Mental health treatment: What are the options?

Mental health treatment: What are the options? (Photo: iStock)

Psychotherapists apply several techniques and modelling techniques to assist clients facing mental, neurological and substance use disorders.

One of these, the biopsychosocial model, is a holistic framework for understanding health and illness by examining the interplay of biological, psychological, and social factors.

Developed by George Engel in 1977, it challenges reductionist biomedical approaches by emphasising that health outcomes arise from dynamic interactions across these three domains.

These include the biological domain, which looks at genetic predispositions, physiological processes, and disease pathology.

The psychological domain, which focuses on thoughts, emotions, behaviours, coping mechanisms, and mental health, and the social domain, focusing on socioeconomic status, cultural influences, relationships, and environmental stressors.

One of the conditions for which we apply this model is in the treatment of depression,  a multifactorial mental disease that affects millions of individuals worldwide.

It represents a fine example of how biological, psychological, and social factors interact to account for the appearance, severity, and recovery of illness.

The biopsychosocial model represents an integrated way of conceptualising depression beyond the limitations of a strictly biomedical one. Biological factors like hereditary predisposition play a vital role in depression.

Studies have found that individuals with a family history of depression are also likely to develop the disorder.

Neurobiological factors like imbalances of neurotransmitters — namely serotonin, norepinephrine, and dopamine — have been largely implicated in depressive symptoms.

Neuroimaging studies have also shown changes in areas of the brain like the prefrontal cortex and hippocampus, which are responsible for mood regulation and cognitive processing.

Psychological factors through cognitive models suggest that depression is associated with negative thinking, low self-esteem, and learned helplessness.

Cognitive triad contends that depressed people have negative views of themselves, the world, and the future.

Moreover, adverse early life experiences such as trauma or neglect can affect maladaptive coping mechanisms and increase vulnerability to psychological distress. Personality traits, such as neuroticism, have also been linked to an increased risk for depression.

Social determinants of health, such as poverty, social isolation, and interpersonal conflicts, are the primary causes of depression. Individuals with inadequate social support are at greater risk of experiencing chronic depressive episodes.

Unemployment, discrimination and violence also exacerbate the condition by creating an environment of chronic stress and insecurity.

Cultural stigma regarding mental illness may also deter individuals from seeking early intervention, thus prolonging suffering and undermining recovery.

The strength of the three dimensions of the biopsychosocial model lies in its comprehension of the dynamic interaction among the three domains. 

Chronic social stress (social), for example, can alter cortisol levels and brain function (biological), which in turn can generate negative thinking and hopelessness (psychological). Similarly, a person with a genetic predisposition to depression may never get it unless triggered by social stressors or psychological trauma.

Biopsychosocial explanations of depression allow for more implicit diagnosis and treatment.

It facilitates integrative therapy comprising pharmacologic intervention, psychotherapy, and social support. Identification and treatment of all three components can yield more effective and sustainable outcomes in mental health care.

- The writer is a counselling psychologist and mental health expert.