Multimodal therapy: what it is and how it works

Although exclusively addressing a dimension of the patient can help to improve it, most of the Psychologists maintain that it is difficult for aspects of people to remain isolated from each other. others.

Having family problems may affect both the physical health and the emotions of the individual, which means that, in case of ignoring these last two, you are not really getting much to increase your welfare.

The multimodal therapy of Arnold A. Lazarus it tries to address up to seven dimensions of the person, see how they interact with each other and start a treatment that tries to improve all of them as a whole. Let's take a closer look at what it consists of.

• Related article: "The 8 benefits of going to psychological therapy"

What is multimodal therapy?

Multimodal therapy, developed by Arnold Lazarus, is a type of treatment that is part of the cognitive-behavioral approach, although he also draws on other psychological approaches and opts for an eclectic type of intervention.

According to this model, the human being is a biological organism, that is, influenced by chemical processes, which at the same time has a whole cognitive and behavioral world, manifested in the form of thoughts, feelings, actions, imagination, and interactions with others people.

Given the complexity of each human being, Lazarus argues that, in the context of therapy, The intervention should not focus on a single aspect of the person. It is necessary to make sure to check that all the components of the person, understood in the form of modalities, work together and efficiently, since if one of them is altered, it can have a negative impact on the the rest.

For example, if the person has a pessimistic thinking style, it is logical to think that he will not only see the glass as half empty. He will also imagine that bad things will happen, he will be living in constant stress and worry, which will show up in the form of physical pain and even the consumption of certain substances. Based on this, and according to multimodal therapy, most psychological problems occur as both a cause and a consequence of several negatively affected aspects.

Given the psychological problems are multifaceted and multicausal, Lazarus proposes the following seven modalities, whose acronyms in English make up the word BASIC I.D., which allow to understand the type of problem that affects the individual and the particular type of dysfunction of him.

• Conduct (Behavior).
• Affect.
• Sensations (Sensation).
• Imagination (Imagery).
• Cognition.
• Interpersonal Relationships.
• Biological processes/Drugs.

Since most of the therapeutic intervention that addresses biological maladjustments involves the use of drugs, the initials of the BASIC model I.D., the D is taken as an acronym for Drugs (medications in English).

Strengths and criticisms

The main point in favor of this model, and which sets it apart from other models that are also multi-component but more limited, is that It is not limited to addressing the three main classical variables, which are the patient's emotions, behavior and thoughts. associates. These three variables are the hallmarks of the Ellis ABC model, the letters standing for affect/emotion, behavior, and cognition.

Although the Ellis model is interesting and has been shown to be useful in therapy, it has the disadvantage that it neglects or addresses, but far above, aspects such as sensations, the patient's imagination, their interpersonal relationships... In addition about what ignore the biological aspects of the individual, which, although they do not explain all of his behavior, help to understand it better.

Theoretical fundament

Multimodal therapy draws on the principles and procedures of experimental psychology and also on Albert Bandura's social learning theory. Within this theory it is argued that behaviors, whether healthy or pathological, are created, maintained and modified through the action of environmental events. That is, external stimuli to the person and from the environment, especially the social environment, influence their behavior.

The first behavioral theories were based on animal models., the clearest case being behavioral theories. This type of approach gave an explanation of animal behavior in a somewhat mechanical way, based above all at the beginning of the stimulus-response, but without going into details of how the animal felt before a certain event. Since they couldn't get inside the animal's mind, they could hardly extrapolate its behavior to the human beyond what was directly observable.

From the more Skinnerian behaviorism, it has evolved until reaching the theories of the cognitive-behavioral approach., in which the cognitive aspects of the person are taken into account, which can be determined by external events. This cognition can manifest itself in the form of behaviors that have an impact on their social sphere and immediate environment. Multimodal therapy takes into account this constant reciprocity between personal actions and environmental consequences.

Application of multimodal therapy

As we have already seen, while most therapies today do not focus on just one aspect of the person, most of them are limited to addressing the state of the person in a trimodal way: cognition, emotion and conduct. In the multimodal model, seven modalities are analyzed, which allow a deeper approach to the reality of the individual, the characteristics of his problem and how this affects other dimensions of the person.

Never forgotten in multimodal therapy is the idea that human beings are biological organisms, that is, biochemical and neuropsychological entities that behave (act and react), feel emotions, sensations, imagine, think (have opinions, values, attitudes, beliefs) and interact with others people.

Although the model defends the idea that all the aspects that make up the person are taken into account, it does highlight that there are two aspects that should have a certain priority: the more biological aspects and interpersonal relationships.

The biological processes of the patient must be taken into account first of all because, in case her problem is due to some kind of drug intoxication, brain injury or genetic problem, it will be necessary to direct the therapy in another way, and under the supervision of a psychiatrist or a doctor. There are not a few cases of people who, after suffering a brain injury, have manifested an important behavioral and personality change, the best known case being that of Phineas Gage.

Regarding interpersonal relationships, it is very important to know how the network of relatives and friends that surround the individual, since, in case of being something dysfunctional, it will hinder his recovery. Toxic family dynamics may be the source of the patient's discomfort, and if this is the case, therapy should focus on working on strategies to improve these same dynamics or find ways to deal with them.

Especially During the first session, the psychotherapist should ask themselves several questions that touch on each of the seven modalities., to make sure which are the most impaired aspects in the patient's life, and how these interact or are the cause or consequence of the main problem. Some questions that can be asked, ordered in each of the modalities, are the following.

1. Conduct

What is the individual doing that contributes to his happiness? What makes you end up hurting? Self-defensive actions, maladaptive behaviors? What should the patient stop doing...

2. Keen

What emotions does the patient display? Are you anxious, depressed, angry… or a combination of different negative emotions? What is it that makes you feel this way? How do you respond when you feel this way?

3. sensations

Do you complain of any deficit or sensory discomfort (chronic pain, tremors, sensation of needles throughout the body...)? What positive feelings do you feel? What emotions are associated with these bodily sensations, both bad and good?

4. Imagination

What fantasies and images are predominantly displayed in your mind? Are they positive or are they negative? Do they represent the patient's self-concept? Do you visualize flashbacks, have nightmares, catastrophic thinking???

5. Cognition

What are your main attitudes, beliefs, values, opinions??? Are they dysfunctional ideas?

6. Relationships

Who are the most important people in the patient's life? What do you expect from others? Which relationships are beneficial to you and which are detrimental to your mental health?

7. Biology and drug use

Is the patient physically healthy? do you have medical complaints? do you consume any substance? do you do sport? what kind of diet do you have? Are you over or underweight?

Tools to use it

There are two main questionnaires used by multimodal therapists.

1. The Multimodal Life History Inventory

The Multimodal Life History Inventory (Lazarus and Lazarus, 1991, 1998) is a 15-page questionnaire that helps guide treatment, as long as the patient completes it. It is usually administered during the first session.

It helps to obtain detailed information about the individual, which allows specifying the type of their main problem and which aspect has a negative impact on the other dimensions of the person.

2. The Structural Profile Inventory

Another useful tool in multimodal therapy is the Structural Profile Inventory (SPI), which consists of a 35-item questionnaire.

It asks questions that reflect essential components of the BASIC I.D. model, allowing to know the degree of activity, emotionality, preoccupation with sensory stimuli, imagination, cognitive ability, interpersonal relationships, and concerns about biological origin.

The SPI is especially useful in couples therapy, where the differences regarding the perception of the problem between both spouses can generate friction.

Discussing them in consultation and recording them more or less objectively through the SPI makes it easier to develop a therapy that contributes to producing a therapeutic context constructive.