Nature therapy, sometimes referred to as ecotherapy, forest therapy, forest bathing, grounding, earthing, Shinrin-Yoku or Sami Lok, is a practice that describes a broad group of techniques or treatments using nature to improve mental or physical health. Spending time in nature has various physiological benefits such as relaxation and stress reduction. Additionally, it can enhance cardiovascular health and reduce risks of high blood pressure.
History
Scientists in the 1950s looked into the reasons humans chose to spend time in nature. There is relatively recent history of the term Shinrin-yoku (森林浴)
or 'forest bathing' gaining momentum as a term and concept within
American culture; the term 'forest bathing' and Shrinrin-yoku was first
popularized in Japan by the former head of the Japanese Ministry of Agriculture, Forestry, and Fisheries, Tomohide Akiyama, in 1982 to encourage more people to visit the forests.
Health effects
Mood
Nature therapy has a benefit in reducing stress and improving a person's mood.Even a small amount of interaction with nature, such as having a tree
outside one’s home in urban communities, has been found to increase
human wellbeing and promote mental health. This may be due to aesthetic reasons, encouragement of physical
activity, or general feelings of connection to nature, where the
increased proximity to nature creates higher feelings of connectivity.
Forest therapy has been linked to some physiological benefits as indicated by neuroimaging and the profile of mood states psychological test.
Stress and depression
Interaction with nature can decrease stress and depression. Forest therapy might help stress management for all age groups.
Social horticulture could help with depression and other mental health problems of PTSD, abuse, lonely elderly people, drug or alcohol addicts, blind people, and other people with special needs. Nature therapy could also improve self-management, self-esteem, social
relations and skills, socio-political awareness and employability. Nature therapy could reduce aggression and improve relationship skills.
Sounds of nature alone can be enough to affect relaxation and
enhance positive emotions while reducing negative emotions, including
depression and anger. Perceiving nature can lower stress levels and aid in recovery for diastolic and systolic blood pressures.
Other possible benefits
Nature
therapy could help with general medical recovery, pain reduction,
Attention Deficit/Hyperactivity Disorder, dementia, obesity, and vitamin D deficiency. Interactions with nature environments enhance social connections,
stewardship, sense of place, and increase environmental participation. Connecting with nature also addresses needs such as intellectual capacity, emotional bonding, creativity, and imagination. Overall, there seems to be benefits to time spent in nature including memory, cognitive flexibility, and attention control.
Research also suggests that childhood experience in nature are
crucial for children in their daily lives as it contributes to several
developmental outcomes and various domains of their well-being.
Essentially, these experiences also foster an intrinsic care for nature.
Criticism
A 2012 systematic review study showed inconclusive results related to the methodology used in studies. Spending time in forests demonstrated positive health effects, but not
enough to generate clinical practice guidelines or demonstrate causality. Additionally, there are concerns from researchers expressing that time
spent in nature as a form of regenerative therapy is highly personal and
entirely unpredictable. Nature can be harmed in the process of human interaction.
Governmental support and professionalization
In Finland, researchers recommend five hours a month in nature to reduce depression, alcoholism, and suicide. South Korea has a nature therapy program for firefighters with post-traumatic stress disorder. Canadian physicians can also "prescribe nature" to patients with mental
and physical health problems encouraging them to get into nature more.
Land management has preserved the natural characteristics of Hopetoun Falls, Australia while allowing ample access for visitors.An image of the Sahara Desert from satellite. It is the world's largest hot desert and third-largest desert after the polar deserts.
The natural environment or natural world encompasses all biotic and abiotic things occurring naturally, meaning in this case not artificial. The term is most often applied to Earth or some parts of Earth. This environment encompasses the interaction of all living species, climate, weather and natural resources that affect human survival and economic activity. The concept of the natural environment can be distinguished as components:
Complete ecological units that function as natural systems without massive civilized human intervention, including all vegetation, microorganisms, soil, rocks, plateaus, mountains, the atmosphere and natural phenomena that occur within their boundaries and their nature.
In contrast to the natural environment is the built environment. Built environments are where humans have fundamentally transformed landscapes such as urban settings and agricultural land conversion,
the natural environment is greatly changed into a simplified human
environment. Even acts which seem less extreme, such as building a mud hut or a photovoltaic system in the desert,
the modified environment becomes an artificial one. Though many animals
build things to provide a better environment for themselves, they are
not human, hence beaver dams and the works of mound-building termites are thought of as natural.
People cannot find absolutely natural environments on
Earth, naturalness usually varies in a continuum, from 100% natural in
one extreme to 0% natural in the other. The massive environmental
changes of humanity in the Anthropocene have fundamentally effected all natural environments including: climate change, biodiversity loss and pollution from plastic and other chemicals in the air and water.
More precisely, we can consider the different aspects or components of
an environment, and see that their degree of naturalness is not uniform. If, for instance, in an agricultural field, the mineralogic composition and the structure of its soil are similar to those of an undisturbed forest soil, but the structure is quite different.
Earth science generally recognizes four spheres, the lithosphere, the hydrosphere, the atmosphere and the biosphere as correspondent to rocks, water, air and life respectively. Some scientists include as part of the spheres of the Earth, the cryosphere (corresponding to ice) as a distinct portion of the hydrosphere, as well as the pedosphere (to soil) as an active and intermixed sphere. Earth science (also known as geoscience, the geographical sciences or the Earth Sciences), is an all-embracing term for the sciences related to the planet Earth. There are four major disciplines in earth sciences, namely geography, geology, geophysics and geodesy. These major disciplines use physics, chemistry, biology, chronology and mathematics to build a qualitative and quantitative understanding of the principal areas or spheres of Earth.
The Earth's crust or lithosphere, is the outermost solid surface of the planet and is chemically, physically and mechanically different from underlying mantle. It has been generated greatly by igneous processes in which magma cools and solidifies to form solid rock. Beneath the lithosphere lies the mantle which is heated by the decay of radioactive elements. The mantle though solid is in a state of rheicconvection. This convection process causes the lithospheric plates to move, albeit slowly. The resulting process is known as plate tectonics. Volcanoes result primarily from the melting of subducted crust material or of rising mantle at mid-ocean ridges and mantle plumes.
An ocean is a major body of saline water and a component of the hydrosphere. Approximately 71% of the surface of the Earth (an area of some 362 million square kilometers) is covered by ocean, a continuous body of water that is customarily divided into several principal oceans and smaller seas. More than half of this area is over 3,000 meters (9,800 ft) deep. Average oceanic salinity is around 35 parts per thousand
(ppt) (3.5%), and nearly all seawater has a salinity in the range of 30
to 38 ppt. Though generally recognized as several separate oceans,
these waters comprise one global, interconnected body of salt water
often referred to as the World Ocean or global ocean. The deep seabeds
are more than half the Earth's surface, and are among the
least-modified natural environments. The major oceanic divisions are
defined in part by the continents, various archipelagos and other criteria, these divisions are : (in descending order of size) the Pacific Ocean, the Atlantic Ocean, the Indian Ocean, the Southern Ocean and the Arctic Ocean.
A river is a natural watercourse, usually freshwater, flowing toward an ocean, a lake, a sea or another river. A few rivers simply flow into the ground and dry up completely without reaching another body of water.
The water in a river is usually in a channel, made up of a stream bed between banks. In larger rivers there is often also a wider floodplain
shaped by waters over-topping the channel. Flood plains may be very
wide in relation to the size of the river channel. Rivers are a part of
the hydrological cycle. Water within a river is generally collected from precipitation through surface runoff, groundwater recharge, springs and the release of water stored in glaciers and snowpacks.
Small rivers may also be called by several other names, including stream, creek and brook. Their current is confined within a bed and stream banks. Streams play an important corridor role in connecting fragmented habitats and thus in conserving biodiversity. The study of streams and waterways in general is known as surface hydrology.
A lake (from Latin lacus) is a terrain feature, a body of water that is localized to the bottom of basin. A body of water is considered a lake when it is inland, is not part of an ocean and is larger and deeper than a pond.
Natural lakes on Earth are generally found in mountainous areas, rift zones and areas with ongoing or recent glaciation. Other lakes are found in endorheic basins
or along the courses of mature rivers. In some parts of the world,
there are many lakes because of chaotic drainage patterns left over from
the last ice age.
All lakes are temporary over geologic time scales, as they will slowly
fill in with sediments or spill out of the basin containing them.
A pond is a body of standing water, either natural or human-made, that is usually smaller than a lake. A wide variety of human-made bodies of water are classified as ponds, including water gardens designed for aesthetic ornamentation, fish ponds designed for commercial fish breeding and solar ponds designed to store thermal energy. Ponds and lakes are distinguished from streams by their current speed.
While currents in streams are easily observed, ponds and lakes possess
thermally driven micro-currents and moderate wind-driven currents. These
features distinguish a pond from many other aquatic terrain features,
such as stream pools and tide pools.
Human impact on water
Humans impact the water in different ways such as modifying rivers (through dams and stream channelization), urbanization and deforestation. These impact lake levels, groundwater conditions, water pollution, thermal pollution, and marine pollution. Humans modify rivers by using direct channel manipulation. We build dams and reservoirs and manipulate the direction of the rivers
and water path. Dams can usefully create reservoirs and hydroelectric
power. However, reservoirs and dams may negatively impact the
environment and wildlife. Dams stop fish migration and the movement of
organisms downstream. Urbanization affects the environment because of
deforestation and changing lake levels, groundwater conditions, etc.
Deforestation and urbanization go hand in hand. Deforestation may cause
flooding, declining stream flow and changes in riverside vegetation. The
changing vegetation occurs because when trees cannot get adequate water
they start to deteriorate, leading to a decreased food supply for the
wildlife in an area.
The atmosphere of the Earth serves as a key factor in sustaining the planetary ecosystem. The thin layer of gases that envelops the Earth is held in place by the planet's gravity. Dry air consists of 78% nitrogen, 21% oxygen, 1% argon, inert gases and carbon dioxide. The remaining gases are often referred to as trace gases. The atmosphere includes greenhouse gases such as carbon dioxide, methane, nitrous oxide and ozone. Filtered air includes trace amounts of many other chemical compounds. Air also contains a variable amount of water vapor and suspensions of water droplets and ice crystals seen as clouds. Many natural substances may be present in tiny amounts in an unfiltered air sample, including dust, pollen and spores, sea spray, volcanic ash and meteoroids. Various industrial pollutants also may be present, such as chlorine (elementary or in compounds), fluorine compounds, elemental mercury, and sulphur compounds such as sulphur dioxide (SO2).
The ozone layer of the Earth's atmosphere plays an important role in reducing the amount of ultraviolet (UV) radiation that reaches the surface. As DNA
is readily damaged by UV light, this serves to protect life at the
surface. The atmosphere also retains heat during the night, thereby
reducing the daily temperature extremes.
Earth's
atmosphere can be divided into five main layers. These layers are
mainly determined by whether temperature increases or decreases with
altitude. From highest to lowest, these layers are:
Exosphere: The outermost layer of Earth's atmosphere extends from the exobase upward, mainly composed of hydrogen and helium.
Thermosphere: The top of the thermosphere is the bottom of the exosphere, called the exobase. Its height varies with solar activity and ranges from about 350–800 km (220–500 mi; 1,150,000–2,620,000 ft). The International Space Station
orbits in this layer, between 320 and 380 km (200 and 240 mi). In
another way, the thermosphere is Earth's second highest atmospheric
layer, extending from approximately 260,000 feet at the mesopause to the
thermopause at altitudes ranging from 1,600,000 to 3,300,000 feet.
Mesosphere: The mesosphere extends from the stratopause to 80–85 km (50–53 mi; 262,000–279,000 ft). It is the layer where most meteors burn up upon entering the atmosphere.
Stratosphere: The stratosphere extends from the tropopause to about 51 km (32 mi; 167,000 ft). The stratopause,
which is the boundary between the stratosphere and mesosphere,
typically is at 50 to 55 km (31 to 34 mi; 164,000 to 180,000 ft).
Troposphere:
The troposphere begins at the surface and extends to between 7 km
(23,000 ft) at the poles and 17 km (56,000 ft) at the equator, with some
variation due to weather. The troposphere is mostly heated by transfer
of energy from the surface, so on average the lowest part of the
troposphere is warmest and temperature decreases with altitude. The tropopause is the boundary between the troposphere and stratosphere.
Other layers
Within the five principal layers determined by temperature there are several layers determined by other properties.
The ozone layer
is contained within the stratosphere. It is mainly located in the lower
portion of the stratosphere from about 15–35 km (9.3–21.7 mi;
49,000–115,000 ft), though the thickness varies seasonally and
geographically. About 90% of the ozone in our atmosphere is contained in
the stratosphere.
The ionosphere:
The part of the atmosphere that is ionized by solar radiation,
stretches from 50 to 1,000 km (31 to 621 mi; 160,000 to 3,280,000 ft)
and typically overlaps both the exosphere and the thermosphere. It forms
the inner edge of the magnetosphere.
The homosphere and heterosphere:
The homosphere includes the troposphere, stratosphere and mesosphere.
The upper part of the heterosphere is composed almost completely of
hydrogen, the lightest element.
The dangers of global warming are being increasingly studied by a wide global consortium of scientists. These scientists are increasingly concerned about the potential long-term effects of global warming on our natural environment and on the planet. Of particular concern is how climate change and global warming caused by anthropogenic, or human-made releases of greenhouse gases, most notably carbon dioxide,
can act interactively and have adverse effects upon the planet, its
natural environment and humans' existence. It is clear the planet is
warming, and warming rapidly. This is due to the greenhouse effect,
which is caused by greenhouse gases, which trap heat inside the Earth's
atmosphere because of their more complex molecular structure which
allows them to vibrate and in turn trap heat and release it back towards
the Earth. This warming is also responsible for the extinction of natural
habitats, which in turn leads to a reduction in wildlife population. The
most recent report from the Intergovernmental Panel on Climate Change
(the group of the leading climate scientists in the world) concluded
that the earth will warm anywhere from 2.7 to almost 11 degrees
Fahrenheit (1.5 to 6 degrees Celsius) between 1990 and 2100. Efforts have been increasingly focused on the mitigation of greenhouse gases that are causing climatic changes, on developing adaptative strategies to global warming, to assist humans, other animal, and plant species, ecosystems, regions and nations in adjusting to the effects of global warming. Some examples of recent collaboration to address climate change and global warming include:
The Kyoto Protocol,
which is the protocol to the international Framework Convention on
Climate Change treaty, again with the objective of reducing greenhouse
gases in an effort to prevent anthropogenic climate change.
The Western Climate Initiative,
to identify, evaluate, and implement collective and cooperative ways to
reduce greenhouse gases in the region, focusing on a market-based cap-and-trade system.
A significantly profound challenge is to identify the natural
environmental dynamics in contrast to environmental changes not within
natural variances. A common solution is to adapt a static view
neglecting natural variances to exist. Methodologically, this view could
be defended when looking at processes which change slowly and short
time series, while the problem arrives when fast processes turns
essential in the object of the study.
Climates can be classified
according to the average and typical ranges of different variables,
most commonly temperature and precipitation. The most commonly used
classification scheme is the one originally developed by Wladimir Köppen. The Thornthwaite system, in use since 1948, uses evapotranspiration as well as temperature and precipitation information to study animal species diversity and the potential impacts of climate changes.
Weather is a set of all the phenomena occurring in a given atmospheric area at a given time. Most weather phenomena occur in the troposphere, just below the stratosphere. Weather refers, generally, to day-to-day temperature and precipitation activity, whereas climate is the term for the average atmospheric conditions over longer periods of time. When used without qualification, "weather" is understood to be the weather of Earth.
Weather occurs due to density (temperature and moisture)
differences between one place and another. These differences can occur
due to the sun angle at any particular spot, which varies by latitude
from the tropics. The strong temperature contrast between polar and
tropical air gives rise to the jet stream. Weather systems in the mid-latitudes, such as extratropical cyclones, are caused by instabilities of the jet stream flow. Because the Earth's axis is tilted relative to its orbital plane, sunlight
is incident at different angles at different times of the year. On the
Earth's surface, temperatures usually range ±40 °C (100 °F to −40 °F)
annually. Over thousands of years, changes in the Earth's orbit have
affected the amount and distribution of solar energy received by the
Earth and influenced long-term climate.
Surface temperature
differences in turn cause pressure differences. Higher altitudes are
cooler than lower altitudes due to differences in compressional heating.
Weather forecasting is the application of science and technology to
predict the state of the atmosphere for a future time and a given location. The atmosphere is a chaotic system, and small changes to one part of the system can grow to have large effects on the system as a whole. Human attempts to control the weather have occurred throughout human history, and there is evidence that civilized human activity such as agriculture and industry has inadvertently modified weather patterns.
Evidence suggests that life on Earth has existed for about 3.7 billion years. All known life forms share fundamental molecular mechanisms, and based
on these observations, theories on the origin of life attempt to find a
mechanism explaining the formation of a primordial single cell organism
from which all life originates. There are many different hypotheses
regarding the path that might have been taken from simple organic molecules via pre-cellular life to protocells and metabolism.
Although there is no universal agreement on the definition of
life, scientists generally accept that the biological manifestation of
life is characterized by organization, metabolism, growth, adaptation, response to stimuli and reproduction. Life may also be said to be simply the characteristic state of organisms. In biology, the science of living organisms, "life" is the condition which distinguishes active organisms from inorganic matter, including the capacity for growth, functional activity and the continual change preceding death.
A diverse variety of living organisms (life forms) can be found in the biosphere on Earth, and properties common to these organisms—plants, animals, fungi, protists, archaea, and bacteria—are a carbon- and water-based cellular form with complex organization and heritable genetic information. Living organisms undergo metabolism, maintain homeostasis, possess a capacity to grow, respond to stimuli, reproduce and, through natural selection, adapt to their environment in successive generations. More complex living organisms can communicate through various means.
An ecosystem (also called an environment) is a natural unit consisting of all plants, animals, and micro-organisms (biotic factors) in an area functioning together with all of the non-living physical (abiotic) factors of the environment.
Central to the ecosystem concept is the idea that living organisms are continually engaged in a highly interrelated set of relationships with every other element constituting the environment in which they exist. Eugene Odum, one of the founders of the science of ecology,
stated: "Any unit that includes all of the organisms (i.e.: the
"community") in a given area interacting with the physical environment
so that a flow of energy leads to clearly defined trophic structure,
biotic diversity, and material cycles (i.e.: exchange of materials
between living and nonliving parts) within the system is an ecosystem."
The human ecosystem concept is then grounded in the deconstruction of the human/nature dichotomy,
and the emergent premise that all species are ecologically integrated
with each other, as well as with the abiotic constituents of their biotope.
A more significant number or variety of species or biological diversity
of an ecosystem may contribute to greater resilience of an ecosystem
because there are more species present at a location to respond to
change and thus "absorb" or reduce its effects. This reduces the effect
before the ecosystem's structure changes to a different state. This is
not universally the case and there is no proven relationship between the
species diversity of an ecosystem and its ability to provide goods and
services on a sustainable level.
The term ecosystem can also pertain to human-made environments, such as human ecosystems
and human-influenced ecosystems. It can describe any situation where
there is relationship between living organisms and their environment.
Fewer areas on the surface of the earth today exist free from human
contact, although some genuine wilderness areas continue to exist without any forms of human intervention.
Biogeochemical cycles
Chloroplasts conduct photosynthesis and are found in plant cells and other eukaryotic organisms. These are chloroplasts visible in the cells of Plagiomnium affine — many-fruited thyme-moss.
The nitrogen cycle is the transformation of nitrogen and nitrogen-containing compounds in nature. It is a cycle which includes gaseous components.
The water cycle,
is the continuous movement of water on, above, and below the surface of
the Earth. Water can change states among liquid, vapour, and ice at
various places in the water cycle. Although the balance of water on
Earth remains fairly constant over time, individual water molecules can
come and go.
The carbon cycle
is the biogeochemical cycle by which carbon is exchanged among the
biosphere, pedosphere, geosphere, hydrosphere, and atmosphere of the
Earth.
The oxygen cycle is the movement of oxygen within and between its three main reservoirs: the atmosphere, the biosphere, and the lithosphere. The main driving factor of the oxygen cycle is photosynthesis, which is responsible for the modern Earth's atmospheric composition and life.
The phosphorus cycle
is the movement of phosphorus through the lithosphere, hydrosphere, and
biosphere. The atmosphere does not play a significant role in the
movements of phosphorus, because phosphorus and phosphorus compounds are
usually solids at the typical ranges of temperature and pressure found
on Earth.
Wilderness is generally defined as a natural environment on Earth that has not been significantly modified by human activity. The WILD Foundation
goes into more detail, defining wilderness as: "The most intact,
undisturbed wild natural areas left on our planet – those last truly
wild places that humans do not control and have not developed with
roads, pipelines or other industrial infrastructure." Wilderness areas and protected parks are considered important for the survival of certain species, ecological studies, conservation, solitude, and recreation. Wilderness is deeply valued for cultural, spiritual, moral, and aesthetic reasons. Some nature writers believe wilderness areas are vital for the human spirit and creativity.
The word, "wilderness", derives from the notion of wildness; in other words that which is not controllable by humans. The word etymology is from the Old Englishwildeornes, which in turn derives from wildeor meaning wild beast (wild + deor = beast, deer). From this point of view, it is the wildness of a place that makes it a
wilderness. The mere presence or activity of people does not disqualify
an area from being "wilderness". Many ecosystems that are, or have been,
inhabited or influenced by activities of people may still be considered
"wild". This way of looking at wilderness includes areas within which
natural processes operate without very noticeable human interference.
Wildlife includes all non-domesticated
plants, animals and other organisms. Domesticating wild plant and
animal species for human benefit has occurred many times all over the
planet, and has a major impact on the environment, both positive and
negative. Wildlife can be found in all ecosystems. Deserts, rain
forests, plains, and other areas—including the most developed urban
sites—all have distinct forms of wildlife. While the term in popular
culture usually refers to animals that are untouched by civilized human
factors, most scientists agree that wildlife around the world is (now)
impacted by human activities.
Before flue-gas desulfurization was installed, the air-polluting emissions from this power plant in New Mexico contained excessive amounts of sulfur dioxide.Amazon rainforest in Brazil.
The tropical rainforests of South America contain the largest diversity
of species on Earth, including some that have evolved within the past
few hundred thousand years.
It is the common understanding of natural environment that underlies environmentalism — a broad political, social and philosophical
movement that advocates various actions and policies in the interest of
protecting what nature remains in the natural environment, or restoring
or expanding the role of nature in this environment. While true
wilderness is increasingly rare, wild nature (e.g., unmanaged forests, uncultivated grasslands, wildlife, wildflowers) can be found in many locations previously inhabited by humans.
Halting human-induced global warming, which represents pollution, a threat to biodiversity, and a threat to human populations.
Shifting from fossil fuels to renewable energy
in electricity, heating and cooling, and transportation, which
addresses pollution, global warming, and sustainability. This may
include public transportation and distributed generation, which have benefits for traffic congestion and electric reliability.
Reducing the import of second hand electronic appliances from developed countries to developing countries.
Criticism
In
some cultures the term environment is meaningless because there is no
separation between people and what they view as the natural world, or
their surroundings. Specifically in the United States and Arabian countries many native
cultures do not recognize the "environment", or see themselves as
environmentalists.
Biopsychosocial models (BPSM) are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio-environmental factors. These models specifically examine how these aspects play a role in a range of topics but mainly psychiatry, health and human development.
The term is generally used to describe a model advocated by George L. Engel
in 1977. The model builds upon the idea that "illness and health are
the result of an interaction between biological, psychological, and
social factors".
The idea behind the model was to express mental distress as a
triggered response of a disease that a person is genetically vulnerable
to when stressful life events occur. In that sense, it is also known as
vulnerability-stress model.
It then became referred to as a generalized model that interpreted similar aspects, and became an alternative to the biomedical and/or psychological dominance of many health care systems.
As of 2017 the BPSM had become generally accepted. It grew in interest for researchers in healthcare and active medical professionals in the decade to 2020.
Current status
A
2024 review proposed use of the BPSM because the biomedical model did
not fit the social and psychological aspects of health problems.
A 2023 review said that in the previous decades substantial
evidence had arisen supporting BPSM, although the theory of it remained
unclear.
A 2021 review found a substantial gap between healthcare
professionals knowledge of the BPSM and their adoption of it in clinical
practice.
A 2018 review found that BPSM in primary care could lead to
improved clinical outcomes, through creating awareness of factors
impacting health and enhancing self-management of patients' illnesses.
A 2007 review said that the biopsychosocial model was widely accepted as the most heuristic approach to understanding and treating chronic pain.
A 2004 review said the BPSM was widely used as both a philosophy
of clinical care and a practical clinical guide useful for broadening
the scope of a clinician's gaze. It proposed the model had evolved into a
biopsychosocial and relationship-centered framework for physicians. It
proposed three clarifications to the model, and identified seven
established principles.
Self-awareness.
Active cultivation of trust.
An emotional style characterized by empathic curiosity.
Self-calibration as a way to reduce bias.
Educating the emotions to assist with diagnosis and forming therapeutic relationships.
Using informed intuition.
Communicating clinical evidence to foster dialogue, not just the mechanical application of protocol.
Institutional recognition
In
the decade to 2015 there was a rising interest among healthcare
researchers and practicing medical professionals in the biopsychosocial
model. However, despite the rising interest, medical schools had limited use
of the model in their curriculums relative to the increasing literature
about the model.
Biopsychosocial model vs. Biomedical model
The biopsychosocial and biomedical models offer distinct perspectives on understanding and addressing health and illness.
Biomedical model
The biomedical model,
which was historically prevalent, takes a reductionist approach by
focusing on biological factors and treating diseases through medical
interventions. It sees diseases as isolated physical abnormalities.
While this approach was once deemed sufficient, research within
psychology and the social sciences cast doubt on its effectiveness.
Biopsychosocial model
The
biopsychosocial model adopts a holistic viewpoint, acknowledging the
complex interplay of biological, psychological, and social factors in
shaping health and illness. It sees diseases as outcomes of dynamic interactions among various
dimensions. The model emphasizes the interconnectedness of these
dimensions, recognizing their mutual influence on an individual's
health.
The BPSM has been extended to consider additional holistic
elements influencing the perceived necessity for healthcare and the
focus on health-related matters: Information, Beliefs, and Conduct.
Based on the model's dependence on perception, it has been considered
imperative to actively engage the individuals or communities whose
requirements are being addressed, regardless of whether the focus is on their health, education,
employment, housing, or any other needs. A key term in the
biopsychosocial model is "syndemic" which refers to a set of health
problem factors that interact synergistically with each other ranging
from socioeconomic status to genetics.
Treatment under the biopsychosocial model is comprehensive,
involving medical, psychological, and social interventions to address
overall well-being.
In relation to patient populations
Health
inequities, often rooted in social determinants of health, highlight
the disparities in health outcomes experienced by different populations.
The BPSM provides a framework for comprehending how health
disparities arise and persist, which makes it a model of interest in
targeting health inequities.
Some patients that fall under the biopsychosocial model may not
fall under the biomedical model, as the biopsychosocial model considers
factors that may not physiologically manifest in a person. These patients include those affected by health inequities and those at risk of infirmity.
In relation to prevention
Preventative medicine considers preventative measures to stop patients from obtaining infirmity in the first place. By combatting preventable chronic diseases which make up a majority of
deaths in patients of the US, the BPSM has been considered a potential
tool to improve patient outcomes. SAMHSA has promoted BPSM approaches in preventing opioid use.
In relation to gender
Within
the framework of the biopsychosocial model, gender is regarded by some
as a complex and nuanced construct, shaped by the intricate interplay of
social, psychological, and biological factors. This perspective, as echoed by the Gender Spectrum Organization,
defines gender as the multifaceted interrelationship between three key
dimensions: body, identity, and social gender.
In essence, this characterization aligns with the fundamental
principles of the biopsychosocial model, emphasizing the need to
consider not only biological determinants but also the profound
influences of psychological and social contexts on the formation of
gender.
According to the insights of Alex Iantaffi and Meg-John Barker,
the biopsychosocial model provides a comprehensive framework to
understand the complexities of gender. They illustrate that biological, psychological, and social factors are
not isolated entities but rather intricately intertwined elements that
continually interact and shape one another. In this dynamic process, a
person's gender identity emerges as the result of a complex interplay
between their biological characteristics, psychological experiences, and
social interactions. This holistic perspective is in harmony with the biopsychosocial
model's approach, which acknowledges the inseparable connection between
these various dimensions in influencing an individual's overall
well-being.
In essence, within the biopsychosocial paradigm, gender is not
merely a product of biological determinants; rather, it is a dynamic and
interconnected aspect of human identity. This perspective urges a more nuanced understanding, encouraging
researchers and medical professionals to consider the intricate
interplay of social, psychological, and biological factors when
exploring and addressing the complexities of gender.
Models, theories and theorists
The following models or theories are regarded as biopsychosocial;
Kozlowska's Functional Somatic Symptoms approach sees attachment relationships and other factors as causes of somatic problems. Siegel's Interpersonal Neurobiology
(IPNB) model is similar to Kozlowska's approach, but sees the
individual brain and mind, and interpersonal relationships, as part of
one reality, rather than separate elements.
In 2012 Lumley and colleagues used a non-Engel model to conduct a
biopsychosocial assessment of the relationship between pain and emotion.
In 1986 Zucker and Gomberg used a non-Engel biopsychosocial perspective to assess the etiology of alcoholism.
Potential applications
Understanding of medical effects
When
Engel first proposed the biopsychosocial model it was for the purpose
of better understanding health and illness. While this application still
holds true the model is relevant to topics such as health, medicine,
and development. Firstly, as proposed by Engel, it helps physicians
better understand their whole patient. Considering not only
physiological and medical aspects but also psychological and
sociological well-being. Furthermore, this model is closely tied to health psychology.
Health psychology examines the reciprocal influences of biology,
psychology, behavioral, and social factors on health and illness.
Primary care
BPSM
can improve primary care clinical outcomes, through creating awareness
on the interactions among biological, psychological, sociocultural, and
spiritual factors, and enhancing self-management of patients' illnesses.
Chronic and ill-defined conditions
BPSM is useful to address chronic diseases and ill-defined illnesses to which patients mount unique responses.
Pain
BPSM
can be applied in relation to pain. Several factors outside an
individual's health may affect their perception of pain. For example, a
2019 study linked genetic and biopsychosocial factors to increased
post-operative shoulder pain. Future studies are needed to model and further explore the relationship between biopsychosocial factors and pain.[36]
A BPSM appraisal can be used in diagnosis of depression and anxiety.
One advantage of applying the biopsychosocial model to developmental psychology is that it allows for an intersection within the nature versus nurture debate. This model provides developmental psychologists a theoretical basis for the interplay of both hereditary and psychosocial factors on an individual's development.
Care
The BPSM approach has been used as a framework for or component of care.
Biopsychosocial research
Wickrama
and colleagues have conducted several biopsychosocial-based studies
examining marital dynamics. In a longitudinal study of women divorced
midlife they found that divorce contributed to an adverse
biopsychosocial process for the women. In another study of enduring marriages, they looked to see if hostile
marital interactions in the early middle years could wear down couples
regulator systems through greater psychological distress, more
health-risk behaviors, and a higher body mass index (BMI). Their
findings confirmed negative outcomes and increased vulnerability to
later physical health problems for both husbands and wives.
Kovacs and colleagues meta-study examined the biopsychosocial experiences of adults with congenital heart disease. Zhang and colleagues used a biopsychosocial approach to examine parents own physiological response when facing children's negative emotions, and how it related to parents' ability to engage in sensitive and supportive behaviors. They found parents' physiological regulatory functioning was an
important factor in shaping parenting behaviors directed toward
children's emotions.
A biopsychosocial approach was used to assess race and ethnic
differences in aging and to develop the Michigan Cognitive Aging
Project. Banerjee and colleagues used a biopsychosocial narrative to describe the dual pandemic of suicide and COVID-19.
Despite its theoretical robustness and growing empirical support,
the implementation of this model in clinical practice remains
inconsistent, hindered by systemic, professional, and cultural
barriers.
Artificial intelligence-driven tools are also being explored to
integrate biopsychosocial data into clinical decision-making, enabling
personalized treatment plans that reflect the complexity of each
patient's condition.
Criticisms
There have been a number of criticisms of Engel's biopsychosocial model.
Benning summarized the arguments against the model including that it
lacked philosophical coherence,
was insensitive to patients' subjective experience,
engendered an undisciplined eclecticism
that provided no safeguards against either the dominance or the
under-representation of any one of the three domains of bio, psycho, or
social.
Psychiatrist Hamid Tavakoli argued that Engel's biopsychosocial model should be avoided because it
unintentionally promoted an artificial distinction between biology and psychology, and
caused confusion in psychiatric assessments and training programs,
ultimately it has not helped the cause of trying to de-stigmatize mental health. The perspectives model does not make that arbitrary distinction.
A number of these criticisms have been addressed. For example, the
biopsychosocial pathways model describes how it is possible to
conceptually separate, define, and measure biological, psychological,
and social factors, and thereby seek detailed interrelationships among
these factors.
As of 2017 whilst Engel's call to arms for a biopsychosocial
model had been taken up in several healthcare fields and developed in
related models, it had not been adopted in acute medical and surgical
domains.
History
The BPSM was proposed in the late 1800s.
The idea that there are several factors that may contribute to one's mental suffering is nothing new.
Psychologist Urie Bronfenbrenner
popularized the belief that social factors play a role in developing
illnesses and behaviors. Engel later used Bronfenbrenner's research as a
column of his biopsychosocial model and framed this model to display
health at the center of social, psychological, and biological aspects.
Adolf Meyer's
psychobiology model is considered the forerunner to the biopsychosocial
model by many. Meyer emphasised understanding mental illness in the
context of a patient's personal history over diagnostic categories. Meyer laid down the groundwork for understanding the interplay of
psychology and biology but tended to view these as separate entities
that interacted. Engel's model represents a broader and more integrated
approach that considers biological, psychological, and social factors as
interconnected elements.
The WHO definition of health adopted in 1948 implied a broad socio-medical perspective.
Roy Grinker actually coined the term 'biopsychosocial' long before Engel (1954 vs 1977). However Grinker was seeking to highlight biological aspects of mental
health, rather than Engel's emphasis on psychosocial aspects of general
health.
Engel broadened medical thinking by re-proposing a separation of body and mind. The idea of mind–body dualism goes back at least to René Descartes,
but was forgotten during the biomedical approach. Engel emphasized that
the biomedical approach is flawed because the body alone does not
contribute to illness. Instead, the individual mind (psychological and social factors) play a
significant role in how an illness is caused and how it is treated.
Engel proposed a dialogue between the patient and the doctor in order to
find the most effective treatment solution.
George L. Engel and John Romano of the University of Rochester in 1977, are widely credited with being the first to propose a biopsychosocial model. Engel struggled with the then-prevailing biomedical approach to medicine as he strove for a more holistic approach by recognizing that each patient has their own thoughts, feelings, and history. In developing his model, Engel framed it for both illnesses and psychological problems.
Emergence within the context of psychiatry
The
biopsychosocial model is not just one of many competing possibilities -
another intelligently constructed explanation of health. Its emergence
is best understood within a historical context. The biopsychosocial
model's emergence in psychiatry was influenced by the credibility
problem in psychiatry as a medical specialism that arose during wartime
conditions.
By the 20th century, psychiatry was still a relatively new field. In the Victorian era,
psychiatry was faced with two key challenges: firstly, taking control
of the asylum system from lay administrators and secondly, constructing a
credible knowledge base for medical authority over mental illness. At
the time, the solution to this was developing a rhetoric of
justification for psychiatry which was that the brain is the root of
insanity, and physicians are the guardians of mental health. This
position both reflected and contributed to the rise of eugenics thought in western intellectual culture. However, this was challenged by the shellshock problem after World War I
– there was a fundamental incompatibility between a eugenic view of
lunacy and the sad reality of respectable men breaking down with
predictable regularity in the war trenches. This led to the recognition
of neurosis and acceptance of psychoanalysis in psychiatric discourse. A year after the end of the war, the British Psychoanalytical Society and the Medical Section of the British Psychological Society were both established, marking the start of a nuanced interplay between biological psychiatry and medical psychotherapy. The Tavistock Clinic
played a significant role in bridging the gap between these approaches
and favoured a unified psychosomatic approach. Under these conditions,
the biopsychosocial model was set up to revolutionise our understanding
of psychiatry and health.
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