Abstract
Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.
Highlights
In his 1977 paper, Engel stated his belief that in order for a medical science to have a complete understanding of disease, as the underpinning for rational treatment and health care, “it would need to incorporate the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of the illness, that is the physician role and the health care system” ((1), p.132)
Emotional climate refers to the overall intensity and valence of family emotional exchange. It colors all aspects of family relationships, and is likely a key factor contributing to emotional status and outcomes in family members
A negative family emotional climate (NFEC) includes hostility, criticism, verbal attacks, etc., and it is similar to the criticism construct of Expressed Emotion [EE; [8]]
Summary
In his 1977 paper, Engel stated his belief that in order for a medical science to have a complete understanding of disease, as the underpinning for rational treatment and health care, “it would need to incorporate the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of the illness, that is the physician role and the health care system” ((1), p.132). Medicine needed a biopsychosocial model (BPS) [See [2] for an in-depth analysis of Engel’s Biopsychosocial Model in the context of paradigms, models, and theories]. Engel’s Biopsychosocial Model was based in systems theory, which assumes that all levels of organization are linked to each other in a hierarchical relationship, so that change in one affects change in the others. The BPS model itself did not include specific aspects of the biological, psychological, or social factors, nor mechanisms by which interrelation occurs [3]. This lack of specificity limited critical research which would fully instantiate the model and provide guidance for adequate scientific inquiry, education, and clinical applications of the model
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