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Biopsychosocial Trauma Paradigm

Posted on January 9, 2015

Over the holidays, I had a chance to step back from my trainings and reevaluate my material and approach to the trauma informed paradigm. I have learned so much from all the great people at my trainings in 2014 and wanted to integrate that experience into a fresh look at a very complex subject. Through this review, I got some insight into a new approach that could help structure our efforts to create trauma informed services, organizations, and communities.

If you have been to one of my trainings in the last couple of years, you might remember Daniel Siegel’s definition of the mind as, “a relational and embodied process that regulates the flow of energy and information.” His Triangle of Well-being Model demonstrates how the mind interacts with the brain and relationships, and is an important concept of psychology and the human condition. In his great book, Mindsight, Siegel explains his model:

“When I say the mind is embodied, I mean that the regulation of energy and information flow happens, in part, in the body.  It occurs where we usually imagine our mental life taking place, in the circuits and synapses of the brain, inside the skull.  But it also occurs throughout the body, in the distributed nervous system, which monitors and influences energy and information flowing through our heart and our intestines, and even shapes the activity of our immune system.

Finally, the mind is a relational process. Energy and information flow between and among people, and they are monitored and modified in the shared exchange.  This is happening right now between you and me, though my writing and your reading.  These packets of information-words on a page or spoken out loud-emerge from my mind and now enters yours.  If we were sitting together in the same room, we would exchange all sorts of signals with each other, symbols we’d share in word form or in the nonverbal realm of eye contact, facial expression, tone of voice, posture, and gesture.  Relationship are the way we share energy and information flow, and it is this sharing that shapes, in part, how the flow is regulated.  Our minds are created within relationships – including the one we have with ourselves.”

I have spent many hours thinking about Siegel’s Triangle of Well-being and how it helps show the impact of trauma and how we, as helpers, assist our clients in their journey to post-traumatic growth. Recently I have hit a roadblock with my understanding of Siegel’s model, and I started thinking about a more complete approach that really embodies all the complexity of our work.

My main struggle with Siegel’s (who, just for the record, I admire and respect tremendously) Triangle of Well-being is that it does not take into account the environment outside relationships. While relationships are critical to every aspect of our lives, we have also witnessed the power of socioeconomic factors on our clients. Poverty, unemployment, homelessness, and other environmental factors play a powerful role in people’s lives. I was also struggling with the label of “Brain” in the Mind/Brain/Relationship model. We know that trauma impacts much more of our body than just our brains and nervous systems. We can hold traumatic memories in areas of our bodies associated with the abuse, and it is well established that unresolved trauma can result in a variety of physical illnesses that impact many systems beyond just the nervous system. I also have witnessed the power of (non-brain) diseases on the entire person. In Siegel’s defense, we could argue that it is hard to separate the brain and body as separate entities; however, this label does focus our attention away from the overall impact of physical health on the mind (i.e. the research on how exercise impacts our psychological health) and our ability to effectively engage in relationships.

Stepping back from the Triangle of Well-being, something jumped into my consciousness that started to address the limitations I was facing with the model. One word seemed to resonate: biopsychosocial. Could this approach help us better understand the complexity of trauma and help show a path forward to post traumatic growth, even for those clients with devastating histories of trauma?

The term biopsychosocial came into the lexicon in the middle of last century as an alternative to traditional medical practices that focused exclusively on the physical self. The biopsychosocial movement challenged both medical and mental health professionals to also consider social and psychological factors in their diagnosis and treatment of clients and patients. Most professionals adapting this approach realized that the diseases and problems facing their patients and clients were much more complex than just a physical issue, and looking for solutions and treatments that includes social and psychological factors often led to better clinical outcomes.

In relation to Siegel’s Triangle of Well-being, I see the biopsychosocial model as providing a more universal approach to viewing of the individual. Replacing the Mind with Psychology does not lesson the role of the mind. Instead, it opens up the examination of other psychological phenomenon, such as spirituality. Substituting Biology for Brain allows the consideration of not just the nervous systems but the interactions of all systems within the body. The health and impact of disease can now be brought into our understanding of the person’s well-being. Finally, replacing Relationships with Social includes the impact of the environment, culture, and socioeconomic factors that relationships alone do not fully capture.

I see the biopsychosocial model as a way to look more globally at the interrelationship of trauma, the person, and society. In the next few weeks, I’m going to explore the biological, social, and psychological aspects of trauma. My first goal is to bring forth a simple biopsychosocial model of trauma that can be utilized in the assessment and treatment of clients. My second goal is to use this model to better identify the characteristics of systems and societies that are able to transform the pain and suffering of trauma into the wisdom and courage inherent to post-traumatic growth.

A few lofty goals to start 2015! I really want to encourage you to be part of this journey. Please use our new interactive format to help further the ideas and concepts presented. As a community, I’m excited to see our insight come together towards a new approach to helping those struggling to overcome past pain and trauma.