The statistics on chronic diseases are daunting: 90 million Americans have one or more of these diseases, and 70% of all deaths are attributed to them. It is difficult to fathom that 75% of adults age 65 and older and 30% of all children and adolescents have these diseases, that 1,700 new cases of diabetes are diagnosed every day, and that the direct cost of treatment is more than $400 billion a year.
Even more discouraging is the fact that health care professionals have very little to offer those with chronic illness. Why is this? Chronic illness is the subjective experience of chronic disease. This means that its expression is varied depending on several biopsychosocial factors, including personality, coping resources, and cultural factors.
Unfortunately, the health care system focuses primarily on the biological dimension of illness, and the psychosocial and cultural dimensions are ignored or inadequately addressed. The result is needless suffering and disability and predictions that the prevalence rates will skyrocket as the population ages without comprehensive, biopsychosocial treatment and disease prevention programs.
Despite recent recommendations of national commissions and blue ribbon panels that health professionals be trained in and expected to provide comprehensive, biopsychosocial treatment, little change has been made in the training programs or expectations for comprehensive treatment. In short, a major health care crisis looms, and it comes at a time when organized health care seems unprepared to meet it.
Fortunately, psychologists, particularly those who practice psychotherapy, are remarkably well positioned to respond to this major health care challenge. Recently, the American Psychological Association has re-visioned psychology as a primary health care specialty that embraces the biopsychosocial perspective.
As graduate and postgraduate programs focus more extensively on health psychology, behavioral medicine, neurosciences, and psychopharmacology, psychologists will be increasingly able to meet the challenge of comprehensively and effectively treating chronic illness. The immediate challenge for such psychologists will be to augment their psychosocial perspective and psychotherapeutic strategies with sufficient biological understanding of the common chronic illnesses to provide comprehensive, biopsychosocially oriented treatment.
Biopsychosocial Aspects
The approach described and illustrated in the accompanying video articulates the various phases of chronic illness: crisis, stabilization, resolution, and integration. It emphasizes how the course of chronic disease is affected by biopsychosocial and cultural factors. Furthermore, the approach relies on a comprehensive biopsychosocial assessment and treatment tailored to the client's needs and expectations.
A Biopsychosocial Assessment Strategy
The key components of a biopsychosocial assessment include the following:
- the illness process itself—illness phase and type and level of symptoms and impairment;
- psychological need that includes life stage, roles, and responsibility of the client;
- inner resources—premorbid personality style and coping resources;
- external resources—financial, cultural, and subcultural factors and social support; and
- client explanation of his or her illness and expectations and readiness for treatment.
Biopsychosocial Intervention Strategy
This approach also emphasizes the value of tailoring or matching the treatment process to type and level of symptoms and impairment, need, inner and outer resources, and client expectations and readiness for treatment of illness. The approach provides a protocol for focusing treatment, developing a tailored treatment approach, and choosing specific interventions. The video describes and illustrates the biopsychosocial assessment and treatment strategy with a clinical case.
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