Biopsychosocial Workshop
More than 30 years ago, the internist George Engel wrote an article in Science calling for a new approach to health. He spoke of developing a biopsychosocial model which recognizes that biological, psychological (for example, thoughts, emotions, and behaviors), and social factors (abbreviated "BPS") all play a critical role in how people deal with or adapt to disease or illness. This is in contrast to the traditional biomedical model of medicine that suggests every disease process can be explained by simple physical events (such as an infectious agent entering the body).
In an article in 2004 reviewing George Engel’s legacy, Francesc Borrell-Carrió, et al, wrote:
“The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care.”
In this workshop we will try to identify key biological, psychological and social issues that affect people with mood disorders. Topics will include:
- Brain and Mood – We will summarize the literature that shows how mood and mood disorders relates to brain functioning. We will also present some interesting data that shows that the simplistic notion of “biological” or “non-biological” depression (which somehow predicts whether to treat with medications or psychotherapy) is contradicted by data that shows that psychotherapy works by changing the brain.
- Mood charting, how and why to do it – In this section we will talk about why it is important to keep track of your mood on a regular basis, why it is often difficult to remember how you were feeling later, and what some of the barriers are to paying attention to mood in a constructive way.
- Social rhythms and the importance of routine – One of the most effective treatments for people with bipolar disorder involves systematically examining and modifying daily social rhythms. Many people with mood disorders find that their lives fall into patterns that may not be that healthy, with too much isolation and too little exposure to the outdoors. We will talk about how to make changes in this area.
- Circadian rhythms and light and sleep – In this portion of the workshop we will expand on the topic of our body’s “clock” and how it can easily malfunction in our technological society and how this malfunction can play a critical role in the development of depression.
- Dealing with stress and mindfulness – Most of us “filter” our experience through the lens of thoughts, ideas, fears, beliefs about the world and our place in it. Often these beliefs lead to unhappiness. Here we will talk about how a practice of mindfulness can lead to a clearer sense of the world, and a feeling of strength and peace in the face of stress.
- Inter-personal issues and patterns – Moods and mood disorders have a big effect on relationships. Those who are close to us adapt to how changing moods affect them in ways that may or may not be healthy. Here we will talk about some common patterns in relationships.
- Approaches to anxiety – Anxiety often accompanies a mood disorder. In this portion of the workshop we talk about ways of dealing with anxiety, especially approaches that don’t involve using medications, such as cognitive and behavioral interventions.
- Substances - use and misuse. Half of those who have mood disorders also have trouble at times with substance use. We will talk about why this is true and what can be done about it.
- Medications, what they can do, what they can't – When dealing with something as nebulous as depression, it is easy to feel frustrated and to hope that a doctor can find the “perfect” medication regimen that will take away all of our problems. In fact, some people come to see us hoping that we can figure out the perfect treatment without having to talk with us, sort of like taking your car in to the mechanic and leaving it there to be fixed. Here we talk about new medications, what they can do, and what they can’t.
- The value of psychotherapy – We will summarize the literature on the effectiveness of psychotherapy for people with mood disorders. We will also talk about how enduring patterns can develop in how we perceive the world around us (schemas) and how these patterns may relate to chronic depression.
- Diet and health issues – What we eat matters more for those with depression than those without. People with depression more often have nutritional deficiencies, weight problems, diabetes, and a host of other problems related to diet, and these problems can make it harder to recover from depression.
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