Lecture 2 - biopsychosocial model PDF

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2 - biopsychosocial model Biopsychosocial model  Opposite to the biomedical model o Left no room within its framework for the social, psychological, and behavioral dimensions of illness"  Medical model left no room for psychosocial aspect  Bio = biological  Psycho = psychological  Social = social (environment)  Biomedical model doesn’t account for all variability and BPS model helps to account for that The variability challenge  Experiences are unique to the individual o Inter variability: variability between different people eg/ if family experiences a hurricane, all ppl of family will experience different o Intra variability: changes within same person  Biomedical doesn’t explain inter or intra much, BPS is better at that Elements of development  Multi directionality: development includes both growth and decline  Plasticity/flexibility: brain structure changes, flexibility: able to adapt depending on environment. Brain biologically and behaviorally adapt  The historical context: world events that shape people eg. Great depression 9/11  Multiple causation: many things that affect development, work in isolation and with one another Strengths  Acknowledges factors outside "biological"  Helps to account for inter and intra variability  Easy to understand  Strong evidence in its effectiveness to improve patient outcomes o Is the best establishes alternative to the medical model o Never intended to replace biomedical model Challenges  Ignored spiritual aspects of health  It accounts for all variables - challenging to work with practically  Lack of guidelines or clinical treatments - no DSM Why is medical model still dominant?  It's what we know best  Hard work - collaboration to put BPS model into work  Medicine is still rooted in objectivity and quantitative "science", medicine hasn’t caught up to doing science that is subjective  Healthcare system are controlled by those who oversee funding o Still rooted in biomedical model  Disease codes drive cost and funding - every disease has code Cognitive behavioral model

CBM defined  Combines behavioral model and cognitive model - these were 2 separate models in psych  3 components  Multiple and reciprocal interactions among thoughts, feeling, behaviour  Don’t confuse is BPS model, BPS is a perspective and CBM is a model (used my health care professional)  Entry level for intervention is thoughts and behaviours (not feelings)  Hard to change feelings, try to change thoughts and behaviours which influence feelings Cognitive (1st element)  Contributions of thoughts and beliefs to maladaptive behaviours and negative emotions  Cognitive domain: internal rules ,standard you set for self, etc.  Acquisition and performance of behaviours  How one interprets or perceives the events, not the event itself  Assumptions 1. Cognition affects emotion and behaviour 2. Cognition can be monitored and changed 3. By altering cognition, one can exert desired emotional and behavioral changes Levels of Cognition  Focus on role of distorted or unhelpful thoughts in illness  Levels of cognition to work with: 1. Schemas: core beliefs, unconditional evaluation you have of yourself and other people influenced by early experiences and stick with the person unless identified and challenged - hard to change with therapy 2. Information processing biases: types of thinking that can be maladaptive eg. Black or white thinking (one or the other thinking), exaggerating negative quality 3. Automatic thoughts - stream of consciousness, hard to work with because hard to interfere with stream of consciousness Behavioral (2nd element)  Tied into principles of learning  Focuses on measurable, overt behaviours  Many behaviours believed to be a result of aging have been shown to be modifiable. Goal is to:  Process of learning adaptive behaviours o Reduce maladaptive behaviours o Increase adaptive behaviours  Antecedents - what's happening before performance of the behaviour , helps answer why someone does behaviour  Consequences - what happened after performing that behaviour, can be good or bad Principles of CB assessment  Check medical data - old ppl take a lot of meds  Behavioral assessment o Define the problematic behaviours o Contextualize behaviour - what happened before  Cognitive assessment o Self report  Get assessments from multiple sources

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Self reports Second party ratings Observation Follow up clinical interview

Cognitive Behavioral therapy  A form of psychotherapy  Time limited, learning based approach  Goal = change unhelpful thoughts and behaviours to adaptive ones  Focused on factors which maintain problem not what initially caused problem  Instructional and educational component - learn about diff behaviours Techniques of CBT  Behavioral activation and engagement o Identifying and scheduling specific positive and enjoyable activities to increase positive and enjoyable sources o Can positively reinforce  Apply differential reinforcement - reinforcing a behaviour or cognition in appropriate context - in MI, the behaviour or the thought doesn’t match what’s going on. Cognition and behaviour matches context  Generalization of stimuli and responses - broaden response to similar stimuli, generalize the appropriate response to similar situations  Shaping and chaining - larger task into smaller steps and then putting them all together  Extinction - removed maladaptive cognition  Exposure and relaxation - person learns there's no threat and how to relax  Skills training - communication, etc Does it work?  Most extensive tested form of psychotherapy  Mostly effective o Publication bias - don’t see publications where CBT is bad or did nothing o Quality of trials - few gold standard o Wait list controls - what comparison group you have. People in CBT vs people in wait list for CBT CBT for older adults  Effectiveness can range across types of older adults, but can benefit from here  Considerations - financial considerations, transportation, mobility issues other active health issues (older ppl have more than 1 chronic disease)  Adaptations - adapt to your clients o Group CPT can be rlly good according to literature for old ppl cuz social isolation Mental health from CBM  How does this model relate to mental health and illness? o Maladaptive cognitions, maladaptive behaviours  Goal is adaptation o Capacity of an individual to meet own needs effectively within the environment  Aging may impact the cognitive and behavioral aspects of model Case study: applying CBT

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Lillian lives in long term care facility. She has been there for 2 years now. From her first week living there she has jointed the knitting circle. For the past 4 week her knitting friends haven't seen her at the group. The nurses check in and she says she's not up to it.

Apply CBM Test question  Assessment - stay away from feelings o Think about the principles  Cognitive - ask her a Question, get other reports, ask nurses family, see if shes doing other maladaptive behaviours  Behaviour - contextualize the behaviour  Intervention - you see depressive symptoms o Techniques of CBT  Behavioral activation and engagement, shaping and chaining...