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Biopsychosocial model
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The '''biopsychosocial model''' (BPS model) or '''cognitive behavioral model''' (CBM) looks at biological, psychological and social factors to explain why disorders occur and is a tool used by psychologists to examine how psychological disorders develop.<ref>{{Cite web | url = http://study.com/academy/lesson/what-is-the-biopsychosocial-model-definition-example.html | title = What is the Biopsychosocial Model? - Definition & Example - Video & Lesson Transcript {{!}} Study.com | last = Mitchell | first = Gina | date = | website = |language=en|archive-url=|archive-date=|url-status= | access-date = 2018-10-29| publisher = Oxford University|series=|at=Chapter 4 Lesson 15 | author-link = }}</ref><ref name="Geraghty2019" /> {{Quote2|[[Exercise]] or activity programmes are the archetypal BPS intervention. This was shown to us in our trial when we used [[graded exercise therapy]] in [[chronic fatigue syndrome]].<ref name=":0">{{Cite book | url =https://books.google.com/books?hl=en&lr=&id=chwtWAt76JoC&oi=fnd&pg=PR15 | title = Biopsychosocial medicine: an integrated approach to understanding illness | last = | first = | date = 2005| publisher = Oxford University Press|others=| year = |isbn=0198530331|edition=1st|location=Oxford | pages = |oclc=|editor-link = Peter White|chapter=|quote=|editor-last2 = |editor-link2 = |editor-last = White|editor-first = Peter}}</ref>|[[Peter White]]|Biopsychosocial Medicine}} == BPS model in chronic fatigue syndrome == [[File:ChronicFatigueSyndrome-BPS-model-CBT-GET.jpg|none|thumb|'''The biopsychosocial model for [[ME/CFS]] by Vercoulen et al (1998).'''<br> Fatigue: the subjective feeling of fatigue; fatigue subscale of the Checklist Individual Strength. Focusing on (Bodily) Symptoms: somatisation subscale of the Symptom Checklist. (Level of) Physical Activity: Sickness Impact Profile (SIP) subscale mobility (SIP-MOB) and the Physical Activities Rating Scale. (Functional) Impairment: impairment in daily life; subscale of activities at home of the SIP. Sense of Control (over Symptoms): selected items of the modified Pain Cognition List on a specific five-point scale. Causal Attributions: Causal Attributions List (high scores: physical attributions, low scores: psychosocial attributions).<br /> ''Source: Maes, M., & Twisk, F. N. (2010). Chronic fatigue syndrome: Harvey and Wessely's (bio) psychosocial model versus a bio (psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways. BMC medicine, 8(1), 35. License: CC-BY-2.0'']] Vercoulen et al (1998) created a highly influential biopsychosocial (BPS)model for "chronic (subjective) fatigue" which was used for [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]], and justified the use of both [[cognitive behavioral therapy]] and [[graded exercise therapy]] as treatments.<ref name="Vercoulen1998" /><ref name="Maes2010" /> However, Vercoulen et al's BPS was developed using patients that did not meet any recognized diagnostic criteria for CFS, instead they selected a mix of patients with [[idiopathic chronic fatigue]] and [[chronic fatigue syndrome]];<ref name="Vercoulen1998" /> only 68% of these patients experienced [[post-exertional malaise]], which later became regarded as the hallmark symptom of ME/CFS.<ref name="Vercoulen1998" /> [[File:ChronicFatigueSyndrome-BPS-Wessleymodel.jpg|none|thumb|'''The (bio)psychosocial model of 'chronic fatigue' by Wessely and Harvey, which is used to justify [[cognitive behavioral therapy]] and [[graded exercise therapy]] treatments for [[chronic fatigue syndrome]]''' ''Source: Maes, M., & Twisk, F. N. (2010). Chronic fatigue syndrome: Harvey and Wessely's (bio) psychosocial model versus a bio (psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways. BMC medicine, 8(1), 35. License: CC-BY-2.0'']] [[Simon Wessely|Wessely]] and [[Samuel Harvey |Harvey]] (2009) proposed a development of Vercoulen's biopsychosocial model for not only chronic fatigue syndrome, but for ''all'' causes of fatigue, including psychiatric disorders, biological illnesses including AIDS, and fatigue without a known cause.<ref name="Wessely2009" /> Wessely and Harvey's model has been referred to as a psychosocial model.<ref name="Wessely2009" /><ref name="Maes2010" /> This theoretical model proposed that the all chronic fatigue syndrome and all fatigue was caused by [[Cognitive behavioral model#threeps|the 3Ps]]: '''predisposing factors''' (e.g. [[personality traits and patient attitudes in ME/CFS|personality traits]] or other pre-existing [[risk factors]]), '''precipitating factors''' (e.g. a virus, stress or other trigger) and '''perpetuating factors''' (psychological or behavorial factors, e.g., too much rest, being excessively focused on symptoms, beliefs about the illness being caused by a virus, or the patients' other thoughts and behaviors). It did not recognize a [[genetics of chronic fatigue syndrome|genetic predisposition]] for CFS. <ref name="Maes2010" /> == History == In a 1977 article in Science,<ref name="Engel1977">{{Cite web | url = http://www.jstor.org/stable/1743658?seq=1#page_scan_tab_contents | title = The Need for a New Medical Model: A Challenge for Biomedicine|journal =Science|language=en | access-date = 2018-12-20 | date = 1977 | last = Engel | first = George L. | author-link = George Engel|archive-url=|archive-date=|url-status=}}</ref> psychiatrist [[George Engel|George L. Engel]] called for "the need for a new medical model." The BPS model is the dominant model used to understand [[mental illness]] and combines biological, psychological and social factors. ==Evidence== Song and Jason (2005) concluded that their "current investigation found that the Vercoulen et al. model adequately represented chronic fatigue secondary to psychiatric conditions but not CFS."<br the name="SongJason2005" /> ==Criticism == Song and Jason (2005) attempted to replicate Vercoulen's model, but found it did not fit patient data.<ref name="SongJason2005" /> {{Quote box|Vercoulen et al. (1998) suggested their findings indicated that individuals with CFS attribute their symptoms to physical causes, are overly preoccupied by physical limitations, and do not maintain regular activity. According to this model, these factors cause individuals with CFS to be functionally impaired and to experience severe fatigue. The fact that this model could not be replicated with either the CFS or those with medical reasons for their chronic fatigue... suggests an important distinction between individuals with chronic fatigue due to a psychiatric condition versus CFS. In other words, the present study does not support a purely psychogenic explanation for CFS. | title = Thoughts, beliefs and a lack of activity cannot explain Chronic Fatigue Syndrome|source=Song and Jason (2005)}} The BPS model has been criticized for being inappropriately applied to organic biological diseases, and [[medically unexplained physical symptoms]] (diseases that cannot yet be fully explained by medical science). [[Psychologization]] is the assumption that a disease or illness that cannot yet be explained by medical science must be wholly or partlypsychological in nature, and is used to justify psychological treatments such as [[cognitive behavioral therapy]]. BPS models have frequently been applied to ME/CFS, [[fibromyalgia]] (FM/FMS), peptic ulcers and other illnesses that are now understood to be physiological diseases.<ref name=":0" /> Davey Smith states that peptic ulcer was "the classic BPS disease" but that "[[cognitive behavioral therapy]] rather disturbingly had no effect"; only the discovery of ''[[helicobacter pylori]]'' in 1983 allowed the patients to be cured.<ref name=":0" /> The application of the BPS model for ME/CFS has led to [[graded exercise therapy]] (GET or GES) and [[cognitive behavioral therapy]] (CBT) as treatment for ME/CFS in a number of countries including the [[United Kingdom|UK]]. == Controversy == The use of the BPS model, and its CBT and GET treatments, in [[ME/CFS]] has been heavily criticized by many researchers, charities and patient groups.<ref name="twisk2009" /><ref name="IIMER">{{Cite web | url = http://www.investinme.org/Documents/Fact%20Sheets/Invest%20in%20ME%20Research%20-%20Flaws%20in%20BPS%20Theory%20for%20ME%20Fact%20Sheet.pdf | title=Notes on the Ineffectiveness of the Biopsychosocial Model for Treating Myalgic Encephalomyelitis | last = Invest in ME Research | author-link = Invest in ME Research | first = | date = | website = | archive-url = | archive-date = |url-status = | access-date = October 30, 2018}}</ref> The BPS model provides the justification for the use of exercise therapy in ME/CFS.<ref name=":0" /> These controversial treatments were used in the [[PACE trial]], which [[David Tuller]], [[Keith Geraghty]], [[Robert Courtney]], [[Angela Kennedy]], [[Tom Kindlon]], [[Alem Matthees]], [[Mark Vink]] and many others have exposed the PACE trial as deeply flawed, and potentially fraudulent, and many others have analyzed and reported on the significant harms and [[ethical issues]] resulting from the use of CBT or GET in patients with ME/CFS.<ref name="Vink2017data">{{Cite journal | last = Vink | first = Mark | author-link = Mark Vink | date = 2017 | title = Assessment of Individual PACE Trial Data in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Cognitive Behavioual Therapy and Graded Exercise Therapy are Ineffective, Do Not Lead to Actual Recovery and Negative Outcomes may be Higher than Reported | url =https://www.researchgate.net/publication/312328779_Assessment_of_Individual_PACE_Trial_Data_in_Myalgic_EncephalomyelitisChronic_Fatigue_Syndrome_Cognitive_Behavioral_and_Graded_Exercise_Therapy_are_Ineffective_Do_Not_Lead_to_Actual_Recovery_and_Negati | journal = J Neuro Neurobiol | volume = 3 | issue = 1 | pages = |doi=10.16966/2379-7150.136|quote=|via=}}</ref><ref name="Vink2016PACE">{{Cite journal | last = Vink | first = Mark | author-link = Mark Vink | date = 2016 | title = The PACE Trial Invalidates the Use of Cognitive Behavioral and Graded Exercise Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Review | url =http://dx.doi.org/10.16966/2379-7150.124 | journal = Journal of Neurology and Neurobiology | volume = 2 | issue = 3|doi=10.16966/2379-7150.124|issn=2379-7150}}</ref><ref name="twisk2009" /><ref name="Geraghty2016" /><ref name="Geraghty2018" /><ref name="Geraghty2019" /> The [[UK Parliament House of Lords PACE Trial debate 6th February 2013]] and the [[UK Parliament Grand Committee Room debate 21st June 2018]] debated the PACE trial. [[Carol Monaghan]] MP for the [[:Category:UK SNP politicians|Scottish National Party]] stated at a February 20th debate in the House of Commons Hansard, “I think that when the full details of the trial become known, it will be considered one of the biggest medical scandals of the 21st century.”<ref>{{Cite web | url = http://www.virology.ws/2018/03/28/trial-by-error-a-q-and-a-with-scottish-mp-carol-monaghan/ | title = Trial By Error: A Q-and-A with Scottish MP Carol Monaghan | last = Tuller | first = David | date = Mar 28, 2018 | website = [[Virology blog]]|language=en-US|archive-url=|archive-date=|url-status= | access-date = 2018-10-29}}</ref><ref>{{Cite web | url = https://hansard.parliament.uk/commons/2018-02-20/debates/990746C7-9010-4566-940D-249F5026FF73/PACETrialPeopleWithME | title = PACE Trial: People with ME - Hansard | last = | first = | date = Feb 20, 2018 | website = hansard.parliament.uk|language=en|archive-url=|archive-date=|url-status= | access-date = 2018-10-29|edition=Volume 636}}</ref> ==Notable studies== * 1977, The Need for a New Medical Model: A Challenge for Biomedicine<ref name="Engel1977" /> [http://www.jstor.org/stable/1743658?seq=1#page_scan_tab_contents (Abstract)] * 1989, Management of chronic (post-viral) fatigue syndrome<ref>{{Cite journal | last = Wessely | first = S. | author-link = Simon Wessely | last2 = David | first2 = A. | author-link2 = | last3 = Butler | first3 = S. | author-link3 = | last4 = Chalder | first4 = T. | author-link4 = Trudie Chalder | date = Jan 1989 | title = Management of chronic (post-viral) fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/2553945 | journal = The Journal of the Royal College of General Practitioners | volume = 39 | issue = 318 | pages = 26–29|doi=|issn=0035-8797|pmc=1711569|pmid=2553945|access-date=|quote=|via=}}</ref> [https://europepmc.org/articles/PMC1711569/ (Full text)] *1998, The Persistence of Fatigue in Chronic Fatigue Syndrome and Multiple Sclerosis: The Development of a Model<ref name="Vercoulen1998">{{Cite journal | last = Vercoulen | first = J.H. M.M. | author-link = Jan Vancoulen | last2 = Swanink | first2 = C.M. A | author-link2 = Caroline Swanink | last3 = Galama | first3 = J. M. D | author-link3 = Jochem Galama | last4 = Fennis | first4 = J. F. M | author-link4 = Jan Fennis | last5 = Jongen | first5 = P. J. H | author-link5 = Peter Jongen | last6 = Hommes | first6 = O. R | author-link6 = Otto Hommes | last7 = van der Meer | first7 = J.W.M | author-link8 = Jos van der Meer | last8 = Bleijenberg | first8 = G | author-link8 = Gijs Bleijenberg | date = Dec 1, 1998 | title = The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model | url = http://www.sciencedirect.com/science/article/pii/S0022399998000233 | journal = [[Journal of Psychosomatic Research]] | volume = 45 | issue = 6 | pages = 507–517|doi=10.1016/S0022-3999(98)00023-3|issn=0022-3999|quote=|via=}}</ref> [https://www.sciencedirect.com/science/article/abs/pii/S0022399998000233 (Abstract)] * 2005, A population-based study of chronic fatigue syndrome (CFS) experienced in differing patient groups: An effort to replicate Vercoulen et al.'s model of CFS<ref name="SongJason2005">{{Cite journal | last = Song | first = Sharon | author-link = Sharon Song | last2 = Jason | first2 = Leonard A | author-link2 = Leonard Jason | date = Jun 2005 | title = A population-based study of chronic fatigue syndrome (CFS) experienced in differing patient groups: An effort to replicate Vercoulen et al.'s model of CFS | url = https://www.researchgate.net/profile/Leonard_Jason/publication/228366737_A_population-based_study_of_chronic_fatigue_syndrome_CFS_experienced_in_differing_patient_groups_An_effort_to_replicate_Vercoulen_et_al's_model_of_CFS/links/0deec51acf70e3203b000000/A-population-based-study-of-chronic-fatigue-syndrome-CFS-experienced-in-differing-patient-groups-An-effort-to-replicate-Vercoulen-et-als-model-of-CFS.pdf | journal=Journal of Mental Health|language=en | volume = 14 | issue = 3 | pages = 277–289|doi=10.1080/09638230500076165|issn=0963-8237|quote=|via=}}</ref> [https://www.researchgate.net/profile/Leonard_Jason/publication/228366737_A_population-based_study_of_chronic_fatigue_syndrome_CFS_experienced_in_differing_patient_groups_An_effort_to_replicate_Vercoulen_et_al's_model_of_CFS/links/0deec51acf70e3203b000000/A-population-based-study-of-chronic-fatigue-syndrome-CFS-experienced-in-differing-patient-groups-An-effort-to-replicate-Vercoulen-et-als-model-of-CFS.pdf (Full text)] * 2009, Chronic fatigue syndrome: identifying zebras amongst the horses.<ref name="Wessely2009">{{Cite journal | last = Harvey | first = Samuel B. | author-link = Samuel Harvey | last2 = Wessely | first2 = Simon | author-link2 = Simon Wessely | date = 2009-10-12 | title = Chronic fatigue syndrome: identifying zebras amongst the horses |url =https://www.ncbi.nlm.nih.gov/pubmed/19818158 | journal = BMC medicine | volume = 7 | issue = | pages = 58|doi=10.1186/1741-7015-7-58|issn=1741-7015|pmc=2766380|pmid=19818158|quote=|via=}}</ref> ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766380 Full text]) *2009, A review on cognitive behavorial therapy (CBT) and [[graded exercise therapy]] (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS<ref name="twisk2009">{{Cite journal | last = Twisk | first = Frank N.M. | author-link = Frank Twisk | author-link2 = Michael Maes | last2 = Maes | first2 = Michael | date = 2009 | title = A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS | url = https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ | journal = Neuro Endocrinology Letters | volume = 30 | issue = 3 | pages = 284–299|issn=0172-780X|pmid=19855350}}</ref> [https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/ (Abstract)] *2010, Chronic fatigue syndrome: Harvey and Wessely's (bio) psychosocial model versus a bio (psychosocial) model based on inflammatory and oxidative and nitrosative stress<ref name="Maes2010">{{Cite journal | last = Maes | first = Michael | last2 = Twisk | first2 = Frank NM | author-link = Michael Maes | author-link2 = Frank Twisk | date = 2010-06-15 | title = Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways |url =https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-8-35 | journal = BMC Medicine | volume = 8 | issue = 1 | pages = 35|doi=10.1186/1741-7015-8-35|issn=1741-7015}}</ref> [https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-8-35 (Full text)] *2011, Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up<ref name="Nunez2011">{{Cite journal | last = Núñez | first = Montserrat | author-link = Montserrat Núñez | last2 = Fernández-Solà| first2 = Joaquim | author-link2 = Joaquim Fernández-Solà | last3 = Nuñez | first3 = Esther | author-link3 = Esther Nuñez | last4 = Fernández-Huerta | first4 = José-Manuel | author-link4 = José-Manuel Fernández-Huerta | last5 = Godás-Sieso | first5 = Teresa | author-link5 = Teresa Godás-Sieso | last6 = Gomez-Gil | first6 = Esther | author-link6 = Esther Gomez-Gil | date = Mar 2011 | title = Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up | url =http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf | journal = Clinical Rheumatology | volume = 30 | issue = 3 | pages = 381–389|doi=10.1007/s10067-010-1677-y|issn=1434-9949|pmid=21234629|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf (Full text)] *2016, 'Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability'<ref name="Shakespeare">{{Cite journal | last = Shakespeare | first = Tom | author-link2 = | author-link = | last2 = Watson | first2 = Nicholas | last3 = Alghaib | first3 = Ola Abu | author-link3 = | date = 2017-02-01 | title = Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability | url = https://doi.org/10.1177/0261018316649120 | journal = Critical Social Policy|language=en | volume = 37 | issue = 1 | pages = 22–41|doi=10.1177/0261018316649120|issn=0261-0183|quote= | author-link4 = | author-link5 = |via=}}</ref> [https://doi.org/10.1177/0261018316649120 (Full text)] *2016, 'Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?<ref name="Geraghty2016">{{Cite journal | last = Geraghty | first = Keith J. | last2 = Esmail | first2 = Aneez | author-link2 = Esmail Aneez | author-link =Keith Geraghty | date = 2016-08-01 | title = Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm? | url = https://bjgp.org/content/66/649/437 | journal = Br J Gen Pract|language=en | volume = 66 | issue = 649 | pages = 437–438|doi=10.3399/bjgp16X686473|issn=0960-1643|pmid=27481982}}</ref> [https://bjgp.org/content/66/649/437 (Abstract)] *2017, Contesting the psychiatric framing of ME/CFS<ref>{{Cite journal | last = Spandler | first = Helen | author-link = Helen Spandler | last2 = Allen | first2 = Meg | author-link2 = Meg Allen | date = Aug 16, 2017 | title = Contesting the psychiatric framing of ME/CFS | url = https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf | journal=Social Theory & Health|language=en | volume = 16 | issue = 2 | pages = 127–141|doi=10.1057/s41285-017-0047-0|issn=1477-8211|quote=|via=}}</ref> [https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf (Full text)] *2018, '[[ME/CFS|Myalgic encephalomyelitis/chronic fatigue syndrome]] and the biopsychosocial model: a review of patient harm and distress in the medical encounter'<ref name="Geraghty2018">{{Cite journal | last = Geraghty | first = Keith J. | author-link =Keith Geraghty | author-link2 =Charlotte Blease | last2 = Blease | first2 = Charlotte | date = 2018-06-21 | title = Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter |url =https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1481149?scroll=top&needAccess=true&journalCode=idre20& | journal = Disability and Rehabilitation|language=en | pages = 1–10|doi=10.1080/09638288.2018.1481149|issn=0963-8288}}</ref> [https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1481149?scroll=top&needAccess=true&journalCode=idre20& (Abstract)] * 2019, The ‘[[Biopsychosocial model|cognitive behavioural model]]’ of chronic fatigue syndrome: Critique of a flawed model<ref name="Geraghty2019">{{Cite journal | last = Geraghty | first = Keith | author-link = Keith Geraghty | last2 = Jason | first2 = Leonard | author-link2 = Leonard Jason | last3 = Sunnquist | first3 = Madison | author-link3 = Madison Sunnquist | last4 = Tuller | first4 = David | author-link4 = David Tuller | last5 = Blease | first5 = Charlotte | author-link5 = Charlotte Blease | last6 = Adeniji | first6 = Charles | author-link6 = Charles Adeniji | date = Jan 1, 2019 | title = The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model | url = https://doi.org/10.1177/2055102919838907 | journal = Health Psychology Open|language=en | volume = 6 | issue = 1 | pages = 2055102919838907|doi=10.1177/2055102919838907|issn=2055-1029|quote=|via=}}</ref> [https://www.researchgate.net/profile/Charles_Adeniji/publication/330901648_The_%27Cognitive_Behavioural_Model%27_of_Chronic_Fatigue_Syndrome_Critique_of_a_Flawed_Model/links/5cc5d76e299bf12097873e33/The-Cognitive-Behavioural-Model-of-Chronic-Fatigue-Syndrome-Critique-of-a-Flawed-Model.pdf (Full text)] == See also == * [[Cognitive behavioral model]] (the 3Ps model) * [[Cognitive behavioral therapy]] * [[Ethical issues]] * [[Graded exercise therapy]] * [[Medically unexplained physical symptoms]] (MUPS) * [[Music therapy]] * [[PACE trial]] * [[Psychologization]] | last4 * [[UK Parliament House of Lords PACE Trial debate 6th February 2013]] * [[UK Parliament Grand Committee Room debate 21st June 2018]] * [[UK Parliament Commons Chamber debate 24th January 2019]] * [[Wessely school]] == Learn more == * [http://www.investinme.org/Documents/Fact%20Sheets/Invest%20in%20ME%20Research%20-%20Flaws%20in%20BPS%20Theory%20for%20ME%20Fact%20Sheet.pdf Notes on the Ineffectiveness of the Biopsychosocial Model for Treating Myalgic Encephalomyelitis]<ref name="IIMER" /> - [[Invest in ME Research]] == References == {{reflist}} [[Category:Psychological paradigm]] [[Category:Medical hypotheses]]
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