Neurobiopsychosocial (NBPS) Model

Key Points

 

• Holistic Perspective: The NBPS model emphasizes the importance of viewing health and illness through a comprehensive lens, integrating neurological, biological, psychological, and social factors to understand an individual’s overall well-being.

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• Personalized Treatment: By considering the interplay of various components affecting health, healthcare providers can create tailored treatment plans that address the unique needs and circumstances of each patient, leading to more effective interventions.

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• Interconnected Factors: The model highlights that health issues often arise from the interaction of multiple elements, such as stress (psychological), physical health (biological), and environmental influences (social), rather than being isolated to a single cause.

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• Technological Advancements: The NBPS model incorporates modern technologies, such as neuroimaging and neurostimulation, to enhance the understanding and treatment of health conditions, enabling more precise diagnostics and innovative therapies.

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Video: The original Biopsychosocial model by George L. Engel

 

 

The original biopsychosocial model of health and illness is a framework developed by George L. Engel that states that interactions between biological, psychological, and social factors determine the cause, manifestation, and outcome of wellness and disease. Historically, popular theories like the nature versus nurture debate posited that any one of these factors was sufficient to change the course of development. The biopsychosocial model argues that any one factor is insufficient; the interplay between people’s genetic makeup (biology), mental health and behavior (psychology), and social and cultural context determines the course of their health-related outcomes.

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The New Biopsychosocial (NBPS) Model of Health

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The Neurobiopsychosocial (NBPS) model represents a significant advancement over the traditional biopsychosocial model by incorporating neurological factors as a distinct and crucial component in understanding health and illness. While the biopsychosocial model, introduced by George Engel in 1977, provided a more holistic approach to healthcare by considering biological, psychological, and social factors, the NBPS model further refines this perspective by explicitly recognizing the role of the brain and nervous system.

This enhanced model acknowledges that neurological processes play a fundamental role in mediating the interactions between biological, psychological, and social factors. By including the "neuro" component, the NBPS model provides a more comprehensive framework for understanding the complex interplay of factors that influence an individual's health and well-being.

The NBPS model's inclusion of neurological factors allows for a deeper understanding of how brain function and neural pathways contribute to health outcomes, offering new insights into diagnosis, treatment, and prevention strategies. This expanded approach enables healthcare providers to develop more targeted and effective interventions that address the full spectrum of influences on a patient's condition.

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Neurological Influences

 

This encompasses the vital role of the brain and nervous system in shaping overall well-being, highlighting key aspects such as neurotransmitter activity, brain structure, neuroplasticity, and stress response. Imbalances in neurotransmitters like serotonin and dopamine are linked to mental health disorders, affecting mood and behavior, while neuroimaging reveals structural differences in the brains of individuals with various conditions. Neuroplasticity, the brain's ability to adapt and reorganize, is needed for recovery and learning, facilitating targeted interventions for issues like stroke and mental health disorders.

 

Additionally, chronic stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol levels that can harm immune function and overall health. Importantly, these neurological factors interact dynamically with biological, psychological, and social influences, emphasizing the complexity of health and the necessity for a comprehensive approach in treatment. By incorporating these elements into the Neurobiopsychosocial model, healthcare providers can create more effective, personalized interventions that address the multifaceted nature of health and illness.

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Biological Influences

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Biological influences on health include an individual’s genetic makeup and history of physical trauma or infection. Many disorders have an inherited genetic vulnerability. The most significant single risk factor for developing schizophrenia, for example, is having a first-degree relative with the disease (risk is 6.5%); more than 40% of monozygotic twins of those with schizophrenia are also affected. If one parent is concerned, the risk is about 13%; if both are affected, the risk is nearly 50%.

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It is clear that genetics have an essential role in the development of schizophrenia, but equally clear is that there must be other factors at play. Certain non-biological (i.e., environmental) factors influence the expression of the disorder in those with a pre-existing genetic risk.

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Psychological Influences

 

The psychological component of the biopsychosocial model seeks to find a psychological foundation for a particular symptom or array of symptoms (e.g., impulsivity, irritability, overwhelming sadness, etc.). Individuals with a genetic vulnerability may be more likely to display negative thinking that puts them at risk for depression; alternatively, psychological factors may exacerbate a biological predisposition by putting a genetically vulnerable person at risk for other risk behaviors. For example, depression on its own may not cause liver problems, but a person with depression may be more likely to abuse alcohol and, therefore, develop liver damage. Increased risk-taking leads to an increased likelihood of disease.

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Social Influences

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Social factors include socioeconomic status, culture, technology, and religion. For instance, losing one’s job or ending a romantic relationship may place one at risk of stress and illness. Such life events may predispose an individual to developing depression, which may, in turn, contribute to physical health problems. The impact of social factors is widely recognized in mental disorders like anorexia nervosa (a disorder characterized by excessive and purposeful weight loss despite evidence of low body weight). The fashion industry and the media promote an unhealthy standard of beauty that emphasizes thinness over health. Despite the obvious health risks, this exerts social pressure to attain this “ideal” body image.​​

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Application of the Biopsychosocial Model

The NBPS model states that the workings of the body, mind, and environment all affect each other. According to this model, none of these factors in isolation is sufficient to definitively lead to health or illness—the deep interrelation of all three components leads to a given outcome.

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Health promotion must address all three factors. A growing body of empirical literature suggests that the combination of health status, perceptions of health, and sociocultural barriers to accessing health care influences the likelihood of a patient engaging in health-promoting behaviors, like taking medication, proper diet or nutrition, and physical activity.

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Case Study: Applying the Neurobiopsychosocial Model to Post-Traumatic Stress Disorder (PTSD)

 

To illustrate the practical application of the Neurobiopsychosocial Model, let's consider a case study of PTSD treatment using EEG-guided neurofeedback.

 

Background

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A 35-year-old military veteran presented with symptoms of PTSD, including intrusive memories, nightmares, and hypervigilance. These symptoms significantly impacted his daily life, relationships, and overall well-being.

 

Application of the Neurobiopsychosocial Model

 

• Neurological Component: EEG-guided neurofeedback was employed to address the neurological aspects of PTSD. This technique harnesses the brain's neuroplasticity, allowing the patient to actively participate in reshaping his brain's activity patterns. The neurofeedback sessions focused on regulating brain wave patterns associated with PTSD symptoms.

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• Biological Component: The treatment plan thoroughly evaluated the patient's physical health, including hormone levels and sleep patterns. Sleep quality was monitored and improved through a combination of neurofeedback and behavioral interventions.

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• Psychological Component: Cognitive-behavioral therapy (CBT) was integrated into the treatment plan to address the psychological aspects of PTSD. This helped the patient develop coping strategies and reframe traumatic memories.

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• Social Component: The treatment approach included family therapy sessions and support group participation to address the social aspects of recovery. This helped improve the patient's relationships and social support network.

 

Outcome

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By addressing all components of the Neurobiopsychosocial Model, the patient experienced significant improvement in PTSD symptoms. The EEG-guided neurofeedback helped alleviate symptoms, while the comprehensive approach ensured that all aspects of the patient's health and well-being were addressed.

 

Conclusion

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The Neurobiopsychosocial Model offers a holistic and integrative approach to understanding and treating complex health conditions. By considering the interplay of neurological, biological, psychological, and social factors, healthcare professionals can develop more effective and personalized treatment strategies. As demonstrated in the PTSD case study, this model allows for a comprehensive approach that addresses multiple aspects of an individual's health and well-being, leading to more successful outcomes.

 

The future of healthcare lies in embracing such integrative models that recognize the complexity of human health and behavior. As our understanding of neuroplasticity and brain health continues to evolve, the Neurobiopsychosocial Model will likely play an increasingly important role in developing innovative and effective treatments for various conditions.