Biopsychosocial Perspective

This study of stress experienced during the transition from one’s own home into an independent/assisted senior housing community among older women was conducted using a mixed-methods approach that included (a) qualitative data collection via time-use diaries and open-ended interview questions, (b) quantitative data collected through structured interview questions and empirically validated scales that measured stress perceptions and coping behaviors, and (c) biological measures of stress reactivity through salivary cortisol. Designed to capture the adaptation period, the study was conducted longitudinally with repeated measures consisting of three interviews, six time diaries, and six sets of saliva collection beginning within 1 month of the move through the first 6 months in residence. The data allowed for triangulation of stressful events, perceptions of stress, and physiological reactivity, and yielded interesting preliminary results. Challenges included veracity of self-report responses, correct timing of saliva collection per protocol specifications, and maintenance of researcher–participant boundaries.

The current study investigated biopsychosocial resilience in an older adult caregiver. A case study was selected for in-depth exploration of resilience in caregiving identified through biopsychosocial (i.e., salivary cortisol) methods. An exemplar of a woman caring for an adult child dying from a genetic disease is presented in the context of multiple stressors. Significant stress was found to be buffered by cognitive reframing and acceptance of interpersonal limits. Early experiences in caregiving for others with terminal illnesses provided a frame of reference, and difficult family dynamics added a layer of complexity. During periods identified as stressful, cortisol levels rose outside of normal bounds. The study implications are that mixed-methods (i.e., biopsychosocial) studies yield important results on individual differences within similar contexts. [Res Gerontol Nurs. 2015; 8(1):29-38.].

The widespread use of the biopsychosocial model amongst various health professions, all of which claim to take a patient-centred approach to their practise, challenges what has been considered a unique and defining feature of osteopathy. This paper discusses the complexity of what is meant by patient-centeredness, and how it is practised and researched by other health professions. The assumption that osteopathy has always taken a patient-centred approach is questioned, and directions for further research are highlighted so that the profession can have a comprehensive working knowledge of its practise, thereby helping to define itself within the broad and competitive healthcare environment. ª

The widespread use of the biopsychosocial model amongst various health professions, all of which claim to take a patient-centred approach to their practise, challenges what has been considered a unique and defining feature of osteopathy. This paper discusses the complexity of what is meant by patient-centeredness, and how it is practised and researched by other health professions. The assumption that osteopathy has always taken a patient-centred approach is questioned, and directions for further research are highlighted so that the profession can have a comprehensive working knowledge of its practise, thereby helping to define itself within the broad and competitive healthcare environment.

Charting a transatlantic movement of so-called 'dynamic psychiatry' during the early twentieth century, this paper reads against the grain of established historiographies. Comparing biographical and autobiographical sources with contemporary correspondence, a history is told which considers the evolution of psychiatric knowledge and clinical practices 'from below'. Revealing a period and place when a 'dynamic' counter-culture challenged the established materialist views of Scottish psychiatry, the longevity of this challenge is considered in the concluding paragraphs.

The experience of lockdown or stay at home for so long can be traumatic and disorienting. There is need to practice lots of selfcare of biopsychosociotechno-spiritual nature. This work aimed at helping people practice holistic selfcare while lockdown due to the COVID-19 pandemic continues or extended

This article presents a new avenue for healthcare risk managers to drive improvement for patients and healthcare organizations alike: Working to reduce avoidable patient suffering. It briefly describes the problem of patient suffering, differentiates between avoidable and unavoidable suffering, and suggests that common risk management tools can be used to tackle the problem. It also highlights a success story from one large health system.

"Despite the implication of the name, Polycystic Ovary Syndrome (PCOS) affects not merely the
ovaries, but endocrine system function, psychological health, psychosocial and psychosexual development throughout the lifespan. Up to 10% of pre-menopausal women meet the diagnostic criteria for PCOS, making it the most prevalent endocrine disorder for this population. Common features of PCOS include: polycystic ovaries, irregular or absent ovulation, disruption of the menstrual cycle, hyperandrogenism, insulin resistance, and central obesity. A review of extant literature reveals that as many as 50% of women with PCOS also meet the diagnostic criteria for a mood or anxiety disorder, with a strong correlation between PCOS and bipolar disorder. While such correlation does not equate to causality, some studies suggest that disruption of the hypothalamic-pituitary-gonadal (HPG) and hypothalamic-pituitary-adrenal (HPA) axes might be the common etiology between the physical manifestations of PCOS and the decreased psychological wellbeing experienced by women with PCOS. Hyperandrogenism is a particular source of concern in psychosocial and gender identity development. Some studies show a significantly higher prevalence of PCOS among lesbian women and female-to-male transsexuals compared to the general population, while heterosexual women with PCOS frequently report feeling “different” or “less feminine” due to hyperandrogenism and infertility. Researchers recommend implementing routine screening of women with PCOS for psychological disorders, and conversely, screening of women with mood disorders for reproductive endocrinological dysfunction."

Primary care medicine (general practice) is, as a generalist discipline, faced with the key challenge of counteracting fragmentation and developing a framework for conceptualizing and approaching patients as whole persons. At the same time, we are today witnessing a strong international focus on the development of personalized medicine that is tailored according to factors defining each person uniquely. This concept is as old as medicine itself.

[EN] In this paper, we will point out the effectiveness of experiential learning and the satisfaction perceived by all 249 bachelor students of Social Health Education in Northern Italy, who participated in an experiential learning laboratory for the helping relationship. The retrospective investigation is particularly interesting, as the evaluation was carried out at the end of every degree program, from the first group of students up to the last one. Moreover, the results of this partially self-directed laboratory were particularly encouraging, as the satisfaction levels were extremely good, higher than 90%. In order to understand the context, we will present the Social Health Educator and some important features of its university training, focusing, in particular, on the development of specific professional competences and on some psychological and pedagogical relevant theories. We will then describe the materials and research methods and, finally, point out career prospects and topics for further investigation.
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[IT] In questo contributo evidenzieremo la soddisfazione percepita e l’efficacia del metodo formativo di tutta la popolazione dei 249 studenti universitari frequentanti un laboratorio di formazione alla relazione d’aiuto all’interno di un corso di laurea di primo livello in Educazione Professionale del nord Italia. L’indagine retrospettiva è interessante in quanto la misurazione è stata effettuata alla fine ogni triennio a partire dalla prima coorte di studenti fino ad oggi. Inoltre va evidenziato l’incoraggiante risultato raggiunto da questo spazio laboratoriale di formazione parzialmente autodiretta, in quanto ha raggiunto valori di alta soddisfazione, superiori al 90%.
Per comprendere il contesto di riferimento presenteremo anzitutto l’Educatore Professionale e alcune caratteristiche importanti della sua formazione, con particolare attenzione agli aspetti di sviluppo delle competenze specifiche professionalizzanti e di alcune teorie psicologiche e pedagogiche di riferimento. Illustreremo i materiali e i metodi di ricerca utilizzati ed infine evidenzieremo aspetti di approfondimento e prospettive di lavoro.

The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism-both conceptual and pragmatic. This paper extends and fundamentally restructures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more "practical theory" for humancentered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between "health status" and "health and needs assessment", [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on "interventions" vs. "treatments" to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.

The current status of the “biopsychosocial” model in health psy- chology is contested and arguably exists in a stage of infancy. Despite original goals, researchers have developed theoretical inte- grations across biopsychosocial domains only to a limited extent. In addition, the marginalization of “spirituality” in contempo- rary biopsychosocial health perspectives is questionable. This article addresses these issues by providing evidence that supports the inclu- sion of spirituality within current perspectives while at the same time discussing implications this inclusion bears on the concept of health. Overall, a biopsychosocial–spiritual or “holistic” perspective is advanced for use within health psychology, provided it can be approached from a multilevel integrative analysis. In the end, some clinical implications are discussed.

I attempt to impose some conceptual order on the varieties of social explanation in psychiatry. I consider the role of social factors across a wide range of psychiatric sub-disciplines, from the more theoretical to the more practical. I distinguish four explanatory roles: 1. Input-Side roles, 2. Output-Side roles, 3. Process roles, and 4. Kind roles. I provide examples of each type of role. These distinctions hopefully will enable philosophers and practitioners of psychiatry to provide more precise characterisations of the social aspects of psychiatric illness, and to avoid the confusions arising from indiscriminate, hand-waving, use of the ‘biopsychosocial' label.

This book asks how early Christian monastic writers conceived of, represented, and experienced spiritual direction, and its central argument is that they did so medically.  Late antique monastic formation took place through asymmetrical relationships of governance and submission worked out in confession, discipline, and advice.  This study situates those practices against the cultural and intellectual world of the late antique Mediterranean.  In conversation with a biopsychosocial models of health and Urie Bronfenbrenner’s “bioecological” model of development, the first chapter explores the logic of Galenic medicine (2nd c.):  the goal of good health, a widely ranging theory of human nature, diagnostic strategies, and therapeutic techniques.  The next four chapters show how this logic operates in Evagrius Ponticus’ (4th c.) interpretation of dream imagery and demonic attack, in John Cassian’s (5th c.) analysis of wet dreams, in Cassian’s nosology of vices, and in John Climacus’ (7th c.) demonic pathologies of passions.  The second half of the book engages Paul Ricoeur’s theory of metaphor to show that spiritual directors claim trust and obedience by cultivating expertise along medical lines.  This begins with a study of self-representation and popular perceptions of physicians as experts over human bodies and souls and applies it to Basil of Caesarea’s (4th c.) advice on when and whether ascetic Christians should seek medical assistance, to Cassian’s tales of spiritual direction in Egyptian monasticism and the Apostle Paul’s therapeutic hierarchy, and to John Climacus’ multiple metaphors of spiritual direction in a monastery reconceived as clinic.

This paper presents a Thomistic analysis of addiction that incorporates scientific, philosophical, and theological features of addiction. I will argue first, that a Thomistic hylomorphic anthropology provides a cogent explanation of the causal interactions between human action and neuroplasticity. I will employ Karol Wojtyła’s account of self-determination to further clarify the kind of neuroplasticity involved in addiction. Next, I will elucidate how a Thomistic anthropology can accommodate, without reductionism, both the neurophysiological and psychological elements of addiction, and finally, I will make clear how Thomism can provide an ethics and a theology of grace that can be integrated with these ontological and scientific considerations into a holistic theory of addiction.

50 free online copies available at: https://www.tandfonline.com/eprint/B8IPFNWTJVIUZPWXTYA6/full?target=10.1080/01490400.2020.1714519

This special issue responds to the need to investigate the complex links between sex and leisure and their implications for research and practice. The focus is on analyzing the complexity of sex as leisure in various socio-cultural and geographical contexts while focusing on pressing sexual issues and vulnerable populations. The articles address the implementation of a positive sexuality framework for guiding leisure research; sexual play and sex toys based on consumer experience perspectives; using the leisure lens to analyze sex and pornography addiction; quadriplegic sexuality and leisure; rejection and resilience on a gay cruise; relational dynamics of aging, exploitation, and deceit in sex tourism; sexual harassment of solo female travelers; and the complexity of consent in the sexualized leisure space of a pornography expo. This issue will be of general interest to the audience interested in interdisciplinary scholarship as it critically broadens the bio-psycho-socio-cultural perspective of sex as leisure.

Credit-worthiness, as defined by financial institutions credit scoring systems, classify people according to categories of risk. For many sectors of society, decision metrics and scorecard implementations are determinants that serve as a financial gateway to access the most basic human needs for safety and well-being. For those with no credit or credit scores less than excellent, escalating negative circumstances lead to adverse life events associated with financial stress, widening socioeconomic disparities, and worsening biopsychosocial conditions. The impact of credit-worthiness on financial wellbeing and the negative psychological constructs of anxiety, depression, and hopelessness were explored through quantitative research with a focus on improving these factors through a credit restoration intervention. A quasi-experimental research design was employed to survey seventy-two participants before receiving the intervention and after an initial phase of the intervention process. Findings showed a positive difference in the subjective well-being of the psychological constructs and corroborated the need to expand awareness of the impact of credit-unworthiness across a wide range of socio-demographic strata including veteran and military families and suicidal behavior. A recommendation is made to conduct a follow-up longitudinal study to address two national issues, epidemic suicide rates, and credit reporting reform legislation. A longitudinal study could benefit several other issues facing this nation including population health, wellbeing, and other social determinants of health. Further analysis can inform Well-Being and Credit Restoration that contribute to current social issues of significant concern. Well-being is an interdisciplinary field of study that has important implications for psychology, health, economics, public policy, and society. Credit restoration is both a construct and intervention and is part of an interdisciplinary, collaborative, continuum of care which can positively contribute to reducing debt and the financial stress and psychological indicators associated with indebtedness. A follow-up enhanced research design will accommodate a longitudinal study consisting of a pre-test and three posttests and a Credit Restoration Score© measuring client progress over twelve months.

Inheriting the nineteenth century division between the natural- and human-historical sciences, Karl Jaspers emphasizes the psychological understanding of mental disorders as narrative-based, holistic and contextual. However, he also affirms the value of explanatory physiological and neurobiological approaches. Nassir Ghaemi nonetheless interprets Jaspers person-centered, methodologically based pluralism as contradicting George Engel's biopsychosocial project. In our view, Jaspers advances this project. Emphatically, Engel proposed a project and not a product. We have tried to develop a narrative somewhat different than Ghaemi's, with a synergistic consequence, a biopsychosocial model for medicine and psychiatry indebted to both Jaspers and Engel. It is our conclusion that Jaspers' person-centered, methodological pluralism does not contradict biopsychosocial medicine and psychiatry but in fact complements and advances the broader medical model that Engel sought but never ...

In this session the presenters will strive to demonstrate that Biblical principles can be utilized in
social work practice. Participants will review basic social work tenets and Biblical principles. Case
examples will be shared wherein women developed coping skills/strategies rooted in their faith linked
to Biblical principles that they applied in addressing psychosocial stressors in their lives.

The current paper provides an explanation of neurophysiological pain processing based the Dimensional Systems Model (DSM), a theory of higher cortical functions in which the cortical column is considered the binary digit for all cortical functions. Within the discussion, novel views on the roles of the basal ganglia, cerebellum, and cingulate cortex are presented. Additionally, an applied Clinical Biopsychological Model (CBM) based on the DSM will be discussed as related to psychological treatment with chronic pain patients. Three specific areas that have not been adequately addressed in the psychological treatment of chronic pain patients will be discussed based on the CBM. The treatment approaches have been effectively used in a clinical setting. Conclusions focus on a call for researchers and clinicians to fully evaluate the value of both the DSM and CBM.

Dans cette présentation, l'auteur tente de mettre en regard de la complexité des fonctions exécutives les dimensions biologiques, psycho cognitives et affectives, et sociales...
L'important est entre les lignes puisqu'il déploie une logique des systèmes dynamiques en lien avec la démarche thérapeutique à l'aide de quelques modélisations.... cette conférence est complémentaire de l'Introduction théorico-pratiqueLa modélisation : à quoi ça sert ? du 9 septembre 2021

Substance use disorders, as conceptualized by the biopsychosocial model, are dependent upon maladaptive behavior responding to biological, psychological, and social factors. Imbalances, instabilities, and deficits in these facets of life may therefore lead to problematic relationships with substances and the pursuit of reconciling with these domains via risky,
dangerous, or uninformed use of various drugs. However, combining professional, therapeutic treatment in a clinical setting with a medically supervised and individually customized exercise regimen may be the ideal intervention for substance use disorders, as to be explained by
considerations of the biopsychosocial model of understanding substance use disorders

The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism-both conceptual and pragmatic. This paper extends and fundamentally restructures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more "practical theory" for humancentered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between "health status" and "health and needs assessment", [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on "interventions" vs. "treatments" to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.

Background: The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). Methods: A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an 'urn randomisation' algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop selfmanagement strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. Results: There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI − 2.82 to 2.99; p = 0.955), at 6 months (mean difference, − 1.80; 95% CI; − 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, − 1.33; 95% CI − 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. Conclusion: BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. Trial registration: Current controlled trials NCT01666639, 16/08/2012.

Older adults face unique challenges in managing pain conditions, including physical decline, cognitive complications, multi-mor-bidities, increased rate of medication consumption, and awareness of alternative methods. From a biopsychosocial perspective, we know that an interdisciplinary approach leads to more effective strategies for pain management, particularly with older adults. Traditional therapies including exercise, stretching, and strength training may not be appropriate for all older adults, so alternatives must be considered such as acupuncture, chiropractic work, Eastern medicinal approaches, pharmacological intervention, and muscle stimulation. This review aims to highlight multiple pain management strategies in consideration for older adults and their respective challenges to managing pain conditions.

This study is based on the existence of the right to an integral education in childhood, which includes the spiritual and religious dimensions. Multiple studies show that, for religious people, religiosity is a fundamental dimension in their personal development. Religious development depends to a large extent on different factors, such as school education and family. However, not every religious context is positive for human development, which is why societies set limits on religious freedom. A summary of the main studies concluding that, in general, religiosity has a positive influence on people's development (e.g., it makes them happier, more tolerant, more resilient, less susceptible to illness, they have more positive relationships, etc.) is shown below. Finally, guidelines are provided for an integral education of religiosity during childhood and adolescence, valuing the differential role played by psychological development, the family context, the educational context and that of peers. This paper advocates the importance of comprehensive religious education for children who are believers; and of the relevance of teaching about different religious realities for all schoolchildren.

Since Myers (1915) coined the term 'shell shock' to define the prolonged suffering of soldiers returning from the Great War, the psychological and physical result of distressing experiences, known as trauma, has been of academic interest. Transgenerational transmission of trauma effects has been recorded, demonstrating that on some level, the exposure to trauma of one generation can impact individuals of a subsequent generation (Yehuda & Lehrner, 2018). Observational studies on children of holocaust survivors formed the basis of this trajectory of research (Rakoff, 1966), and eventually this phenomenon became referred to as the transgenerational transmission of trauma (TTT). Since then, TTT has been observed in several contexts, including within families who have experienced high rates historical trauma (O'Neill et al., 2016), within regions high-frequencies of historical war and terrorism (Yehuda & Lehrner, 2018) and those who have undergone famine (Ahmed, 2010). This r...

Background: In Germany, a multidisciplinary rehabilitation named "behavioural medical rehabilitation" (BMR) is available for treatment of chronic low back pain (clbp). A central component of BMR is standard exercise therapy (SET), which is directed mainly to improve physical fitness. There is a need to address psychosocial factors within SET and therefore to improve behavior change with a focus on the development of self-management skills in dealing with clbp. Furthermore, short-term effectiveness of BMR with a SET has been proven, but the impact of a behavioural exercise therapy (BET) for improvement of the long-term effectiveness of BMR is unclear. Methods/design: To compare the effectiveness of two exercise programs with different approaches within BMR on the effects of BMR a prospective randomized controlled trial (RCT) in two rehabilitation centres will be performed. 214 patients aged 18-65 with clbp will be, based on an "urn randomisation"-algorithm, randomly assigned to a BMR with SET (function-oriented, n=107) and BMR with BET (behaviour-oriented, n=107). Both exercise programs have a mean duration of 26 hours in three weeks and are delivered by a limited number of not-blinded study therapists in closed groups with six to twelve patients who will be masked regarding study group. The main differences of BET lie in its detailed manualised program with a theory-based, goal-orientated combination of exercise, education and behavioural elements, active participation of patients and consideration of their individual preferences and previous experiences with exercise. The primary outcome is functional ability assessed with the Hannover Functional Ability Questionnaire directly before and after the rehabilitation program, as well as a six and twelve-month follow-up. Discussion: This RCT is designed to explore the effects of BET on the effectiveness of a BMR compared to a BMR with SET in the management of patients with clbp. Methodological challenges arise from conducting a RCT within routine health care as well as from ensuring high treatment integrity. Findings of this study might contribute to a better understanding of the mechanism of action of BMR and the special effects of BET and may be used to improve the quality of these interventions in routine care, therefore reducing the burden to patients with disabling clbp. Trial registration: Current controlled trials NCT01666639

Thanks to the recent progres in medicine, technology, economy and higiene, our life expectancy has raised in cuality and cuantity. Right now 75.8 years is our life expectancy. In this context we analyse the impact of the so called biomedic paradigm of aging and one of its most evident consequences: the medicalization of aging. An integrative biopsicosocial model is proposed. This new paradigm recognice people not just as an organism and take in count that everybody has a history and belong to a social group in a historic moment. This conditions have their byas in health status and disease origin. From this perspective the sense of illness becomes the illness person and the aging process stops being conceptualiced as a exclusively pathological time. We will take in count recent evidence of the potencials in aging, in particular the concept of empathy, as that process that will allow the old age person to take participation in his comunitary context as a support source against the problematics leaving the medicalization as one of severall solutions

Credit-worthiness, as defined by financial institutions credit scoring systems, classify people according to categories of risk. For many sectors of society, decision metrics and scorecard implementations are determinants that serve as a financial gateway to access the most basic human needs for safety and well-being. For those with no credit or credit scores less than excellent, escalating negative circumstances lead to adverse life events associated with financial stress, widening socioeconomic disparities, and worsening biopsychosocial conditions. The impact of credit-worthiness on financial wellbeing and the negative psychological constructs of anxiety, depression, and hopelessness were explored through quantitative research with a focus on improving these factors through a credit restoration intervention. A quasi-experimental research design was employed to survey seventy-two participants before receiving the intervention and after an initial phase of the intervention process. ...

Since Myers (1915) coined the term 'shell shock' to define the prolonged suffering of soldiers returning from the Great War, the psychological and physical result of distressing experiences, known as trauma, has been of academic interest. Transgenerational transmission of trauma effects has been recorded, demonstrating that on some level, the exposure to trauma of one generation can impact individuals of a subsequent generation (Yehuda & Lehrner, 2018). Observational studies on children of holocaust survivors formed the basis of this trajectory of research (Rakoff, 1966), and eventually this phenomenon became referred to as the transgenerational transmission of trauma (TTT). Since then, TTT has been observed in several contexts, including within families who have experienced high rates historical trauma (O'Neill et al., 2016), within regions high-frequencies of historical war and terrorism (Yehuda & Lehrner, 2018) and those who have undergone famine (Ahmed, 2010). This report aims to outline several pathways (biological, psychological, and sociological) by which trauma may be transmitted across generations. Moreover, it discusses several methods of trauma assessment and the related challenges and benefits. Lastly, this report advocates a biopsychosocial approachan interdisciplinary model using the interplay of biological, psychological, and socialenvironmental factorsto research TTT. By promoting the benefits of such an interdisciplinary approach we attempt to break up silos between disciplines and encourage collaboration between academics from various backgrounds researching this topic to better serve individuals impacted by TTT.

Since Myers (1915) coined the term 'shell shock' to define the prolonged suffering of soldiers returning from the Great War, the psychological and physical result of distressing experiences, known as trauma, has been of academic interest. Transgenerational transmission of trauma effects has been recorded, demonstrating that on some level, the exposure to trauma of one generation can impact individuals of a subsequent generation (Yehuda & Lehrner, 2018). Observational studies on children of holocaust survivors formed the basis of this trajectory of research (Rakoff, 1966), and eventually this phenomenon became referred to as the transgenerational transmission of trauma (TTT). Since then, TTT has been observed in several contexts, including within families who have experienced high rates historical trauma (O'Neill et al., 2016), within regions high-frequencies of historical war and terrorism (Yehuda & Lehrner, 2018) and those who have undergone famine (Ahmed, 2010). This r...

in September, before they interacted with the school regimen, and again in May before exams. Anxiety means were one SD above the normative mean for nonpatients at both times. The number of students report.. ing a significant level of depression doubled from September (N = 36) to May (N = 78). The correlation of distress in September and May was .40, indicating that for many students distress was enduring. A biopsychosocial model of initial distress explained more variance (36%) in the cross-validation sample than did any one variable alone. Distressed students had higher Type A scores. Also, anger held in was a risk factor for distress in students with a family history ofcardiovascu!~r disease (CVD). Students who hold anger in may experience prolonged stress which, coupled with a family history of CVD, could make them psychobiologically vulnerable to distress.

At the root of many issues debated today in psychiatry lie basic conceptions of human nature. Arguments regarding the fruitfulness of biopsychosocial, integrative, or reductionistic models, biological versus social causality in mental illness, the adequacy of existing nomenclature and classificatory schemes, the role of psychotherapy, and numerous others reach no decisive resolution because the proponents of the different arguments presuppose fundamentally different views of human existence.

It would seem best then to address the topic of human existence directly and explicitly. Yet no one can address this topic today without granting full weight to the findings and claims of those many sciences and disciplines, such as psychology, sociology, and biology, that already concern themselves with things human. And herein lies precisely the largest conceptual problem: the empirical sciences of human life display no coherent and unified theoretical orientation. Empirical studies approach human life from a bewildering variety of "standpoints" and "perspectives." If the anarchy of "standpoints" in the human sciences is to be reduced, some overarching conceptual framework must be developed for them. And if this framework is to provide intellectual guidance for psychiatry in particular, it must meet specific requirements. It is undeniable first that any theoretical framework that is to be serviceable for psychiatry must ascribe a central place to human biology and to the rapidly growing field of neuroscience. It is evident secondly that this general theory must delineate the shaping of the human being through interpersonal relationships; it must be shown how interaction with a sociocultural environment influences the cognitive, emotional, and conative components of the human mind-brain. And thirdly the formation of the human individual through social interaction must become clear in its earliest stages.

We suggest that the most promising prospects for such an overarching theoretical framework lie in an orientation which in Continental Europe is called "philosophical anthropology." In this phrase the term "anthropology" retains its etymological meaning as the logos, science, of anthropos, the human. The narrower discipline which is labeled "anthropology" in English-speaking countries is usually called "ethnology" in Continental Europe.

Philosophical anthropology found its place within medicine years ago although that place has since been neglected. During the first half of this century, stubbornly irresolvable arguments regarding diagnosis and treatment led some physicians in Continental Europe to raise in a fundamental way the perplexing problem of human nature. Unlike earlier thinkers, however, they realized that this question could no longer be considered solely a "metaphysical" one. With the impressive growth of empirical scientific research into animal and human life, such as biology, zoology, psychology, and sociology, these physicians perceived the possibility of developing a comprehensive theory of human beings through a critical rethinking of empirical data. In addition to drawing on the many empirical sciences, this field adapted certain concepts from the emerging philosophy of human existence. The philosophical categories, however, were re-evaluated and redefined in the light of empirical findings. The central intellectual task lay in constructing a unified view of the multiple facets of human existence that the natural and social sciences as well as philosophy were progressively disclosing. Contrary to "existential philosophy" which conceived humans in total abstraction from their rootedness in nature, the "anthropologists" sought to understand human beings as natural living beings. They began, therefore, with the phenomenon of life itself, a phenomenon which is then conceived in different ways by philosophy and the natural and social sciences. This European orientation was called "anthropological medicine."

What are the respective roles of physiological, psychological and social processes in the development of psychiatric disorders? The answer is relevant for deciding on interventions, prevention measures, and for our (self)understanding. Reductionist models assume that only physiological processes are in the end causally relevant. The biopsychosocial (BPS) model, by contrast, assumes that psychological and social processes have their own unique characteristics that cannot be captured by physiological processes and which have their own distinct contributions to the development of psychiatric disorders. Although this is an attractive position, the BPS model suffers from a major flaw: it doesn’t tell us how these biopsychosocial processes can causally interact. If these are processes of such different natures, how then can they causally affect each other? An enactive approach can explain biopsychosocial interaction. Enactivism argues that cognition is an embodied and embedded activity and that living necessarily includes some basic form of cognition, or sense-making. Starting from an enactive view on the interrelations between body, mind, and world, and adopting an organisational rather than a linear notion of causality, we can understand the causality involved in the biopsychosocial processes that may contribute to the development of psychiatric disorders.