The Biopsychosocial Approach – What Personal Trainers Could Learn from Doctors & Physical Therapists

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“Bio-Psycho-Social” – bit of a mouthful, and yet it is actually written as all one word! Should sound self-explanatory, right? But let’s go ahead and dissect this one…

Now, to be clear, this ‘approach’ isn’t exactly new! It’s actually been around since the late 70’s – the brainchild of George Engel, who developed his ideas during his career at University of Rochester Medical Center in New York.

Often criticized for deviating from the harder, fact-based “Bio-Medical” approach and floundering too much in more speculative and less quantifiable fields; the biopsychosocial model has nonetheless earned its place in the field among Doctors, and nowadays, even Physical Therapists are putting it to use.

The approach postulates that we ought to treat the Patient as a ‘whole’, and in order to do so, we should seek to glean a better understanding of their circumstances from a Psychological and Social perspective… not merely the Biological situation that they present with.

In order to achieve this, they consider some of the following:

A person’s physiological response to stress (along the Biological line)

Their personality traits (along the Psychological line)

Thought patterns / perceptions / emotions (again – Psychological)

Interpersonal Relationships (Social)

Lifestyle (Social)

Access to healthcare / financial situation / level of education (All Social)

And there are many, many other factors they take into consideration – these are just some.

Considering a Patient’s background/history is another aspect – have they been “conditioned” through negative experiences in life? Do they display ‘catastrophic thinking’? Are they currently on medication? (This could be bridged between Biological and Psychological factors). Are they going to therapy? (This could be something Psychological and/or Social).

Do they exercise and or eat a healthy diet? This is obviously quite Biological at first glance… but think about it: there could be underlying Psychological and even Social factors at play here. This is the juncture at which I believe it is important for Personal Trainers to broaden their “approach” when it comes to the Clients they work with!

See, for “us” [Trainers], this is where it starts: Is this prospective Client currently pursuing an active lifestyle, and do they ‘eat right’?

Or: Do my [current] Clients keep up the hard work when they’re not training with me, and do they do all the right things regarding their Nutrition (Food Tracking, Calculating Macros, “Eating Clean”)?

But there is a LOT going on behind the scenes that you might not realize!

The one thing I’ve found with the Fitness Industry is that way too many people get into it with these rose-tinted glasses thinking that it’s going to be all simple and easy:

                ‘Ahhh! I love Fitness – after doing my first class, I just fell in love with it, and I knew this is what I wanted to do!’ … Only thing is, that’s a Group Class; you’re in, you’re out – perhaps a little happy-clappy-chit-chat at the end, but it’s not *Personal Training*.

Thing is, doing Group X is fun – it’s a social affair that implicitly leads to a higher degree of accountability than going solo, and can be very engaging. Personal Training though, is a different beast in and of itself.

See, the Personal part is where a lot of people who decide to take the leap to become “full-on” Trainers rarely realize just how much the Psychological and Social side of things comes into play.

The preconceived notion is that we just get to focus on our session with that ONE person, help them with their unique/individual goals, maybe get to know them a little, but ultimately, focus on Training (maybe giving some advice on Nutrition), but we’ve gotta keep things “professional”, which is where the lines get blurred.

What new Trainers in the Industry fail to realize is that they will quickly become an “on-the-spot psychiatrist/counsellor”; oftentimes people seek out 1-on-1 Training because they don’t like the Group setting, and they want that dedicated focus on *their* goals. But what can often happen is that as the Trainer-Client relationship grows, so too does the level of trust, and that can occasionally lead down some “rabbit holes” that most Trainers aren’t prepared to handle.

I’ve literally seen people leave the Industry because they didn’t realize they would “have to help people with all their emotional baggage too”…

But it’s not their fault. There’s virtually no part of any Personal Training Curriculum (at the basic levels!) that covers psychological issues, and the fact that you may end up being a Client’s cheaper alternative to seeing a ‘Shrink’.

Granted, at the higher levels (Level “3+”, for example – go check out my article on Master Trainers if you’re not sure what these are)… there are chapters/modules in these curricula that delve into some psychological factors; namely, we look at Depression & Anxiety.

So, Exercise Referral Professionals (Trainers with Level 3+ or higher) are better equipped to handle Clients with these conditions. But again – as in that referenced article – there is a very small percentage of Trainers (barely 10%!) who ever go on to get qualified to that level.

The Psychological side of things is a bit much for some people to handle. Not all Trainers are cut out to listen to a Client bleed sad stories or bemoan a stressful situation. It’s like that cliché, guru-wish-wash about ‘being the sum of the 5-6 people you spend the most time with’… Seemingly, some Trainers fear that by spending every workday around this much negativity, it could somehow impact their own emotional wellbeing.

Well, okay – we’re not Psychiatrists, but listening to another person’s problems is just a basic human skill; and sometimes, that’s all someone wants – is for someone to listen. You don’t have to solve their problems. Just lend an ear while you put them through their workout.

And this makes a great segue into the Social side of things…

What you might not realize is that your Client may not have an “All-Star” support system at home. You may just be the only person that they can turn to. Now yes, that’s a LOT of responsibility to bear, but if you do your job right – help them get stronger, fitter and healthier – then you’ll notice that a domino-effect of changes starts to occur…

As that Client starts to look and feel better, their self-confidence will grow. As this happens, they’ll often come out of their shell and begin working on the Social aspects of their life more. Their improved quality of life will likely yield more social interactions.

Perhaps having dropped 50lbs, they now feel like doing a half-marathon or running an Obstacle Course Race; plunging into an environment with hundreds of other like-minded people will then create new relationships, and before you know it, they’ve gone and developed their own support system from scratch.

You’re never [usually] going to know straight away what a new Client’s situation is [at home]. They might be recently divorced. They may have just lost a parent or sibling. They might have recently overcome Cancer, and have been mentally/emotionally changed for it. Maybe they’ve been involved with a lawsuit that had an unfavourable outcome. They could be going through a financial rough-patch, and so, Personal Training is every bit the *luxury* and investment for them.

But ours is not to judge. Although we – as Trainers – never have to swear the Hippocratic oath like Doctors and Physical Therapists, I believe that it is our duty to help people to the best of our abilities, without prejudice, and always with their best interests at heart.

So, on a Biological level, you may simply have someone who is mentally/emotionally unburdened, has a great social life, and is just looking to drop a few lbs… Those are the easy cases. However, when we come across the “not-so-easy” ones, we would do well to consider WHY that’s the case.

One acronym that is connected to the Biopsychosocial Approach is: ‘A.B.C.




I like this, because we already expect and encourage the first and last ones, but do we pay enough attention to how important the second one is? To “belong”.

When we say “Act”, we mean – stay as active as possible in all areas of your life – socially, mentally and [of course] physically…

By “Belong”, it’s wise to *connect* with your community – we all [at our core] want to be a part of a ‘Tribe’ of sorts. It is human nature.

And by “Commit”, I [at least] mean that you should commit to yourself! First and foremost. But to elaborate, we should commit to seeking out new challenges in life, and getting more engaged with friends and loved ones.

By acting on our Fitness & Nutrition, we address the Biological side of things. By belonging, we bridge the Psychological and Social; and we do the same through committing.

One of the best examples I can give of a community/group of people who embody the most exemplary form of both “A.B.C.” as well as having super healthy biopsychosocial factors in their lives would be the people of Okinawa (Japan).

You’ve probably seen the documentaries about how Okinawa is one of the few places in the world with an ultra high number of Centenarians in their ranks. Heck, there’s even a scientific study on them called: The Okinawan Centenarian Study!

A few years back I saw one of said documentaries, and they were going around the world analyzing the places where the Centenarian populations were the highest in the world; even Sardinia (Italy) was featured [among other places]. And oddly enough, they were evaluating key factors such as: their diet / how much regular exercise they get in / their social norms and practices…

With their diet, lo-and-behold, it turns out their nutrition is über-healthy! They eat LOTS of vegetables – everything from leafy greens to sweet potatoes. They eat plenty of meat, however, it is more the “accompaniment” of the dish (i.e. instead of a huge steak with a side of veggies, there is more rice and vegetables with a side of meat like cubed pork, or sliced beef). And surprise, surprise – they have virtually ZERO processed foods and/or beverages! Everything is what nature provides.

Regarding physical activity, they all exercise EVERYDAY!! Nothing insanely vigorous – just enough to keep the body strong, flexible and *active*. Whether they’re practicing Kenpo (or Karate), going for a walk, riding a bike or merely stretching… they do any one or more of these activities simply as part of their daily routine.

Typically, when they pursue these activities, it is done on a group-basis. And keep in mind, I’m talking about eating AND exercising! Meals are a very social affair, and they exercise together also. Therefore, you could say that they organize their own form of “Group X”!

Thing is though, while utterly exemplary and the picture of health, they are also unbound by the social norms and practices of “more modern” Western cultures. They’re not glued to iPhones, watching Netflix, stressed about ‘Why Colton Jumped the Fence’ (#bachelorproblems)… They live a far more simplistic lifestyle, and stressors are rendered relatively minimal.

What we can do though (and I’m talking to/about Trainers and non-Fitness Professionals alike), is we can extrapolate lessons from these people. Try and implement gradual and progressive little changes over time to our Nutrition, our Daily Activities, and our Social Interactions.

By making [what I am now going to coin as] ‘Micro-Adjustments’ to these various aspects of our lives, we will ensure that we improve our Biological condition, ameliorate any Psychological malady, and vastly enhance our Social wellbeing. As much for ourselves as individuals implementing these changes, as using these examples to help our Clients do the same. Who knows… we may even improve our chances of becoming Centenarians ourselves!

That’s all for today’s article. As ever, I hope it got the gears churning, and has helped you view things through a broader lens. I’ll catch you next time.

Yours in Training,

Chris Atkinson | Master Personal Trainer, SDO

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