The economy of health and meaning: A case study of implementing BEHI as a biosemiotic and salutogenic model of care

Abstract

Since twentieth century, psychosomatic methods have been considered and implemented in the health systems. In the last two decades, the bioenergy economy-based health improvement (BEHI) as a psychosomatic model has been developed from the biosemiotics and embodied cognition perspectives. In this case study, we trace the development of the BEHI model and, through the integration of other psychosomatic and contextual models, propose methods and environments for its implementation. BEHI is an integrative model for health promotion and well-being, by facilitating the transcendence from the impulsive and reactive to the proactive and unconditional ways to happiness. This positive and body-centered approach seeks to optimize energy-information flows through four fields of body, narrative, relationships, and intentionality. The results demonstrate significant improvements in different health conditions through the application of the BEHI model. Therefore, the BEHI model represents an effective approach that can be integrated into healthcare services to enhance both physical and mental health.

Introduction

A major question in the medical anthropology is how one can expect the knowledge gained from studying the dead and the sick to care for the living? In “The Birth of the Clinic”, Michel Foucault raised this question and argued that a professional physician tries to identify the disease by overlooking the person as an individual.[1] The historical roots of biomedicine might actually be responsible for the medical hegemony and the existing marginal, impoverished, and low-prestige attitude toward health issues in medical discourse. This is probably why both the public and the professionals perceive health as either a state of silence of the organs or an ideal state of complete biological, psychological, and social well-being. Owing to our tendency to use a large number of images full of precise and meticulous details to describe various illnesses, a pathological disease-centered approach is generally adopted to deal with the concepts of humanity and health. In other words, the broad medicalization of life and death has obscured the face of humanity behind illness.[2] Although healthcare givers strive to maintain ethical considerations and effective, empathetic clinical relationships, health personnel, and patients turn into mere subjects of faceless medicine when the existing medical model focuses entirely on treatment rather than patient experience, identity, and psychological growth and well-being.[3]

According to Ivan Illich, in order to relegate social iatrogenesis (prioritizing the medical system’s interests over those of the public) and cultural iatrogenesis (assuming a disease-centered rather than a person-centered approach) and thus ensure that medicine reinforces a culture of health instead of promoting a culture of illness, changes need to be applied to the existing medical model. In this new model, attention should be shifted from fighting diseases to individual and public care, evolution, and well-being.[4] In recent decades, significant efforts have been made to develop a systemic model of health based on physical, psychological, and relational resources.

In one of such efforts, psychosomatic medicine was developed based on systems biology and biosemiotics.[5] Biosemiotics is the exploration of how meaning is created within the living world. More specifically, it examines the processes of signification, communication, and the development of habits in living organisms.[6] While this model led to significant changes in education and treatment, it remained within the framework of the biomedical model and only modified some of its aspects.[7] Other movements, such as behavioral medicine and health psychology, also attempted to give a more active role to the patient in recovery and prevention. Moreover, some transdiagnostic therapeutic approaches widely used in psychosomatic medicine, e.g., solution-focused therapy, mindfulness, acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT), focused on how to eliminate barriers to health promotion and prevent psychosomatic pathways causing more complicated disorders and maladaptive health behavior.[8]

Among these emerging transdiagnostic care models, BEHI (bioenergy economy-based health improvement) was recently introduced and employed in various health domains. BEHI adopts biosemiotics to present a psychosomatic model to facilitate health processes through cognitive, behavioral, bodywork, and mindfulness-based interventions.[9,10,11] The BEHI uses a biosemiotics metalanguage to blend molecular changes with communicative actions, fostering an integrative approach that synchronizes symbolic and non-symbolic systems. It combines body-centered, cognitive, emotional, and transpersonal principles into a flexible design suitable for clinical and educational environments, serving as a transformative, health-promoting program. BEHI’s transdiagnostic method is shown to be as effective, or more so, than other programs like MBSR, MBCT, and ACT, aligning well-being dimensions with a sophisticated care model.

In this case study, we sought to explain the various aspects of this health-promoting interventional model. Therefore, after an introduction to the model and summarizing previous studies on its application, we comprehensively explained the benefits of BEHI as a proposed health promotion intervention to be integrated into the health system.

Methods

This case study explores the emergence and development of the BEHI model. It examines findings from studies that demonstrate the model’s impact on various diseases and health conditions. Building on these results and the methods used to integrate the interventions, a proposed BEHI integration program is presented.

Results

Cause of development

While the rapid pace of social, technological, and health changes in the twenty-first century provided us with numerous opportunities to body control, from selective activation and gene editing to various types of smart prosthetics, it has also raised complex economic, cultural, and ethical issues.

The current health crises are partly caused by increased physical and social passivity and greater concentration of power and capital due to technological advancements, especially artificial intelligence.[12,13] In today’s world, life expectancy has grown but the elderly are not valued in and the youth no longer see them as a source of experience and wisdom. Years lived with illness have lengthened, but the mythical and spiritual beliefs that once gave meaning to human suffering no longer suffice. The costly burden of this long but valueless lifespan weighs heavily on the healthcare system.[14,15]

Due to the cancerous growth of artificial intelligence, the protestant ethic, which once considered human endeavor as valuable, is becoming obsolete and larger numbers of young and educated individuals will gradually have to join the ranks of the unemployed. Meanwhile, the environmental crises caused by our greed and unsustainable lifestyle have darkened our future and created numerous physical and mental health issues.

Under such rapidly changing and complex circumstances, many health professionals including Goli raises several questions including whether the healthcare system can sustainably develop without a cohesive care model? Is health without meaning and happiness truly economical? Can a meaningful and value-creating life be guaranteed solely by relying on clinical guidelines, sporadic prevention measures, and strategic international agreements[3]?

The fundamental strategies of BEHI

Goli believes that sustainable development of happiness is indispensable for maintaining an integrated health model. He argues that health, like other instrumental values such as literacy, wealth, and social relationships, would not cause any perceived value or add value to our lives unless it activates our reward system by transforming into intrinsic values of happiness and satisfaction.[16]

The bioenergy economy (BEE) model that proposed by Goli and it is founded on the grounds of not only eastern psychophysical techniques (e.g., yoga, Qigong, and Reiki), but also Freud’s libidinal economy, theories proposed by Reich and Lyotard, and systems and biosemiotics theories.[17,18] The title of BEE, as it evolves from a mind-body intervention into an integrative model for health and well-being, has been updated to “Bioenergy Economy-based Health Improvement” in light of recent research and literature. Goli sees life through the energy-information flow and the function-meanings chain it produces and believes that sustainable health requires attunement with the evolutionary flow of life.

From the biosemiotic perspective, life is constructed from a chain of interpretations, i.e., cell membrane receptors interpret molecules and antigens of other cells. Their interpretation would turn into a meaning or function, such as the opening of a valve or activation of a pump. This will, in turn, be interpreted by the DNA to functions like RNA replication. Various signs elucidate this network of meanings. Information shapes our bodies and minds through vibrations (energy), atomic, molecular, and cellular (material) forms, visual, linguistic, and numerical (symbolic) signs, and contemplations, metacognitions, presence, and flow (reflections). As seen, this model replaces the gap between the mental and the physical with a flow of energetic-material-symbolic-reflective signs which are constantly translating into one another. In other words, the complex human life can be described as a product of this network of linguistic and prelinguistic interpretations and meanings.

Goli identifies ontological gaps between mind/body, human/nature, and medicine/life to be responsible for the major problems within the existing biomedical model. In the philosophy of medicine, the term “ontological gap” refers to the divide between different conceptual frameworks for understanding health, illness, and disease. This gap often arises between the biological or physiological aspects of medical science and the experiential or subjective aspects of patient experiences.[19] The semiotic model Goli and colleagues proposed in the book “Biosemiotic Medicine: Healing in the World of Meaning” is actually a way to deal with the schism between the prevailing medical and health model.[20,21]

BEHI seeks to enhance the coherence and interdependence of meanings, i.e., the same evolutionary path that life has taken while gradually developing from unicellular creatures to the global network of the internet. The fundamental question of this approach is how to harmonize and align energy-information pathways which are not in alignment with either life or other pathways. Goli considers nondual values and whole-body experiences as elemental strategies of bioenergy economy.[22] Goli recommends the optimization of energy investment in the four fields of body, narrative, relationship, and intention as the best transformation path for psychophysical health enhancement. Integrated and vigilant body experience with a sense of connection to others and life, on the one hand, and harmony of energy investment on values of pleasure and virtue of self and others, on the other hand, would enhance top-down organization and thus increase resilience and health. Therefore, BEHI focuses on health promotion and facilitation, not as a substitute for extensive and complex biomedical treatments, but as an adjusting and complementary platform to enhance care and appropriate health/disease behaviors.

There is obviously a drastic difference between individuals who perceive themselves as a part of a semantic network connected to others and life and those who see themselves as a machine that might have a soul. The first group develops a physical relationship with themselves, others, and the world rather than a cognitive and contractual relationship. This change in perspective can transform education, care, treatment, and health discourse and give the patients a more active role in developing more harmonic self-care and meaning-making.

The origins of BEHI

The BEHI model draws its theoretical foundations from systems theory and biosemiotics, conceptualizing humans as interconnected networks of symbols across individual, interpersonal, and transpersonal levels. The model also uses the free energy principle (introduced by Friston) as a macro pattern for elaborating brain function.[23]

As a psychoeducation and healthcare model, BEHI is based on enhancing coherence between mechanical, symbolic, relational, and nonlocal bodies. Techniques integrated into this approach were adapted from bioenergetics, narrative therapy,[24] bodily awareness meditations,[25] and energy healing techniques like Reiki and therapeutic touch,[26] as well as reflections and transpersonal psychological meditation.[9] It’s worth noting that this approach is not eclectic but rather presented within a coherent theoretical and cognitive framework, often adjusted, and structured based on individual needs. A variety of body awareness, cognitive, narrative, and mindfulness techniques (e.g., pragmatics of speech attention defusion, tautology, and some body awareness meditation techniques) were developed by Goli based on extensive clinical and educational experience and numerous clinical trials.

BEHI’s care and transformation process

The individual or group process of BEHI usually begins with “body economy” or promoting body awareness in the mechanical body and reaching a state of balanced energy (tensegrity).[23]

In the second field, or “narrative economy”, subjects become familiar with symbolic bioenergy misleads and learn to direct attention and find and employ values and nondual narratives. At this stage, they become more aware of subtler energy flows created with every mechanical and emotional change and learn to maintain a deeper state of energy balance in the body (focused-fluent state). The focused-fluent state is created with awareness of the body’s center of gravity and releasing habitual obstructions or contractions in the body.

In the third field, or “relational economy”, subjects learn to replace their closed, essentialist understanding self-centered personality with a relational identity. They also learn how the communicative system features change in response to alterations in distance, angle, and relation with others. At this stage, body awareness evolves to a field understanding of the body; a living and subtle field that changes in every communicative domain and assists, like a sensor, in understanding the synergistic or limitative states.

In the fourth field, or “the economy of intention”, subjects become aware of their intentions toward the future and life. They learn how intentions arising from non-life drives like spitefulness or melancholic drives like greed can disrupt one’s range of foresight and existential bond with others. At this stage, body awareness expands into an experience of boundlessness and a deeper understanding of/with/to life is achieved through bodily, cognitive, and reflective experiences.

The application of these stages is modified depending on individual or group settings and health status of the subjects (healthy or ill, outpatient, or inpatient). Obviously, individual sessions are more personal and less structured but group sessions are more structured.

During the development process of body awareness and nondual values, subjects learn to achieve more sustainable happiness and satisfaction with less free energy by directing their bioenergy from the lowest levels of bioenergy economy or impulsive levels (releasing pleasure) to the learned level (cumulative pleasure), higher proactive levels (constructive pleasure), and ultimately the being level (unconditioned pleasure).

Timeline

Development of the interventions and BEHI’s model structure began in 2006 after several psychosomatic studies and therapeutic interventions. The model was designed based on various body awareness practices such as yoga, Qi Gong, Loven’s bioenergetic exercises, and mindfulness meditation. Clinical work and refinement continued, leading to the completion of the model in 2012. Educational workshops (14 series of 12-20-hour workshops) were also held to present the developed model to both the public and therapists in different countries (Iran, Turkey, Germany, and the USA) since 2009.

In order to present the model to relevant experts, a book titled “Bioenergy Economy” was published in 2010 under the supervision of CarlScheidt and Michael Wirsching.[9] Moreover, the bioenergy economy and psychosomatic health chair and 18 educational courses were launched in the US Energy Medicine University in 2011.[27] Efficacy assessment has been constantly performed to date to determine the usefulness of the interventions in various diseases and the general population (US Energy Medicine University).[27] An intensive theoretical-practical course on bioenergy economy was also integrated in the two-year postdoctoral curricula of psychosomatic medicine and psychotherapy at Freiburg University, Isfahan University of Medical Sciences, and Mashhad University of Medical Sciences in 2014 (two-year postdoctoral curricula.). In 2019, a similar course was added to the one-year psycho-oncology postgraduate program at University of Freiburg and Isfahan University of Medical Sciences.

In 2021, a comprehensive care program for healthcare providers (healerhealing.org) was developed based on BEHI’s model and supported by DAAD Organization and University of Freiburg. In September 2023, the program was approved by the Ministry of Health and Medical Education as a national continuing education program and hundreds of physicians, psychologists, and psychiatrists have benefited from it ever since. Because of the rare psychoeducational programs that have positive effects on functional capacity as an indicator of cardiac fitness, a psychocardiology guideline based on BEHI program was developed and approved by ministry of health.[28]

In order to increase the audience of the program, BEHI Radio (in Persian) was launched in 2022 and could successfully attract tens of thousands of listeners in various platforms.[29] During Covid-19 pandemic for arising mental health problems, Homeland Journey (safar dar vatan) a 40-day mindfulness-based psychoeducational program was designed based on BEHI program and used vastly in different platforms and social media by more than 320,000 participants.[30] From 2023, BEHI Institute started to work globally for promotion and development of BEHI international professional courses and high tech researches and productions based on BEHI model.[27,31]

This comprehensive approach has been documented in articles and books, both in Persian and English, to share the outcomes and insights gained from applying the BEHI model in diverse clinical and research settings.

The studies on BEHI model

Various studies have been conducted on the effectiveness of the BEHI program, some of which are still ongoing, while others have been completed but not yet published. Some others have been published, and their results have been made public. The studies that have been published so far are indicated in Table 1. Given the nature of the model and the necessity of interventions in study samples, clinical trial models have been used in all conducted research, some with control groups and some without.

Table 1.

The studies whose results have been published to date

Authors	Year	Participants	Indicators	Interventions	Results in BEHI group in comparison to other groups
Derakhshan et al.[32]	2016	30 patients with migraine intervention and control group (cross-over model	Depression, Anxiety, Pain intensity, Pain frequency	Intervention group: BEE (BEHI) Control group: No intervention	Depression↓ Anxiety↓ Pain intensity↓ Pain frequency↓
Goli et al.[33]	2019	15 women with MPS (intervention group)	Pain, Quality of life, Depression, Anxiety	six sessions of BEE (BEHI)	pain intensity↓ depression↓ quality of life ←→ anxiety↓
Keyvanipour, et al.[34]	2019	30 women 23 to 50 years old with high anxiety sensitivity intervention and control group	dot-probe test, neutral reaction time, emotional response time, and interference score	Intervention group: BEE (BEHI) Control group: No intervention	dot-probe test↓ neutral reaction time↓ emotional response time↓ interference score↓.
Tavakolizadeh, et al.[35]	2021	40 patients with Coronary heart disease intervention and control group	vegetative function, Forgiveness, quality of Life	Intervention group: BEE (BEHI) Control group: No intervention	heart rate↓ forgiveness↑ quality of life/physical Dimenssion↑
Farzanegan et al.[36]	2022	20 patients with the stage I-III of breast cancer (intervention group)	Depression, anxiety, quality of life, and sleep quality	BEE (BEHI) protocol	Depression↓ Anxiety↓ quality of life/physical functioning↑ quality of life/social role functioning↑
Ghassemi et al.[37]	2020	50 obese women intervention and control group	attitude toward the body image,	Intervention group: Obesity specific training package of BEE (BEHI) Control group: No intervention	Attitude toward body image↑
Goudarzi et al.[38]	2023	45 married women aged 20 to 40 referred to counseling centers 2 intervention and 1 control group	sexual satisfaction, sexual assertiveness	Intervention group 1: CBT Intervention group 2: BEE (BEHI) Control group: No intervention	sexual satisfaction↑ sexual assertiveness↑ There was no significant difference between the two interventions
Behreini et al.[39]	2024	60 person with distress symptoms	career stress, physical symptoms, feeling of solidarity, quality of life	Intervention group 1: MBSR Intervention group 2: BEE (BEHI) Control group: No intervention	career stress↓ Somatoform symptoms↓ quality of life↑
Farzanegan, et al.[40]	2024	6o patients with MI	Blood Pressure Functional capacity LVEF Depression Anxiety FBS Lipids	2 groups: Cardiac Rehabilitation with or without BEE (BEHI) intervention	METs↑ Depression↓ anxiety↓
Farzanegan, et al.[41]	2025	45 patients with IBS 2 intervention and 1 control group	IBS Severity Index, Depression, Anxiety, somatic symptoms	Intervention group 1: MBCT Intervention group 2: BEE (BEHI) Control group: No intervention	IBS symptom severity↓ somatic symptoms↓ depression↓ anxiety↓ There was no significant difference between the two interventions
Goli et al.[42]	2025	37 patients with IBD 2 intervention and 1 control group	quality of life sense of coherence D Personality type Perceived stress	Intervention group 1: ACT Intervention group 2: BEE (BEHI) Control group: No intervention	quality of life↑ perceived stress↓ sense of coherence↑

MPS: Myofascial Pain Syndrome, BEE: Bioenergy economy, CBT: Cognitive behavioral therapy, IBS: Irritable bowel syndrome, MBCT: Mindfulness-Based Cognitive Therapy, MBSR: Mindfulness-Based Stress Reduction, LVEF: Left ventricular ejection fraction, FBS: Fasting blood sugar, MI: Myocardial infarction, METs: Metabolic equivalents, ACT: Acceptance and Commitment Therapy

As seen in Table 1, the investigated indicators in the conducted studies have shown significant physical and psychological and quality of life improvement across various groups including patients with breast cancer, IBS, and coronary heart diseases. In addition to the mentioned studies, more than 40 individuals have participated in BEHI programs so far, and the results of changes in quality of life, well-being, etc., have been collected and will be published soon.

Contributions of the BEHI program

Here, we can summarize the advantages of the BEHI psychosomatic model of care in understanding and managing health and well-being:

1. BEHI employs a biosemiotics metalanguage to conceptualize health conditions and design psychoeducational programs, allowing an understanding of molecular changes within the same framework as symbolic and communicative actions.[3,20]

2. Utilizing strategies such as whole-body perception and nondual narrative, BEHI offers an integrative approach that synchronizes non-symbolic and symbolic meaning-making systems, facilitating the consciousness evolution and health promotion.[16]

3. BEHI integrates body-centered, cognitive, emotional, behavioral, dynamic, and transpersonal principles into a systemic model, making it suitable for designing flexible clinical and educational environments.[9,11]

4. With its transdiagnostic and contextual approach, BEHI serves as an effective complementary psychoeducative program for transformative and health-promoting services.[4]

5. The top-down approach and techniques utilized in BEHI provide efficient methods for liberating bioenergy from entrenched ideas and emotions.[4]

6. Evidence suggests that BEHI is as effective, or even more effective, than other contextual approaches like MBSR, MBCT, and ACT in various conditions.[39,40]

7. BEHI aligns the dimensions of happiness, satisfaction, and meaningfulness in well-being, presenting a sophisticated utilitarian care model. It proposes four levels of pleasure, ranging from immediate and intense to sustainable and unconditioned.[16]

BEHI’s conceptual model

As mentioned earlier, Goli and colleagues could successfully design a conceptual model of the BEHI program. Over the years, this model evolved to a final model through Goli’s clinical studies, utilizing the results obtained from the mentioned research, and considering various other psychosomatic interventions [Figure 1].[16]

Figure 1.

The conceptual model of BEHI program[16]

All dimensions explained in the care process, along with health promotion goals and therapeutic interventions, are included in this model. As seen, the primary goal of the model is health promotion and enhancing the sense of well-being in individuals as described by BEHI and achieving unconditioned pleasure. Achieving this goal requires attention to the various dimensions of the human system, categorized into four groups of body, narrative, relation, and intention by Goli. Meanwhile, to achieve unconditioned pleasure in various aspects of life, Goli recommended four methods, i.e., timely, attuned, fulfilled, and functional methods, to ensure the achievement of unconditioned pleasure. The present article elaborates on this model and its various aspects.

Currently, the BEHI therapeutic program is designed based on this model and is implemented not only in various clinical trials, but also in community-based therapeutic models whose protocol is outlined in the BEHI program handbook.

Discussion

BEHI protocol has progressed through the stages of clinical trials described by the NIH model of institutionalizing and integrating behavior change interventions, psychotherapy, and lifestyle modification. Community-level studies can now be conducted and the obtained results can be used to design and implement integration stages in collaboration with policymakers.

Various mental health programs are currently integrated into healthcare systems worldwide. Among these, mindfulness-based stress reduction (MBSR), dialectical behavior therapy (DBT), solution-focused brief therapy (SFBT), and mindfulness-based cognitive therapy (MBCT) are most popularly adopted. Knowing the history of the institutionalization of these interventions, which closely resembles the proposed path by the NIH for integrating interventions, can facilitate the design of integration models for BEHI and expedite BEHI’s institutionalization at the community level and its inclusion in guidelines.

The design of DBT in the late twentieth century aimed at minimizing behaviors leading to suicidal thoughts and reinforcing the idea that “life is worth living”. Clinical trials were gradually conducted during the development of this model. After some years of performing studies and reviewing their results, DBT interventions were recommended in various international guidelines, including the American Psychiatric Association and NHS in the UK. In the early twenty-first century, DBT was integrated into the healthcare systems of some countries such as Ireland[43] and the results of its application were examined and presented at the community level. DBT is currently institutionalized in some schools worldwide. In New York, for example, the method was introduced to improve the mental health of adolescents. Since the effectiveness of such interventions was approved by psychologists, Miller et al.[44] integrated DBT interventions in schools of New York. By 2020, 50 school districts used five methods to include DBT in their programs. They reported improved coping methods, avoiding inappropriate methods and blaming others, as well as decreased emotion dysregulation. Assessments in 2023 also showed that these interventions could effectively prevent suicidal thoughts and emotion dysregulation among the students. However, the success of DBT programs requires the collaboration of not only school principals, teachers, and counselors, but also students and their families.[45]

Another therapeutic model integrated into healthcare systems worldwide is MBSR. Mindfulness, based on Buddhist meditations, was designed in the second half of the twentieth century and later transformed into one of the stress control methods with specific psychosomatic programs.[46] Over time, various health promotion studies demonstrated its efficacy and cost-effectiveness. As a result, protocols based on its use were designed for different community groups. In the early twenty-first century, MBSR was integrated into healthcare systems of some countries including the UK, Australia, and the Netherlands[47] and also recommended by therapeutic guidelines.[47] Various integration methods, e.g., translating research findings into stakeholders’ language, stakeholder education, designing interventions for different groups, and educational classes, were implemented to institutionalize such interventions. Among the very effective methods of integrating MBSR was the use of clinical champions, i.e., individuals in different organizations who volunteer to implement and advocate a method and to collaborate with the healthcare system during the execution of the program.[48]

Another psychosomatic-based therapeutic model is mindfulness-based cognitive therapy (MBCT), which was designed and institutionalized in the UK as a preventive program for depression relapse. MBCT is a psychosocial therapy program based on research results, and its translation into practical knowledge has been integrated into the UK system.[49] Research on this therapy model even shows its superiority over drug therapy.[50] In 2009, the National Institute for Clinical Excellence (NICE) recognized MBCT as a model for controlling depression relapse in the UK. MBCT has also been integrated into other countries, including Sweden and Australia. It is noteworthy that integration of this program occurred in less than 10 years after the publication of its practical model in 2002, and it has been referenced in guidelines. Since the UK has a comprehensive national healthcare service, it serves as a suitable example for integrating such interventions, and numerous results of integrating interventions in the UK have been published.[51] Multiple resources can be used to institutionalize interventions with similar methods when designing intervention model.

Another widely used psychotherapy method is SFBT. Many countries have integrated SFBT into their healthcare systems to treat depression and improve family functioning and behavioral health.[52] Developed in the 1980s, inspired by Milton Erickson’s Brief Hypnotherapy, SFBT is designed to address individual complaints by tailoring solutions to their unique characteristics, resources, beliefs, and experiences, thus individualizing the approach.[53] This model was gradually evolved and implemented in public health centers in the United States. Since various studies demonstrated its effectiveness in clients, after only 20 years of its introduction, large-scale community-based studies on its efficacy were designed and conducted.[54] The process of integrating SFBT into the US healthcare system began with case studies or small clinical trials and then gradually developed to pilot studies and community-based research. A recent meta-analysis evaluated the effects of SFBT on adolescents and adults receiving community-based services at centers other than hospitals. The results confirmed the therapeutic effects of SFBT on depression, family functioning, and psychosocial functioning of the participants.[55] The same process is expected to be followed for the institutionalizing of BEHI model.

Over the past 20 years, BEHI has also undergone a complex journey, from its initial conceptualization based on the concept of bioenergy and various models to its goal of promoting unconditioned pleasure across the four dimensions of human life through four different methods. During this period, Goli has performed numerous studies, collaborated with partners in different areas, and gained positive outcomes in a range of people from healthy individuals with/without symptoms of anxiety and depression to those in the end-of-life period. Some of the participants were trained as well, to serve as peer support in different treatment groups. Considering these experiences and previous studies, it appears feasible to implement the BEHI model in community-based clinical trials in collaboration with various healthcare organizations or organizations engaged with diverse community groups, such as education and welfare, to assess its benefits.

Given the dimensions and stages of the BEHI model, it falls within the framework of mental health programs. Mental health and well-being promotion is under the supervision of different organizations worldwide. While the primary focus of BEHI is health promotion, when organizations seek classifications for such programs, they often resort to either disease-based classifications (pathogenic view) or health promotion to prevent diseases (still pathogenic). However, the BEHI model sees health as well-being and aims to create and improve well-being in under all circumstances of human life. Therefore, according to the World Health Organization (WHO) categorization, BEHI would fall under preventive programs within the Mental Health and Substance Use Department, supervised by the Communicable and Non-Communicable Diseases division.[54] Since the WHO’s approach to mental health is based on prevention, the design of preventive community-level interventions would be appropriate.[56,57]

Iran is a developing country in the Middle East whose healthcare system has been developed mostly based on the guidelines of the WHO’s Eastern Mediterranean Regional Office (EMRO). Currently, mental health in Iran is directly assessed by the Welfare Organization and the Office of Mental and Social Health and Substance Abuse (under the supervision of the Ministry of Health). Nevertheless, all governmental institutions, especially factories where occupational medicine and management improvement programs are implemented, schools which are responsible for not only education, but also lifestyle modification, municipalities responsible for many urban health programs, cultural centers, health campaigns in cities, and healthy lifestyle initiatives (e.g., physical activity promotion), are all major players in urban and rural health.

Therefore, community-based studies need to be designed and community-level interventions need to be conducted based on the existing mental health monitoring system and the NIH model.[58] In other words, in order to integrate the BEHI program and determining its efficacy in the health system of Iran, primary community-based studies should be conducted in collaboration with local and national stakeholders in various urban and rural regions. The obtained results can then be used to integrate BEHI into the governmental mental health screening system. The next stage in the implementation of the BEHI program would, hence, be the design of community-based interventions on individuals covered by health centers while considering the following:

1. Translating knowledge and converting the results of studies and BEHI protocol into the language of mental health stakeholders at the Ministry of Health, the Welfare Organization, and the Ministry of Education;

2. Designing various protocols for different target groups, especially adolescents and women[59];

3. Advocating for interventions by lobbying with stakeholders and selecting clinical champions;

4. Using peer activists[60,61] to share their experiences and make interventions more relatable to the lives of individuals with symptoms;

5. Designing recording, monitoring, and evaluating methods to obtain results and adjust the initial methods based on outcome assessment; and

6. Designing guidelines to promote public health based on BEHI interventions.

One of the first stakeholders that should be engaged in negotiations is the Office of Mental and Social Health and Substance Abuse which has designed the national mental health program in Iran. This screening, prevention, and treatment program is currently integrated into the health system of urban and rural health centers affiliated with universities and necessitates the presence of mental health professionals at these centers. According to this program, a comprehensive mental health screening of children and adolescents is mandatory for their school registration. The program recruits health professionals, physicians, and mental health experts to assess different aspects of mental and social health of individuals and their substance abuse status using valid and relevant questionnaires. Any individual requiring further help (based on initial evaluations) would be referred to a psychologist in the center. As seen, a comprehensive screening system is currently active in the governmental health centers of Iran.

Finally, with international collaborations, larger clinical trial models can be designed in other countries to examine the effects of the BEHI model on the mental and physical health structure of individuals in different groups and with various disorders. It is, however, important to remember that Goli does not solely focus on the pathogenic approach, i.e., he considers humans as a holistic mind-body structure moving toward health through “the pleasure of being”. Therefore, clinical studies can be conducted not only in healthcare centers, but also in health promotion centers such as various sports facilities, health education centers, and media. Although the breadth of utilizing this program may facilitate further studies, strategic planning for achieving specific goals is also required. This is the path that Goli and colleagues are pursuing for advancing BEHI to promote health in the future.

Limitation and recommendation

Since the BEHI model hasn’t been studied in many areas of the world, we can’t yet recommend its implementation on a global scale. To address this gap, we encourage further research to explore how BEHI could improve the quality of life for both healthy individuals and patients in different countries.

Conclusion

Based on what has been stated, the BEHI model is one of the approaches that can be employed to enhance physical and mental health. Presenting the results obtained from studies related to this model will significantly aid health policymakers in justifying its use. In this way, with the cooperation and help of various stakeholders who are involved in the policymaking and implementation of various health promotion programs, the necessary policies will be designed to integrate and institutionalize this model in the health system.

To further justify the various stakeholders, it is recommended to conduct more studies among different communities of healthy individuals or patients. Additionally, conducting cost-effectiveness studies is essential for the economic justification of using this model.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.