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Editorial
. 2023 Mar 30;17(1):12.
doi: 10.1186/s13030-023-00268-3.

Mind body medicine: a modern bio-psycho-social model forty-five years after Engel

Gregory Fricchione  1   2   3
Affiliations
Editorial

Mind body medicine: a modern bio-psycho-social model forty-five years after Engel

Gregory Fricchione. Biopsychosoc Med. .
No abstract available

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Conflict of interest statement

The author declares that there are no competing interests.

Figures

Fig. 1
Fig. 1
A version of the Yerkes Dodson Curve is depicted graphing performance on the y-axis and arousal or stress on the x-axis. The biphasic nature of the relationship is enhanced in the setting of task difficulty. From: Diamond et al, 2007, p. 3 (open access) [34]. "Reprinted from Neural Plasticity 2007:60803. Diamond DM, Campbell AM, Park CR, Halonen J, Zoladz PR. The temporal dynamics model of emotional memory processing: a synthesis on the neurobiological basis of stress-induced amnesia, flashbulb and traumatic memories, and the Yerkes-Dodson law, with permission from Hindawi via STM guidelines"
Fig. 2
Fig. 2
Hormesis Curve. From: Calabrese and Agathokleous, 2020, p 2, [35]. "Reprinted from Environmental Research, 186, 109559. Calabrese EJ, Agathokleous E., Theodosius Dobzhansky's view on biology and evolution v.2.0: "Nothing in biology makes sense except in light of evolution and evolution's dependence on hormesis-mediated acquired resilience that optimizes biological performance and numerous diverse short- and longer-term protective strategies.” P. 2,2020, Apr 21 with permission from Elsevier via STM guidelines"
Fig. 3
Fig. 3
An Inverted U shaped hormesis curve depicting the longitudinal relationship of aging to the dose and intensity of stress over a lifetime. Epel, 2020, p.3, [34, 37]. "Reprinted from Ageing Research Reviews, 63:101167. Epel, E. The geroscience agenda: Toxic stress, hormetic stress, and the rate of aging. P. 3, 2020, Sep 28 with permission from the author and from Elsevier via STM guidelines"
Fig. 4
Fig. 4
Mind Body Medicine Stress to Resilience Ratio – Adapted from: Fricchione, 2015 [39]. "Reprinted from Mind body medicine. In: Fogel B, Greenberg D (Eds). Psychiatric Care of the Medical Patient. 3rd Edition. Oxford University Press, 2015. With permission from Oxford Publishing Ltd. via STM guidelines"
Fig. 5
Fig. 5
Each mitochondrion is a sensory-motor analyzer-effector that responds to sensory stimuli contextualized by psychosocial factors and other stressors that in turn engender a variety of mediators, which will differentially affect mitochondrial functioning. If stress is toxic to the organism’s attachments in the setting of a handicapped resilience state, mito-allostatic overload may ensue leading to a vulnerability to accelerated biological aging and NCD and viral pathophysiology. From: Picard and McEwen, 2018, p. 30, [85]. "Reprinted from Psychosomatic Medicine, Feb/Mar; 80(2). Picard M, McEwen BS. Psychological Stress and Mitochondria: A Conceptual Framework. P. 30, 2018, with permission from the author via STM Guidelines
Fig. 6
Fig. 6
Mitochondrial Resilience and Adaptation. Developmental detrimental embedding may handicap mitochondrial resilience and adaptive capacity while protective embedding will enhance them. Persistent stress activation leads to mitochondrial allostatic load (MAL), which is then transmitted via molecular signals into cellular physiology changes resulting in overall allostatic load (AL). Energy ramifications of these micro-physiological states will be influential all the way up the line at the level of the organism’s macro-system health and social performance. Picard and McEwen, 2018, p. 31, [85]. "Reprinted from Psychosomatic Medicine, Feb/Mar; 80(2). Picard M, McEwen BS. Psychological Stress and Mitochondria: A Conceptual Framework. P. 31, 2018, with permission from the author via STM guidelines"
Fig. 7
Fig. 7
Model for proteostasis control by the ISR. Different pathologies may have distinct hormetic set points that relate to phenotypic fitness, such as cognition and behavior. As considered here, either reduced or increased ISR activation can be maladaptive. Therefore, depending on the disease or pathology and the optimal hormetic set point for a particular phenotype, activation of the ISR (e.g., with sephin1) or inhibition of the ISR (e.g., with ISRIB) would restore optimal homeostatic cell fitness. Costa-Mattioli and Walter, 2020, p. 7, [106]. "Reprinted from Science. 2020 Apr 24; 368(6489). Costa-Mattioli M, Walter P. The integrated stress response: From mechanism to disease. p. 7, 2018, with permission from the American Association for the Advancement of Science via STM guidelines."
Fig. 8
Fig. 8
Neurons and Effects of Stress. Chronic stress in increasing amounts and frequency will cause a biphasic curve reflecting negative remodeling of dendrites and synaptic connections in many brain regions, including hippocampus, amygdala, medial prefrontal and orbitofrontal cortex (upper section). Such effects of acute and chronic stress operate in space and time in an inverted U-shaped manner (lower section). Acute stress, mediated by glucocorticoids, excitatory amino acids and other mediators can enhance excitability and promote memory over minutes to hours as long as the stressor is not overly intense; intense stress can have the opposite effect. Chronic stress causes neuronal remodeling as depicted in the upper section. This is usually largely reversible, as toxic stress subsides, promoting adaptation. Yet, if there is no reversal of the stress-induced changes in neuronal architecture, chronic stress-related NCDs have a better chance of emerging. From; McEwen et al, 2016, p. 13, [110]. "Reprinted from Neuropsychopharmacology Reviews 2016; 41, 3–23. McEwen BS, Nasca C, Gray JD. Stress Effects on Neuronal Structure: Hippocampus, Amygdala, and Prefrontal Cortex. P. 13 with permission from Springer Nature via STM guidelines"
Fig. 9
Fig. 9
The ACC and its analyzer-effector function in selecting the best strategy. A During stress, the ACC assesses the gap between the probability distributions of ‘attainable states’ and ‘goal states’ in a search for plausible strategies or “policies” that constitute a menu of options. Such a gap or divergence is called a Kullback-Leibler divergence (DKL). The greater the relative risk represented by the divergence, the greater the uncertainty about which policy to choose leading to greater amygdalar activation. B Each policy represents a different relative risk (DKL). C Based upon the risk probability distribution, the ACC analyzes each strategy i (i = 1,2, …, n) for the probability that it will reduce negative prediction error and effect an attachment solution to the current separation challenge and thus ensure wellbeing. In this graphic, all probabilities are relatively low. Thus, uncertainty persists about the answer to the potential separation challenge. This can lead to a separation threat-based stress response due to a high level of uncertainty and the intolerance that ensues causing entropic strain with metabolic wear and tear in the system. From: Peters et al, 2017, p. 182 (open access) [116]. "Reprinted from, Progress in Neurobiology, 156. Peters A, McEwen BS, Friston K. Uncertainty and stress: Why it causes diseases and how it is mastered by the brain. P. 182, 2017, under Creative Commons Attribution Non-Commercial No Derivatives license permission from Elsevier via STM guidelines
Fig. 10
Fig. 10
Enhancing biological performance and resilience through the extension of the Hormetic Zone is a potential niche for mind body therapies to exploit. One hormetic stress response will result in a modest amplitude effect and a time-limited response. When hormetic stress responses, perhaps in the form of mind body practices, are performed repeatedly, these responses may summate in stepwise manner and may extend the hormetic zone. From: Leak et al, 2018, [124]. Reprinted from: Dose Response. 2018; 16(3). Leak, R. K., Calabrese, E. J., Kozumbo, W. J., Gidday, J. M., Johnson, T. E., Mitchell, J. R., Ozaki, C. K., Wetzker, R., Bast, A., Belz, R. G., Bøtker, H. E., Koch, S., Mattson, M. P., Simon, R. P., Jirtle, R. L., & Andersen, M. E. Enhancing and extending biological performance and resilience, with permission from Sage Publications
Fig. 11
Fig. 11
A Nested Hierarchy of Inverted U-shaped Curves. Individual curves, in social network theory, interact and summate locally and nationally to contribute to economic, political, social and cultural Bell-shaped curves. From: Putnam and Garrett, 2020 [129]. “Reprinted from, Putnam R, Garrett SR. The Upswing. How America Came Together a Century Ago and How We can Do It Again. NY: Simon and Schuster, 2020, … with permission from Simon and Schuster"
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References

    1. Nakao M, Komaki G, Yoshiuchi K, Deter HC, Fukudo S. Biopsychosocial medicine research trends: connecting clinical medicine, psychology, and public health. BioPsychoSocial Med. 2020;14(1):30. doi: 10.1186/s13030-020-00204-9. - DOI - PMC - PubMed
    1. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–136. doi: 10.1126/science.847460. - DOI - PubMed
    1. Benson H. The relaxation response. New York: William Morrow and Co; 1975.
    1. Kabat-Zinn J. Full catastrophe living. New York: Random House Pub; 1990.
    1. Nakao M. Bio-psycho-social medicine is a comprehensive form of medicine bridging clinical medicine and public health. BioPsychoSocial Med. 2010;4:19. doi: 10.1186/1751-0759-4-19. - DOI - PMC - PubMed

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