely be beneficial.