discussion #5 disease

+

Assessment & Conceptualization in
Chronic Illness Interventions:

An Overview

+
Biopsychosocial Model for
Conceptualizing Chronic Illness

n  Biological and psychological/sociocultural factors play a role
in chronic illness presentation and management; as such, an
integrative conceptualization model is needed in order to
execute treatment strategies that are comprehensive and
effective

n  Biopsychosocial assessment strategies and formulations lead
to treatment plans that combine biological and psychosocial
treatment strategies

n  The biospychosocial conceptualization model is particularly
effective for difficult or treatment resistant cases in which
medical and psychiatic conditions co-exist

+
Biopsychosocial Model

n  The biopsychosocial model can best be described as:

“A HOLISTIC perspective for understanding and
explaining the INTERFACING biological and social forces
that influence health, illness, and well-being” (Engel,
1977)*

n  The goal of using this model is to achieve a
multidimensional conceptualization of an individual’s
presenting problem that can elucidate the use of
comprehensive treatment strategies.

n  These are more powerful than those that can be
devised by the use of a simple psychological,
biological, or social conceptualization.

Engel, G. (1977, April 8). The need for a new medical model: A Challenge to biomedical science. Science, 196, 129-136.

+
Overview

n  From a biopsychosocial perspective, the assessment and
conceptualization process involves:
n  1). The articulation of biological, psychological, and social influences

on health and wellness
n  2). The recognition that the goal of biopsychosocial interventions is to

achieve the integration of the chronic medical condition as part of an
individual’s healthy sense of self

n  3). The realization that patients have their own subjective views of
their illness (illness representation/explanatory model) that impacts
their treatment adherence, and that patients and therapists need to
work collaboratively to construct realistic models of illness
representation that promote wellness

n  4). The commitment to conducting a comprehensive assessment that
allows us to understand a patient’s behavior patterns

n  5). The recognition of the importance of establishing a strong
therapeutic alliance based on a collaborative bond in which patients
and clinicians work together to establish and achieve therapeutic
goals

n  6). The understanding that treatments need to be individually tailored
to a patient’s needs, and such, need to incorporate the use of multiple
theories and treatment modalities.

+
Assessment
n  The goal of a biopsychosocial assessment is to determine the

function of patient behaviors that predict their
responsiveness to treatment

n  It involves the investigation and understanding of two core
patient characteristics:
n  1). Treatment Readiness: The patient’s motivation to engage in

treatment and their interest and ability to work collaboratively
with the clinician to meet therapeutic goals. A patient’s readiness
is also influenced by psychosocial factors that may promote or
hinder treatment adherence.

n  2). Explanatory Model/Illness Representation: A patient’s own
interpretation of his symptoms or disease process. In some cases
a patient’s illness representation may contain misinformation or
misattributions that may need to be addressed.

+
Assessment in Practice
n  A biopsychosocial assessment usually occurs in the context

of a semi-structured interview process that elicits information
about a patient’s illness and its context, the patient’s
perceptions of the cause of the illness, their view of the
disease progression and impact on their quality of life, and
their readiness for change.

n  The assessment should naturally lead to a conceptualization
process that informs the development of a treatment plan that
is specific, realistic, and contains a sequence of attainable
goals that is created in an effort to maximize treatment
success

+
Key Assessment Factors

Thirteen Key Markers in a Comprehensive Assessment (Sperry, 2006)

1. Disease progression and impact of illness on functioning

2. Illness representation/explanatory model

3. Adequacy of health behaviors and exposure history

4. Early parental bond and adverse childhood experiences

5. Personal schemas and family narratives

6. Personality style/dynamics/disorder

7. Family competence level and style

8. Religious and spiritual beliefs

9. Patient resources and self-capacities

10. Readiness for treatment capacity and for self-management

11. Adequacy of treatment relationship with previous providers

12. Alignment between clinician-patient explanatory models and
treatment goals

13. Phase of illness

+
Conceptualization
n  Case Conceptualization consists of:

n  1. Diagnostic Formulation: A cross-sectional descriptive

statement about the nature and the severity of a patient’s
psychiatric presentation

n  2. Clinical Formulation: Offers the rationale for the
development and maintenance of the symptoms and behavior
patterns. It is the integration of all aspects of a patient’s and links
the diagnostic and treatment formulations.

n  Treatment Formulation: It is a “blueprint” of the treatment
interventions and provides the treatment goals, treatment plan,
and interventions in relation to educated predictions about the
course and potential outcomes of treatment.

+
Clinician vs. Patient Conceptualization

n  Parallel to the three aspects of a comprehensive clinician
conceptualization, patients have their own case formulation
as follows:

Clinician Patient

Diagnostic Formulation Description of presenting problem/
concern, symptomatic distress and
degree of life functioning impairment

Clinical Formulation A patient’s own explanatory model or
illness representation

Treatment Formulation A patient’s expectations for treatment

* Similarities in the therapist’s and patient’s conceptualization are generally
linked to greater treatment adherence and treatment effectiveness.

+
The Pattern Analysis Framework

Predisposing
Factors

Perpetuating
Factors

Presentation
Factors &
Relational
Response

Factors

Precipitating
Factors

Pattern Analysis is the process of examining the interrelationship among the
individual and systemic dynamics that determine predictable ways of thinking,

feeling, acting and coping in the face of stressful circumstances