We are made up of more than skin and bones. We are more than just a “computer” mind that processes information. We have emotions, the freedom to think, experience physical sensations, and develop social connections.
Psychology is often thought of as the study of the human mind. But even that is an understatement, as branches of psychology have merged with nearly every aspect of the human experience.
The biopsychosocial model of psychology addresses several facets of the human experience in an attempt to gain a more holistic understanding of clients in the field of health.
This model of psychology and health includes the biological (physical), psychological (mental and emotional), and social (relational) components of an individual. Let’s pull that apart in more detail below.
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The biopsychosocial approach was developed by George Engel (1977) and John Romano to counter traditional biomedical models, which focused on pathophysiology. The concept was an attempt to emphasize the importance of understanding human health in its fullest context rather than limiting it to a biological system alone.
The biopsychosocial model considers biological, psychological, and social factors and their network of interactions within the realm of health, illness, and health care delivery (Engel, 1977).
Biological
The biological component of this model refers to genetics, physical health, and the function of our body and internal organs (Papadimitriou, 2017). Physical health affects mental wellbeing in many ways. The brain is an organ and can be prone to illness and disease just like any other organ of the body.
Physical illness also plays an impact on mental and emotional wellbeing. Most of us have experienced pain, illness, and physical discomfort and understand how this affects our mental and social health.
Genetics are the most basic components of how mental health is impacted. The phenotypic expression of genetics plays a role in brain function and perception (Papadimitriou, 2017). This foundational piece of biology influences all aspects of human life.
Psychological
Psychological wellbeing influences mental, physical, and social health (Cozolino, 2017). Unhealthy moods, thinking patterns, and behaviors are often symptoms of mental health conditions and contribute to an individual’s general health.
Psychological health is cyclical. Individuals who have depression or low mood might isolate themselves and avoid physical activities, resulting in less social interaction and higher levels of depression.
Similarly, individuals who are anxious will avoid situations that might be beneficial to other areas of health, such as getting out in nature, going out with friends, taking part in forms of physical activity, or going to regular medical checkups.
Social
Social factors include culture, family, socioeconomic, and relational components. External factors play a role in every aspect of health (Garcia-Gomez et al., 2013). Changes to the environment can play a negative or positive role in mental and physical health.
For example, individuals with low socioeconomic status may not have the means to live in a safe environment, which may also impact mental and emotional health. Family background impacts life choices, such as selection of hobbies, level of education, choice of career, and opportunity to access mental and physical health resources.
The biopsychosocial model uses a holistic viewpoint and acknowledges how health and illness are shaped by the interaction of biological, psychological, and social factors. Where the biomedical model sees disease as isolated, the biopsychosocial model sees them as a result of a dynamic connection between multiple dimensions.
Dynamic component of the model
An important underpinning of the biopsychosocial model is the interaction of how these components work. For example, physical health (biological) can impact type of employment, productivity at work, and therefore access to healthier foods and living environments, which impacts social and psychological aspects of health (Garcia-Gomez et al., 2013).
Mental health has also been shown to affect the decision-making process, leading to poorer choices in areas of physical and social health (Garcia-Gomez et al., 2013). For example, those with mental health issues may select unhealthy coping mechanisms (e.g., alcohol, drugs, or gambling) and unhealthy relationships rather than getting treatment for psychological issues or taking steps to improve wellbeing.
Further, physical activity is negatively correlated with depression, low mood, and anxiety and has both mental and physical benefits (Ohrnberger et al., 2017).
There is also a strong relationship between social interaction and mental health. Loneliness and social isolation have both been linked to higher rates of mortality and lower levels of physical health (Steptoe et al., 2012).
These dynamic interactions show the importance of considering the biopsychosocial model and assessing each of the components within it.
An Example of a Biopsychosocial Assessment
Just as the model implies, assessment includes evaluating each of the three areas described above and identifying deficiencies and specific, direct interactions.
Assessment generally involves asking open-ended questions regarding biological, psychological, and social areas of an individual’s life.
Biological assessment
The biological assessment includes factors that influence genetics, physiology, neurology, and chemistry. Questions should inquire about medication, underlying health conditions, history of disease, and family health history.
Examples include:
Are you experiencing any medical conditions that impact your life?
Family history of mental health and substance abuse
What are your current sleep habits?
Amount and type of physical activity
Current dietary habits
To aid in gathering information for a biological assessment, also consider using the client’s biofeedback devices.
Psychological assessment
The goal of the psychological portion of the assessment is to understand an individual’s thoughts, feelings, reasons for behavior, and mental state.
Ideas for assessing psychological components include:
What brings you to therapy today?
Describe your history of mental health.
How would you describe yourself? What are your strengths and weaknesses?
Assess for suicidal and homicidal thoughts, tendencies, and ideations.
What do you hope to get out of therapy?
Social assessment
The social assessment addresses any thoughts or behaviors that affect social situations. These are environmental factors, socioeconomic status, educational history, family relationships, and recreational activities and hobbies.
Questions should include:
Quality of relationships and support of family, friends, and community (Do you feel supported by those around you?)
Employment, educational, or military history
Information on legal issues (Have you been arrested or committed crimes?)
Describe the relationship you have with your immediate family members.
What do you do in your free time?
Assessment in each of these areas may be done through intake forms and face-to-face interviews. In most cases, some of the information may not be relevant to the presenting problem. However, it is the clinician’s job to determine which factors interact and the impact they may have on the client’s wellbeing and to create a treatment plan to address the areas that will allow the client to reach their goals.
Why the Biopsychosocial Approach Is Important in Psychology
The biopsychosocial model provides a wonderful option to gather a more holistic view of an individual and provides more than one way to improve life and wellbeing.
Biological and psychological models cannot explain mental health disorders adequately alone (Tripathi et al., 2019). The bridge between biological and psychological factors warrants further investigation.
The bio-psycho-social model of anxiety
This video explains how the biopsychosocial model helps to explain mental disorders such as anxiety.
The model helps the field of psychology and mental health acknowledge that each of the three systems overlap and interact, playing a role in wellbeing, risk for illness, and effective treatment for clients. This foundation places importance on client self-awareness and the relationship they have with health care providers.
Every client is different. Individual beliefs, drives, values, environmental background, resources, and genetics play a role in both understanding and treatment. Psychological disorders are not the result of a linear cause and effect, which the medical model suggests. Instead, they should be viewed as a complex circular model of multiple causes and effects.
Relationship between mental and physical health
The biopsychosocial model is an important model for the field of psychology because there are both direct and indirect relationships between physical and mental health (Ohrnberger et al., 2017).
As mentioned previously, the dynamic interaction between each of the three components shows the need to consider biological and social areas through the lens of psychology.
5 Activities and exercises
There are many practical ways to implement activities and exercises using the biopsychosocial model.
1. Activity monitoring
Activity monitoring is an exercise used in Cognitive-Behavioral Therapy for behavioral activation. Clients record what they are doing throughout the day, generally going hour by hour, and the moods that follow these activities.
This creates awareness of how much time is spent doing specific tasks (e.g., watching TV, scrolling through social media) and how it makes the client feel. Clients may also start to see how positive behaviors such as physical activity and positive social interaction can improve mood, which is a motivating way to get them to engage in healthy coping mechanisms.
2. Goal worksheets
Setting specific goals in areas of physical (biological), social, and environment (such as work, school, and extracurricular areas) can improve mental and emotional health as well.
Goal worksheets can be a great way to address all areas of the biopsychosocial model. This SMART+ Goals worksheet outlines SMART goals that can be implemented in any area of a client’s life.
3. Scheduling pleasurable moments
Since the biopsychosocial model is based on the concept of holistic healing and wellness, scheduling positive, joyful, and peaceful moments into a client’s daily life and routine can be a helpful activity.
This Pleasant Activity Scheduler provides a guide for thinking about and planning pleasurable moments. These moments may encompass any or every area of the client (biological, psychological, or social). For example, scheduling time with friends (social) to go on a walk (physical/biological) can help with mood (psychological).
4. Mindfulness
Mindfulness is beneficial for physical, mental, emotional, and social health. It helps bring us into the present moment to fully experience life. The Right Here, Right Now worksheet provides guidance for practicing mindfulness in any area of life.
5. Nature walk
The benefits of walking in nature touch on physical health and mental and emotional wellbeing and can be done with friends or loved ones to incorporate a social element as well. Any time spent in nature is good for health.
This worksheet Nature Play provides additional guidelines to focus on in order to make the most of the experience.
4 Tips When Applying the Biopsychosocial Model of Mental Health
One of the most important aspects of applying the biopsychosocial model to mental health is in the assessment process.
Assessment is one foundational way this model sets itself apart from other models used in psychotherapy and counseling. The assessment process tends to be more in depth by including psychological, biological, and social components (see above for examples of each).
In addition to a comprehensive assessment, the following areas should be considered when using the biopsychosocial approach.
1. Collaboration
Collaborating with other medical professionals is an important part of integrating holistic and thorough treatment in the biopsychosocial model. Medical doctors, psychiatrists, nutritionists, social workers, and legal experts are some examples of professionals that can play a part in a client’s treatment plan.
Practitioners should recognize that the relationship with other professionals is central in providing care.
2. Individualized treatment plan
Along with collaboration, the treatment plan for clients should be individualized based on specific biological, psychological, and social factors that are uncovered during the assessment. The treatment plan will include collaboration with appropriate medical professionals and specialists.
3. Cultural competence
It is critical to have cultural competence when using the biopsychosocial model in therapy. Cultural factors play a role in each of the three components of the model and should be understood and addressed in assessment, treatment planning, and ongoing care.
It’s important to understand how a client’s beliefs, values, and background play a role in their past experience, current situation, and choice of effective treatment.
4. Ethical consideration of autonomy
A client’s autonomy is central to the biopsychosocial model. It allows clients to make informed decisions of which aspects of the treatment plan they are open to and willing to comply with.
For example, a client who is against taking psychiatric medication should not be forced or coerced into believing this is the only (or most important) way to treat a mental health problem. Providing multidimensional options to treatment is a critical part of patient care.
Critiques of the Model
While the biopsychosocial model is comprehensive, holistic, and applicable to many areas of the medical field, it is not without its critics.
Lehman et al. (2017) suggest that the model is insensitive to a client’s subjective experience. These authors further claim that the model does not have safeguards in place to protect against allowing one of the three domains to be either over- or under-represented or emphasized.
In other words, there is still the probability that practitioners would focus too much attention on one of the three areas and neglect the rest.
An additional critique of the model is that it unintentionally creates a false distinction between biology and psychology (Wade & Halligan, 2017). This causes confusion in training programs and psychological assessments and has contributed to the stigmatization of mental health.
3 Best Books and Resources
There are a multitude of books and resources on the biopsychosocial model. These books offer deeper insight into the model and practical ways to assess and apply it in a therapy practice.
1. The Biopsychosocial Formulation Manual: A Guide for Mental Health Professionals – William Campbell and Robert Rohrbaugh
This is a comprehensive guidebook that provides a framework for conducting biopsychosocial assessments and formulating interventions in the field of mental health.
The book emphasizes the significance of considering biological, psychological, and social factors when understanding and addressing an individual’s mental health concerns.
It offers practical tools and case examples to aid mental health professionals in effectively integrating these diverse components into their clinical practice. The manual is designed to enhance the assessment and treatment process, ultimately improving patient care and outcomes.
2. The Rise and Fall of the Biopsychosocial Model: Reconciling Art & Science in Psychiatry – Nassir Ghaemi
This text delves into the historical trajectory of the biopsychosocial model in psychiatry and its impact on clinical practice.
The book critically examines the tensions between scientific objectivity and the subjective nature of mental health care, offering insights into reconciling these aspects.
It provides a thought-provoking exploration of how art and science converge in the field of psychiatry.
3. Biopsychosocial Assessment in Clinical Health Psychology – Frank Andrasik, Jeffrey Goodie, and Alan Peterson
This book provides tools for assessing health-related behaviors in each of the three areas of the biopsychosocial model. Through evaluating behavior and psychosocial components of mental illness, it provides evidence-based ideas for assessment and treatment.
The comprehensive text addresses behavioral, cognitive, and emotional issues and needs that clients may present with and how to guide them effectively on a path to holistic wellness.
Breathwork, specifically yogic breathing, has both physical and mental benefits, including decreasing stress and blood pressure, assisting with sleep, improving lung function, and improving cognitive performance (Sharma et al., 2013). This Yogic Breathing worksheet can be a guide for clients to get started with breathwork practice.
These Nurturing vs. Depleting Activities invite clients to review their daily activities and then assess whether these activities help or are detrimental to their mental, physical, and social health. Once they see how their time is spent, they can proactively seek activities that are more nurturing to their physical, social, and psychological health.
As mentioned earlier, being in nature can have many positive effects in all areas of health. This article What Is Nature and Ecotherapy & How Does It Work? expands on these benefits and offers wonderful ideas to help practitioners use nature to incorporate the three aspects of the biopsychosocial model.
This Exercise and Mental Health worksheet is designed for children and can be a great reminder of the benefits of exercise, physical activity, and movement on mental health and other areas of wellness. It explores ideas for becoming more active and encourages children and families to think about forms of exercise they might try.
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The path to health, healing, and wellness has many different roads. The biopsychosocial model provides a holistic approach to treating mental health.
The biological, psychological, and social aspects of an individual’s deficits and opportunities can be addressed to formulate an effective treatment plan. Through cultivating self-awareness and providing options for autonomy, clients can take charge of their health and improve various aspects of their lives.
The biopsychosocial model is both a philosophy of clinical care and a practical guide that clinicians can use for treatment. Moving beyond the one-size-fits all approach, multiple areas can be addressed to improve physical, psychological, and social wellbeing.
Cozolino, L. (2017). The neuroscience of psychotherapy: Healing the social brain. Norton and Company.
Engel, D. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.
Garcia-Gomez, P., Van Kippersluis, O., O’Donnell, E., & Van Doorslaer, H. (2013). Long term and spillover effects of health shocks on employment and income. Journal of Human Resources, 48(4), 873–909.
Lehman, B., David, D., & Gruber, J. (2017). Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass, 11(8), 123–128.
Ohrnberger, J., Fichera, E., & Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Journal of Social Science in Medicine, 195, 24–49.
Papadimitriou, C. (2017). The biopsychosocial model: 40 years of application in psychiatry. Psychiatry, 28, 107–120.
Sharma, V., Trakoo, M., Subramaniam, V., Rajajeyakumar, M., Bhavanani, A., & Sahai, A. (2013). Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students. International Journal of Yoga, 6(2), 104–110.
Steptoe, A., Shanker, A., Demakakos, P., & Wardle, J. (2012). Social isolation, loneliness and all-cause mortality in older men and women. National Academy of Science, 111(15), 5797–5811.
Tripathi, A., Das, A., & Kar, S. (2019). Biopsychosocial model in contemporary psychiatry: Current validity and future prospects. Indian Journal of Psychological Medicine, 41(6), 582–585.
Wade, D., & Halligan, P. (2017). The biopsychosocial model of illness: A model whose time has come. Clinical Rehabilitation, 31(8), 995–1004.
About the author
Dr. Melissa Madeson, Ph.D., believes in a holistic approach to mental health and wellness and uses a person-centered approach when working with clients.
Currently in full-time private practice, she uses her experience with performance psychology, teaching, and designing collegiate wellness courses and yoga therapy to address a range of specific client needs.
Humans are complex creatures.
Just as the model implies, assessment includes evaluating each of the three areas described above and identifying deficiencies and specific, direct interactions.
One of the most important aspects of applying the biopsychosocial model to mental health is in the assessment process.
