In the past, with regards to how a physician approaches a patient with a problem, the physician has isolated a specific component of that patient (be it at the cellular level for some autoimmune diseases, the tissue level for example in musculoskeletal issues, the organ level for some cancers, and so on). There has especially been no consideration of the effects of outside influences. However, this can be to the to the detriment, and possibly injury, of the patient. Contrarily, within the biopsychosocial model of health, the physician approaches the patient as a whole, not a combination of parts. Human beings are made up of several different systems, and influenced by outside systems, that do not act independently of one anotheràeach system is at the same time a component of higher systems. Engel explains that an individual is “…at the same time the highest level of organismic hierarchy and the lowest level of social hierarchy.” As we dive into the next section, focus on what’s above the individual in the hierarchy, and the influence of those components on the individual (specifically their thoughts/mindset)! (Image: Engel, 1980)


So now let’s apply this idea of a patient’s environment affecting their psyche, and then affecting their physical health, to rehabilitation. Research has shown that the use of motivational and cognitive imagery—simply put, looking at pictures to evoke an emotional response—during the rehabilitation (and even training in the absence of injury) of injured athletes can lead to increased relaxation, decreased anxiety, increased self-confidence, pain relief, and increased motivation in that the patients have a greater focus, effort, and ‘drive’ during the program. I understand that these things are difficult to measure. However, the athletes that use motivational and cognitive imagery while returning from injury often return in a shorter amount of time and at a higher skill level than those that don’t (possibly not due to any direct physiological response, but due to the increased motivation, self-confidence, etc.; a positive effect nonetheless).

So, the environment of the patient had an effect on the patient’s psyche, therefore leading to an effect on the patient’s physical health. Dr. Carla Sordoni explains that “It has been established that athletes who are injured can have any of a number of psychological responses to their injury. This makes it necessary to include both physical and psychological therapies as part of the injury rehabilitation program.” Therefore, if a physician does not take into consideration the effects of the environment of a patient on their mindset, if the physician does not look at the patient as a whole, only viewing the patient as a single condition, they can possibly be preventing a more efficient and successful recovery of the patient by not treating (or finding someone who can treat) the psycho or social portions of that biopsychosocial being!


Now, take the example of rehabilitation out of the equation. For simplicity’s sake, let’s look at the effects of what most of us would think of as ‘negative-thinking’ on health status. Those who are sad, depressed, have low self-esteem, and always have a negative outlook on their situation are: less likely to be physically active, more likely to become physically disabled, less likely to be compliant with medical treatment or advice, and more likely to become accepting of their lesion or condition. And it isn’t just sadness that can have a negative impact on health. It appears that those exposed to consistently stressful situations (workplace, home, etc.) are more likely to acquire injuries and diseases. So how then should a patient be handled? Just as surgery and rehab exercises alone will likely not optimally recover a broken femur, positive thoughts alone will not stabilize a sprained ankle. The condition does not exist outside of or in absence of the patient! The patient must be treated as a whole, examining all aspects of the patient as they relate to the condition, in efforts to secure for that [bio][psycho][social] person the most efficient and effective outcome possible.


-The biopsychosocial model of health examines the patient as a whole rather than a combination of parts

-A patient’s outside environment can have as great an effect on their physical health as the patient’s inside environment

-Motivational and cognitive imagery have been used in the rehabilitation of injured athlete to increase self-confidence, increase motivation, decrease anxiety, and more

-The patient should be assessed as a whole, looking at all aspects of that person’s life, and the different effects they may have on the patient’s condition


Andrews, James R. Physical Rehabilitation of the Injured Athlete. ElsevierSaunders, 2012.

Engel, G. L. “The Clinical Application of the Biopsychosocial Model.” Journal of Medicine and Philosophy, vol. 6, no. 2, 1981, pp. 101–124.

Penninx, B W, et al. “Exploring the Effect of Depression on Physical Disability: Longitudinal Evidence from the Established Populations for Epidemiologic Studies of the Elderly.” American Journal of Public Health, vol. 89, no. 9, 1999, pp. 1346–1352.

Scheier, Michael F., et al. “Dispositional Optimism and Recovery from Coronary Artery Bypass Surgery: The Beneficial Effects on Physical and Psychological Well-Being.” Journal of Personality and Social Psychology, vol. 57, no. 6, 1989, pp. 1024–1040.

Sniehotta, Falko F., et al. “Long-Term Effects of Two Psychological Interventions on Physical Exercise and Self-Regulation Following Coronary Rehabilitation.” International Journal of Behavioral Medicine, vol. 12, no. 4, 2005, pp. 244–255.

Sordoni, Carla, et al. “The Use of Imagery by Athletes during Injury Rehabilitation.” Journal of Sport Rehabilitation, vol. 9, no. 4, 2000, pp. 329–338.




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