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

Andy

Andy

Retired committee member
Full title: A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model
Health psychology is multidisciplinary, with researchers, practitioners, and policy makers finding themselves needing at least some level of competency in a variety of areas from psychology to physiology, public health, and others.

Given this multidisciplinary ontology, prior attempts have been made to establish a framework for understanding the role of biological, psychological, and socio-environmental constructs in disease development, maintenance, and treatment. Other models, however, do not explain how factors may interact and develop over time.

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

This paper outlines the role of predisposing, precipitating, and perpetuating factors in disease states and conditions (the 3Ps) and provides examples of how this model may be adapted and applied to a number of health-related diseases or disorders including chronic pain, gastrointestinal disorders, oral disease, and heart disease. The 3P framework can aid in facilitating a multidisciplinary, theoretical approach and way of conceptualizing the study and treatment of diseases in the future.
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Open access, https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02498/full
 
James Morris-Lent said:
beh
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That was my reaction too. I started reading it, but by the time I got half way through the simplistic description of insomnia in BPS terms, I gave up.

All it did was confirm my impression that 'health psychology' as a profession that was invented relatively recently should never have been invented. It gives people with no medical training access to patients with physical diseases and licence to try to make them think or behave differently without properly understanding the disease the patients are suffering from.
 
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).
 
Trish said:
All it did was confirm my impression that 'health psychology' as a profession that was invented relatively recently should never have been invented. It gives people with no medical training access to patients with physical diseases and licence to try to make them think or behave differently without properly understanding the disease the patients are suffering from.
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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.
 
Trish said:
Can you explain in what way it is important?
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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).
 
Thanks, @Snow Leopard. I agree all those areas are worth researching, so medical staff and policy makers can implement helpful policies.

What I am questioning is the profession of health psychologist as someone who has direct input into medical care of individuals with physical illnesses and offers them CBT or other 'therapy'. I wonder what value they can add that can't be done by perceptive doctors and nurses who understand the illness and its treatment. I think for example of the specialist nurses in the UK whose role is largely helping individuals with physical illnesses cope with the effects of those illnesses on their lives. How would a psychologist do that role better?
 
Snow Leopard said:
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).
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You write "understanding" but for some reason I read "speculate with little to no objective support".
 
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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.

Snow Leopard said:
to studying social and systemic factors on health (income, health policy inequities).
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That would be useful. It is also the purview of health economics not psychology (although an undergrad in psych can lead there I guess).

That is, more conceptual work needs to be done to explain how biological, sociological, and psychological factors interact, rather than simply stating that they do interact. The application and combination of another well-known model (i.e., the 3P model) outlined here provides a more robust, and importantly, a time-inclusive argument of how different factors may manifest and subsequently accumulate to propel an individual up the “ladder” and over the “threshold” of disease manifestation. As will be argued, what contributes to or often maintains disease states can be multi-faceted, and can include maladaptive behavioral, cognitive, and emotional factors.
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So it's all multi-faceted and it's complex. It's also bio-psyco and social . . . but the solution is always . . .

Interestingly, a behavioral treatment is considered a first-line, evidence-based practice for helping patients overcome insomnia (Qaseem et al., 2016; Riemann et al., 2017). Cognitive behavioral treatment of insomnia (CBT-I; Perlis et al., 2005) is a manualized treatment with robust evidence for aiding individuals with their sleep problems.
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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 could be, in part, because the biopsychosocial model lacks a framework for understanding how biological, psychological, and socio-environmental factors may contribute at each stage of disease development, in maintaining disease, or in the treatment of disease.
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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:
Contributing factors that are long-standing or lasting are characterized as predisposing
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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.
 
(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.
 
Sarah94 said:
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?
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You are right JHP did publish the special issue on PACE. I think that supports my point that researching the effects of social and psychological factors on physical illnesses may be of value, but the invention of a profession called 'health psychologist' doesn't seem to provide any useful service to people with physical illnesses. The criticisms of PACE would support my case. Therapists who have no medical knowledge trying to get people with serious physical conditions to change their thinking seem to me more likely to do harm than good.
 
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