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more articles by DiGiovanni, Anthony P. , MD  |  author's bio

Mental Health Treatment is Like a Three-Legged Stool

Special to the Journal By Anthony DiGiovanni, MD


People who seek professional help for emotional distress often focus on medication as the answer to their struggle with depression or anxiety. They believe that if they can just find the right pill, their problem will be fixed. However, there is much more to effective treatment of mental health problems than medication alone.


The best framework for mental health treatment entails three aspects of care. It can be thought of as a three-legged stool. If any leg is too short or not strong, the stool will be unstable. This model of treatment, called the biopsychosocial model, is evidence-based and embraces the latest research. The biopsychosocial (BPS) model considers a person’s unique biological, psychological, and social factors as equally important. Each aspect represents a leg of the stool and each is important to one’s overall stability. 


What are the biological considerations in mental health treatment?


Your individual biology is very significant. There is evidence, for example, that people can be genetically predisposed to certain illnesses, among them bipolar disorder, anorexia, and depression. We also know that state of mind and brain function are interconnected: the brain scan of a depressed person shows areas of hypo-function, which indicates a definite physiological component to depression. This means that working your way through depression involves more than just pulling yourself up by your bootstraps. Exploring the biological/physiological component of your emotional distress helps your psychiatrist or psychologist frame what medications might help you.


What does the psychological component in BPS address?


The psychological component in BPS explores the way we think, what our assumptions are, and our ability to cope with stress. This is important because medication does not help with our assumptions or coping skills. This is why talking therapy is so crucial. In therapy, you learn more about how you view things, how you respond to stress, and how you can modify your stress response. The importance of psychology cannot be overstated in effective mental health treatment.


What do you mean when you talk about the social component?


Just as important as your biology and your emotional state (psychology) is the environment in which you live. All the various aspects of your social network make up your environment. In this component of the BPS model you examine the impact of your job or school, your living situation, and your relationships. Do you like your job or not? Do you enjoy school or are you struggling, and why? Are you being abused at home? Are you an alcoholic living with drinkers?


Changing your environment is much harder than taking medication; however, even small changes in your environment can make a difference. If you suffer from depression, for example, more light in your environment can help you start to feel better. Removing alcohol from the home is a good start for someone being treated for alcoholism. Finding a new housing situation for someone who suffers abuse at home is an important environmental change. Another small but helpful change is educating your parents or roommate about what is going on with you and how they can help you. Doing what you can to make your home a calm, safe nesting place can have an impact on your mental health.


Current research supports that talk therapy and environmental change can alter a person’s brain function, which is why the biopsychosocial model for mental health disorders is in such wide use today. BPS is the model of treatment in the Behavioral Services Unit at Cayuga Medical Center. From a patient’s initial mental health evaluation through discharge planning we think in terms of BPS and the mind-body connection. Like a solid three-legged stool, giving equal importance to these three aspects of care provides a balanced and effective approach to treatment.


Dr. DiGiovanni is board certified in psychiatry and neurology. He is on the medical staff of the Behavioral Services Unit at Cayuga Medical Center and specializes in adolescent psychiatry.


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