..Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model, 2019, Wright et al

Full title: A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model

Open access, https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02498/full

 

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The recipe is:

Begin by saying that all factors influence illness, which is hard to disagree with but also vague and can mean anything.

Then claim that psych factors are causally important in some disease and draw an exiting diagram showing how. This can seem persuasive until you ask yourself, for example, how much of caries can really be attributed to things like fear of dentists transmitted from paents to children. There may well be an effect here, but how large is it? It could be one of a million insignificant effects.

The next step is to propose some psych intervention and adopt such low standards that a positive outcome is guaranteed.

A general problem with these ideas seems to be that they are very simple and you don't need to be a psychologist to, for example, understand that fear of dentists is something you should overcome and you don't need an intervention to overcome it. Like in ME/CFs, you don't need a therapist to consider that maybe you should be pushing yourself harder and exercise more. It's basically common sense (it just doesn't work).

 

"The aim here was to apply and adapt the 3P model.. to couch the biopsychosocial model in a way that explains how diseases develop, are maintained, and can be treated."

 

Health psychology is an important field, the problem is that most people in the field are simply questionnaire wielding idiots.

The main problem, which the paper doesn't address is that all of the factors have to be studied at the same time. They can't be studied separately and simply hypothesised, without any direct evidence that they are all somehow connected, which is the way such models are attempted these days.

 

Understanding health related beliefs and behaviours has widespread application in disease prevention and management (applied as health promotion). Diverse applications such as studying behaviour of people involved in risky activities (including driving!), unhealthy behaviours relating to diet, exercise, smoking etc and how to approach health communication to these ends, to studying social and systemic factors on health (income, health policy inequities).

 

You write "understanding" but for some reason I read "speculate with little to no objective support".

 

The lack of awareness of psychologists can be breathtaking.

It's perfectly reasonable to provide information and promote healthy behaviours. No problem there. But all of the promoting I've seen is rather tainted with the idea of bootstrap moralising. If you want people to eat well pay them a living wage and provide them with the tools and means to do that. Ditto all the other factors. It costs money to send children to healthy activities etc etc.

Psychologists are always pointing to all the wrong things. If this all really mattered to them so much they'd be at the forefront of calling for better social outcomes that actually apply to these behaviours not running CBT factories.

That would be useful. It is also the purview of health economics not psychology (although an undergrad in psych can lead there I guess).

So it's all multi-faceted and it's complex. It's also bio-psyco and social . . . but the solution is always . . .

Unfortunately this kind of shallow 'simple fix' stuff from psychology is ubiquitous. It's patronising and when there is a relevant point it doesn't rise above the blindingly obvious. And as for 'robust evidence'? Irrelevant questionnaires and profound researchers beliefs no long term follow up no reporting of adverse results etc (the list is long) always create just the right results. CBT is the shiny new Evidence Based Medicine. Oh joy.

 

I should probably also point out that the focus on the purely psychological leaves out the very real issue of not only the social but the biological. Many social factors that contribute to illness when ameliorated are more preventative in nature. All of illness is biological as we well know.

All of the behavioural (psychological) aspects are secondary. Making them primary simply encourages less effort to be focussed on understanding the underlying biology. I see this as anti-scientific. And as people with ME we all know how a primary focus on behavioural change turns out for the ill.

Great for the psychologist though. Millions and Millions served. I want fries with my CBT.

 

Psychics have been providing the service of making up fictitious explanations for various problems since forever and they do it much cheaper. There is no need to duplicate that, the "need" is fulfilled already.

Sometimes I wonder if anyone in this field even reads or hears what others are saying. It sounds more like thousands of synchronized monologues, where the mere act of making noise is met with approval for... making noise. In Tuller's STAT article, there is one commenter who said he likes the SMILE paper because it incorporates a psychosocial perspective. That's it. It's good because it incorporates something they like. Replace with biblical or astrological perspective or whatever and it's pretty obvious to see the problem but this flies way above their heads.

For the last 40 or so years, the BPS model has been boasting: here's how psychology "creates" illness. It's been an endless stream of that, with various rhetorical devices and logical fallacies, along with the occasion musing over why the model still only has limited acceptability.

And then there's stuff like this:

This is precisely what 40 years of BPS have argued in an endless loop. And still there are people making the serious argument that it would be a good idea to do the thing that has been done in an endless loop for decades. The entire point of the model has been to invent explanations for exactly that, and decades and billions later, there are still people seemingly unaware that this has been roughly 90% BPS efforts.

I'm frankly not even sure if they ever stop to listen to themselves, let alone what others are saying. Not much surprise that the bulk of BPS advice is insultingly basic stuff like "have you tried not being sick anymore?", if BPS proponents are themselves not even aware of the basic things they are doing, or not doing.

I rest my case:

No, they do not actually read or hear what they are saying. The entire thing could be summed as: let's turn all correlations into causes and reverse causation everywhere and see where that takes us. Still just a bunch of "may be"s and "could be"s stringed together with no particular sense or order. It's a fake solution in search of a problem with a broken feedback mechanism that tells them the answer they want whatever the answer actually is or whether the question is relevant at all.

 

This 3P really frustrates me and i am regularly disappointed when I hear it brought up again.

I get the Predisposing eg a couple of genes that may have a pretty small say in whether you get disease x.
Yup, often a trigger- sorry Precipitating factor which causes the disease.

BUT the Perpetuating factors.....Could be ones immune system not working well enough to fight off a bug, no cure yet found eg asthma/ME or Type 2 diabetic ignoring all advice on diet and exercise.
They are unlikely to be ill/disabled people thinking "Wow, this is making my life much better now I can't, work,study,exercise/walk/look after myself. I think I'll choose to stay this way.

 

Sure, but that simply reflects the lack of quality in the field.

 

To be fair, some of them do. Look up "Psychologists Against Austerity".

 

Health psychology can be useful @Trish @duncan , didn't the Journal of Health Psychology publish some stuff criticising PACE? I think @Jonathan Edwards had a piece published there about the flaws in PACE? Or am I misremembering?

 

(This is essentially a repetition of some things that have been said here)

For me the issue with 'the Biopsychosocial model' - and by extension the ideas in this paper - is that it's either
-a truism in response to a non-existent problem.
-a justification to make anything you want into a conversion disorder and to administer your favorite pet psychotherapy to anybody suffering from anything.

Ultimately, reasonable people don't care what works. What matters is reliable evidence, whatever it looks like. I mean we could all write a paper about the 'reliable evidence model of disease intervention' and it would be just as much a truism. However, it would at least be salutary given the present state of affairs.