NOT GOOD;Discussion Question: Comparison of Theories on Anxiety Disorders

Traditionally, physician's have been trained to focus specifically on the body from a biological perspective and for centuries have treated patients according but how much of a physical illness is actually due to psychological or social stressors?  This is the question that George Engle, a psychiatrist and a medical school professor, developed as he trained medical students and worked with cardiologist, John Romano.  In 1977, Engel introduced the biopsychosocial (BPS) model of treatment, which basically drifted away from the disease model to include other factors as possible contributors to medical disorders.  This model takes a holistic perspective in terms of treatment as it accounts for environmental, as well as psychological contributions to one's overall physical health.  

Let's say, for example, that Susie has a horrible migraine headache that will not go away.  Where does she go?  To her physician, right (general practitioner)?  Of course the physician is going to do what he/she has been trained to do, which is to focus on the body.  First, they start by taking blood tests and vital signs and then they may talk to Susie to find out a little about how long she's had the headache and how she would rate her level of pain, etc.  After that, they may schedule Susie for an MRI, or fMRI, as well as other tests to rule out the possibility of any biological origin of the headache.  If those tests come back negative and the physician ascribes to the BPS model, he or she may prescribe a medication but may also ask Susie about any recent changes in her life.  At this point, although Susie had initially not wanted to burden her physician with her problems, she began to tell her physician that a month ago, she lost her job after 20 years, her car was repossessed, her favorite dog died last week, she had been unable to find work, although she had desperately tried, and the phone won't stop ringing as creditors continue to call seeking payment.  

In this example, Susie obviously has a lot going on right now in terms of stress and it clear that she has a migraine.  Both what role do her stressors play in the development of her migraine and why can't she "get rid" of it?  Her physician may give her a prescription (i.e., Imatrex, etc.) but suggests that she see a therapist to help her better manage her stress.  Susie takes her physician's advice and after meeting with her therapist and taking her medication, Susie notices that not only is her headache gone, but she is much less stressed, is more calm overall, and can think more rationally.  As a result, Susie has learned to use some deep breathing techniques, which has helped her to calm down. In therapy, as she discusses her problems, her therapists helps her to grieve her losses and then to develop some short and long-term goals and then to develop an action plan.  Susie realizes that she is feeling much better.  Her self-esteem has improved and she is feeling more confident overall and before she knows it, she has a job offer.  Was this change in Susie due to the medication?.....to therapy?......to both?  Is the BPS model an effective method of treatment for patients with medical issues?

Below are a couple of links that may interest you regarding these issues.


http://www.annfammed.org/content/2/6/576.full

http://www.medschool.lsuhsc.edu/medical_education/undergraduate/spm/SPM_100/documents/BiopsychosocialModel.pdf