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Main issues - Biopsychosocial model

Discuss about the Physical Health and Wellness Study of Jason.

The paper deals with the case study of Jason, a 29-year-old married man suffering from whiplash injury, which persists in creating pain and discomfort, especially if he uses his computer for too long without a break. The purpose of the paper is to analyse the case and apply the wellness wheel and the biopsychosocial model to it. Lastly, the paper presents the action plan for Jason to address his issues.

The biopsychosocial model presented by George Engel emphasise on the intricate variable interaction of various factors that attributes disease. These are biological, social and psychological factors. The biological model refers to biochemical and genetic conditions that led to disease. Mood, behaviour and personality are the psychological factors that determine the health beliefs of the patients and the behaviours of the health care providers. The social factors encompass family support, cultural factors, socioeconomic condition and medical parameters (Wade & Halligan, 2017). 

The main issues arising from the case study are of biological, psychological and social nature.

The biological issue faced by Jason is Whiplash injury, which prevents him from using computer for too long time. He is experiencing neck pain and discomfort. He is need of intense rest and physiotherapy.

The psychological issues faced by Jason are-

  • Fear of losing income with increasing absenteeism at work due to neck pain and discomfort while working on computer
  • Lack of empathy at workplace causing distress- Jason fears losing work cover insurance
  • Added financial burden as Jason is the sole income earner
  • Jason has to support his wife who is homemaker and 3 year old child
  • Lack of financial support will hamper the medication and treatment of Jason

The social issues faced by Jason are lack of cooperation and empathy from his supervisor at workplace. His work cover insurance is at stake, as the insurers perceive that whiplash injury is the minor problem. They feel that Jason absenteeism from work to attend doctor’s appointment is not justified. They demand valid reason for the week off and ten half days of leave, although Jason has stated he was undergoing physiotherapy.  

Chronic pain is the prime concern of Jason in the case study. The dynamic relationship existing among the biopsychosocial factors plays a significant role in chronic pain. In addition, the emotional and the cognitive factors also come into play. Biological changes such as damage to the tendons and ligaments in neck region ultimately manifest as poor mental state and physical health (difficulty in mobility). Emotional balance is lost due to biological and physical changes (Wade & Halligan, 2017).).

According to McCracken and Vowles, (2014) chronic pain have several long-term effects but without obvious physical cause. Sometimes the lingering problem such as stiffness, headache or dizziness, anxiety or weakness is caused by cognitive factors. Anxiety and depression are known as affective factors. Jason may involve in over thinking about the physical illness, which may decrease self-confidence. Patients sometimes engage in catastrophic thinking and fear of losing social and personal life after an illness. The same was the case of Jason. He was anxious due to lack of social support. He was burdened with illness and fear of losing money. The other cognitive factors associated with the chronic pain are avoidance and acceptance. Acceptance of pain leads to value based actions (McCracken & Vowles, 2013).

Critical analysis of the impact of the issues

The intensity of the pain is influenced by self-efficacy. A person with low self-efficacy may suffer for longer period with disability even if a condition like whiplash injury was minor. A patient with high self-efficacy may continue to have normal social and work life after injury. This may include behavioural factors such as reinforcement process and interaction with the environment (Jackson et al., 2014). 

As per the cognitive behavioural theory, every individual have different cognitive abilities and it refers to the ability of interpreting the nature of the reality. This factor influences the coping strategy during chronic pain (Ehde et al., 2014).  As per the social communication model of pain, the social environment shapes the beliefs and attitude of an individual towards health and illness. Poor health beliefs such feeling of victimisation after injury negatively affects treatment outcomes (Craig, 2009). In conclusion, chronic pain and mental distress are outcome of interaction of these factors.

The wellness wheel model is the formwork that helps to determine the factors mot effecting the client during illness. This model has six dimensions determining wellness. It includes Intellectual, physical, emotional, social, spiritual, social and occupational. All these dimensions are interconnected.  These dimensions are important for having balanced lifestyle. This wheel of wellness is developed by Sweeney and Witmer (1991) and Witmer and Sweeney (1992). This model is based on individual psychology. Using these dimensions, a person can engage in self-reflection, to initiate changes for wellness promotion (Kwon, 2015).

Upon critically analysing the Jason’s case study, the two dimensions that is disturbing the lifestyle balance of the patient are- social and emotional dimensions.

According to Williams et al. (2014), emotional wellness of an individual refers to ability of understanding, sharing and managing the feelings. It is the level, to which an individual is enthusiastic about life, in fulfilling personal relationships, and coping up with challenges. Jason is currently unable to manage and accept his feelings. One hand he is trying to cope up with illness and on the other hand, he is facing financial crisis. He has the responsibility to run his family. Jason is losing the work life balance and he is unable to cope up with stress caused. Since Jason has come to me for support, it is indicating that he is taking step towards enhancing emotional wellness.

As per Kwon (2015), the social wellness refers to ability of an individual to interact with others and relate to maintain positive relationship in the community.  Social network is important for healthy life. For men, disturbance in social life at workplace cause fear of unemployment and loss of money. The sense of well being in case of Jason is thus, related to employment and the negative aspect. Lack of cooperation from the insurers is decreasing the energy level of Jason. Poor social wellness leads to loss of skills to interact with others in community.

Wellness Wheel

Cope up with stress

Change in perception

Engage in self reflection

Strengthening the social life

Apply stress management strategies

Address internal and external stressors to better focus on occupation- Acceptance and commitment therapy

·         The client needs to identify his belief system and its negative outcomes

·         The client must analyse if the belief  does promote well being

·         Writing journal to keep the track of thoughts

·         Can be practiced thrice a week for twenty minutes.  

Improve the social network by-

·         Investing more time for family and friends

·         Enjoy the time spend with others

·         Explore the diversity by interacting with people from different cultures.

Jason must recognise if his stress is overwhelmed by anxiety and fear. The manner in which a person responds to internal and external stimulus determines the coping mechanism (McCracken & Vowles, 2014). Jason must come to terms with external factors such as financial burden as it was not under his control. Reducing stress will lead to quick recovery from neck pain and discomfort.

In order to manage conflicts in life, Jason requires to change his thought process. He must change his thinking style to change his perception. Jason must analyse the  outcomes of present thinking patterns and identify the mistaken beliefs. Jason should rationalise his thoughts with strong evidence. If his thoughts are not promoting his wellness, then there is a need to change his belief system that would lead to good health (Lightsey et al., 2014). New beliefs can be established by avoiding over thinking, feeling guilty and avoiding personalisation (Vallejo & Amaro, 2009). For instance, Jason can perceive his supervisor has positive person as he just conveyed the message of the insurer. Perceiving this as negative situation is called over thinking. Jason should not feel victimised for his illness as it is no one’s’ choice. Further Jason should find alternate solution to money and address the financial crisis. Focussing only on problem will not resolve any issue.   

According to Niles et al. (2014), journal writing is the effective means to cope up with the stress. It will help identify the triggers of stressors and if they are internal or external. By keeping the track of thoughts, an individual can improve self-awareness. It is the record that will analyse the factors causing stress, anxiety, or frustration. The client can also rate the intensity of stress on the scale of 10. This record keeping of thoughts will help identify any conflict or challenge. Thus, Jason must involve in self-reflection.

A good social bonding with friends and family increases self-confidence and self-esteem. Social wellness thus acts as source of motivation. It influences cognition, and behavioural processes. It will increase the energy level, which will minimise stress by making a person more enthusiastic to life (Kwon 2015). Therefore, Jason must strengthen the social life.

Conclusion

The action plan is based on evidence from literature. Currently, the main emphasis for the client will be on social dimensions. Jason can overcome his stressful situation if he learns to avoid focusing on unpredictable events and work on events that he can control. Conclusively, the biopsychosocial and wellness wheel model are effective in analysing the psychological condition of the client.

References

Craig, K. D. (2009). The social communication model of pain. Canadian Psychology/Psychologie canadienne, 50(1), 22. https://dx.doi.org/10.1037/a0014772

Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153. https://dx.doi.org/ 10.1037/a0035747

Jackson, T., Wang, Y., Wang, Y., & Fan, H. (2014). Self-efficacy and chronic pain outcomes: a meta-analytic review. The Journal of pain, 15(8), 800-814. doi:10.1016/j.jpain.2014.05.002

Kwon, S. H. (2015). Wheel of Wellness Counseling in Community Dwelling, Korean Elders: A Randomized, Controlled Trial. Journal of Korean Academy of Nursing, 45(3), 459-468. https://doi.org/10.4040/jkan.2015.45.3.459 

McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance of pain and values-based action in patients with chronic pain. Health Psychology, 27(2), 215. https://dx.doi.org/10.1037/0278-6133.27.2.215

McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178. doi:10.1037/a0035623.

Myers, J. E., & Sweeney, T. J. (2008). Wellness counseling: The evidence base for practice. Journal of Counseling & Development, 86(4), 482-493. doi:10.1002/j.1556-6678.2008.tb00536.x

Niles, A. N., Haltom, K. E. B., Mulvenna, C. M., Lieberman, M. D., & Stanton, A. L. (2014). Randomized controlled trial of expressive writing for psychological and physical health: the moderating role of emotional expressivity. Anxiety, Stress & Coping, 27(1), 1-17. doi:10.1080/10615806.2013.802308

Lightsey, O., Boyraz, G., Ervin, A., Rarey, E., Gharghani, G., & Maxwell, D. (2014). Generalized self-efficacy, positive cognitions, and negative cognitions as mediators of the relationship between conscientiousness and meaning in life. Canadian Journal of Behavioural Science-Revue Canadienne Des Sciences Du Comportement, 46(3), 436-445. doi:10.1037/a0034022

Shearer, H. M., Carroll, L. J., Wong, J. J., Côté, P., Varatharajan, S., Southerst, D., ... & van der Velde, G. M. (2016). Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal, 16(12), 1566-1581. doi:10.1016/j.spinee.2015.08.011

Vallejo, Z., & Amaro, H. (2009). Adaptation of mindfulness-based stress reduction program for addiction relapse prevention. The humanistic psychologist, 37(2), 192-206. https://dx.doi.org/10.1080/08873260902892287

Wade, D. T., & Halligan, P. W. (2017). The biopsychosocial model of illness: A model whose time has come. Clinical Rehabilitation, 31(8), 995-1004. doi:10.1177/0269215517709890

Williams, L., Gorman, R., & Hankerson, S. (2014). Implementing a mental health ministry committee in faith-based organizations: the promoting emotional wellness and spirituality program. Social work in health care, 53(4), 414-434. 414-434. doi:10.1080/00981389.2014.880391

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