Why we use the Biopsychosocial Lifestyle Model

The biopsychosocial lifestyle model (BPSL) is a way of thinking about patients and clients in clinical settings that is designed to incorporate every aspect of their life, and reduce some of the drawbacks associated with older medical models. Most clinicians are taught the Biopsychosocial model (BPS) as an all-round model, but this model misses out the crucial elements of lifestyle that do not neatly fit into any of the three factors of the BPS model.

The BPS helps to understand clients by breaking down their factors into 3 main elements.

The first is Biological, and this includes factors such as genetics, family history, medications, substance use, and other medical conditions the client may have.
The second is Psychological, and this includes factors such as the client's cognitive and emotional patterns, attachment style, self image, beliefs, and coping skills.
The third is Social, and comprises the client's family, occupational, romantic, and social relationships.

This is where the BPS stops. However, the BPSL adds one more element into consideration: the client's lifestyle. In this new area we consider important but previously undiscussed elements such as the client's diet, exercise habits, sleep, smoking, and other lifestyle factors.

Why is this important?

As mental health practitioners, how we conceptualise our client is a large part of how we go on to treat the client. This is a problem for previous models such as the medical model, as clinicians who use this model can be blind to many possible avenues of intervention which could significantly help their clients, such as family therapy, occupational therapy, and education, to name just a few. The medical model has a drawback of overly focusing on the biological factors of mental health conditions, and therefore tends to address these conditions through biological interventions, predominantly medication, but occasionally others such as surgery or electroconvulsive therapy.

By broadening our understanding of the multitude of factors which can play a role in our client's presentation, we can better understand the totality of their situation and prepare better and more holistic treatments. For example, through understanding the client's financial and family situation, we may realise that a depressed client does not need antidepressants but instead may benefit from family therapy to reduce tension in the household which is contributing to their symptoms.

This is where the BPSL shines above the BPS. The BPSL framework compels clinicians to thoroughly investigate and acknowledge lifestyle as a potentially pivotal factor in conjunction with the conventional Biopsychosocial elements.

Why lifestyle?

Quite simply, it's a domain that isn't captured by the previous model despite significant research demonstrating its importance in mental health. For example, it's no secret that sleep is a huge factor in mental health; many mental health issues are comorbid with poor quality or disrupted sleep patterns. By improving clients’ sleep, we are often able to bring about significant reduction in symptoms. Additionally, even if a client's symptoms do not improve directly, by being more well rested, our client is likely to be more resilient to the difficulties they face.

Then comes the next huge factor, exercise! Exercise, or the lack of it, has been found to be a factor in a huge number of mental health disorders, particularly mood and anxiety disorders. Understanding our clients’ exercise habits can significantly help us to craft interventions that utilise this powerful element for improvement.

The next lifestyle factor which is often ignored by mental health professionals is diet, despite masses of historical and contemporary evidence of the impact of diet on mood and mental health disorders. Studies have found that dietary interventions alone are able to significantly improve depressive symptoms. Pairing dietary interventions with pharmacology, traditional psychotherapy, improved sleep and exercise renders potential to completely revolutionise a client's life.

This is the power of understanding all the elements of your client. It is not to say that lifestyle factors are the only important factors when conceptualising a mental health disorder, but rather that it is an incredibly powerful tool that can be used in concert with traditional psychotherapy and pharmacology. Without including lifestyle as part of our conceptualisation, we may be unintentionally excluding a huge number of effective interventions from our treatment plans.

How do we use the BPSL?

Luckily the BPSL fits incredibly neatly into the model that is already the norm among most mental health practitioners. A BPSL minded clinician simply has to include these elements in their diagnostic interviews and case conceptualisations. This is traditionally done in a conceptualisation table that uses the 4 Ps (Predisposing, Precipitating, Perpetuation, and Protective). Through the use of the 4 Ps, we can create a table that takes us through a timeline of our client’s life, and helps us conceptualise our clients in a more holistic and well rounded manner.

With this approach we can tackle the low hanging fruit which may facilitate significant improvement in our client's functioning.

Implications for Treatment

One of the most important tenets that all medical and mental health professionals should live by is that good diagnosis precedes good treatment. This does not require simply accurately diagnosing the client's symptoms, but deeply understanding the causes of their condition and identifying the factors that can be intervened for the greatest effect.

Using the BPSL allows us a new dimension through which to view our clients, and it is a dimension that is already well researched and comes with obvious and clear avenues for treatment. By incorporating the BPSL into our practice, we can elevate our treatment plans to be more practical, more holistic, and ultimately more effective.

Conclusion

I’m a firm believer that the BPSL is an upgrade on our standard BPS. I am interested in understanding my clients from as holistic a view as possible in order to give the best care as I can as a clinical psychologist. I use it because it helps me to truly understand my clients and remind me to actively check on areas that are so often ignored and underserved in psychology.

If you or anyone you know feel they might benefit from talking to someone, don't hesitate to reach out! We're here to help.

Chris Henshaw

Clinical Psychologist at Betterment