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Editorial: Embracing a Biopsychosocial Approach to Brain Health

Key findings

  • The fields of neurology and psychiatry are still dominated by the biomedical model of disease, which focuses on the pathophysiology and treatment of illness
  • Faculty at Massachusetts General Hospital's Center for Health Outcomes and Interdisciplinary Research (CHOIR; formerly Integrated Brain Health Clinical and Research Program) believe it's time for a biopsychosocial approach to be applied to the study and treatment of brain health
  • Two emphases should be to prevent neurological and psychiatric illness rather than only treating symptoms and to promote optimal brain functioning through psychosocial interventions rather than addressing only the biological underpinnings
  • A third aspect is to improve physical, emotional, cognitive, and social quality of life
  • Collaborations across disciplines will be needed to accomplish these innovations

In 1977, George Engel proposed the biopsychosocial model of disease (published in Science), positing that the social, psychological, and behavioral dimensions of illness deserve greater consideration. Since then, it's been well established that these factors do influence physical health.

Yet the biomedical model still dominates the understanding of neurological and psychiatric illnesses. Physicians wait for an illness to emerge, try to determine the neurobiological cause, and then offer a drug regimen or surgery.

Ryan A. Mace, PhD, faculty in the Center for Health Outcomes and Interdisciplinary Research in the Department of Psychiatry at Massachusetts General Hospital, Victoria A. Grunberg, PhD, a postdoctoral research fellow in psychology in the center, and Ana-Maria Vranceanu, PhD, the founding director of that Center for Health Outcomes and Interdisciplinary Research, and faculty member of the Henry and Allison McCance Center for Brain Health, believe it's time for the biopsychosocial approach to be applied to the study and treatment of brain health. They present a call to action in NEJM Catalyst.

Redefining Brain Health

The authors propose to redefine brain health as "the promotion of health and well-being across the lifespan through the integration of mind, brain, body, behaviors, and spirituality."

They suggest shifting the focus of research, training and practice:

  • Away from treating symptoms to preventing neurological and psychiatric illness
  • Away from removing disability to promoting optimal brain functioning
  • Away from increasing lifespan to enhancing quality of life

Preventing Illness

An interdisciplinary approach is needed to:

  • Teach protective factors (e.g., healthy lifestyle, coping skills, adherence to primary-care visits) before illnesses occur
  • Treat illness at its earliest stage with psychosocial approaches relevant to brain function (e.g., enhance resiliency, relationships, and access to health care; address stigma and trauma)
  • Reduce the severity of illnesses and associated symptoms through healthier living

A focus on prevention should acknowledge the value of modifying biopsychosocial factors throughout the various phases of life: early (enhancing plasticity during brain development), middle (modifying risky behaviors), and later (building cognitive reserve).

Promoting Optimal Brain Functioning

Key aspects of promoting optimal brain functioning are:

  • Helping patients build resiliency (e.g., positive health behaviors, optimism, coping, strong relationships, and social support) to improve emotional well-being, independence, and productive living
  • Reframing treatment as opportunities to leverage each individual's existing health and strengths, enhance adjustment to illness and improve physical, emotional, and social functioning
  • Identifying and promoting neuroplasticity factors that support neural development, functioning, and recovery across the life course

Promoting optimal brain functioning may improve patient participation and retention and, in turn, normalize care and build trust in health care.

Enhancing Quality of Life

In the fields of neurology and psychiatry, research and clinical practice are often limited to assessing the severity of symptoms and disability. Enhancing patients' quality of life requires attending to additional concerns—the physical, emotional, cognitive, and social functioning that enables individuals to have meaningful lives.

Getting Started

Healthcare systems can start moving toward a biopsychosocial conceptualization of brain health by screening for brain health risk factors in primary care.

Institutions can also explore offering interdisciplinary "brain health services" for individuals and their family members. As presented in Alzheimer's Research & Therapy, that term refers to dementia risk profiling, dementia risk communication, dementia risk reduction, and cognitive enhancement. Brain health services are appropriate in both inpatient and outpatient settings and could be triaged for various levels of care.

Explore research in the Department of Psychiatry

Learn more about the Integrated Brain Health Clinical and Research Program

Related topics


Massachusetts General researchers presented work on psychosocial intervention development and testing for patients. Additional research focused on new technology-based assessment and treatment strategies to enhance patient care.


Massachusetts General Hospital's Clinical and Translational Research Unit (CTRU) supports investigators conducting complex brain disorders research.