Multimodal therapy: what is it and how does it work?

A summary of the characteristics of multimodal therapy by Arnold A. Lazarus.

Although dealing exclusively with one dimension of the patient may help the patient's improvement, most psychologists argue that aspects of people hardly remain isolated from each other.

Having family problems may affect both the individual's physical health and emotions, which means that ignoring the latter two may not really do much to increase the individual's well-being.

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

What is multimodal therapy?

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

Given the complexity of each human being, Lazarus argues that, in the context of therapy, intervention should not focus on a single aspect of the individual.. It is necessary to make sure that all the components of the person, understood as modalities, work together effectively, since if one of them is altered, it can have negative repercussions on the others.

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 itself in the form of physical pain and even the consumption of certain substances. Based on this, and according to multimodal therapy, most psychological problems present themselves as both a cause and a consequence of several negatively affected aspects.

Given that psychological problems are multifaceted psychological problems are multi-faceted and multi-causalLazarus proposes the following seven modalities, whose acronyms form BASIC I.D., which allow us to understand the type of problem affecting the individual and his or her particular type of dysfunction.

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

Since most therapeutic intervention that addresses biological misalignments involves the use of drugs, the acronym for the BASIC I.D. model, D stands for Drugs.

Strengths and criticisms

The main strength of this model, which makes it stand out from other multicomponent but more limited models, is that it is that it does not limit itself to addressing the three main classical variables, which are the patient's emotions, behavior and associated thoughts. associated thoughts. These three variables are the flagship of Ellis' ABC model, the letters standing for affect, behavior and cognition.

Although Ellis' model is interesting and has proved useful in therapy, it has the disadvantage of leaving aside or addressing, but far above, aspects such as sensations, the patient's imagination, his interpersonal relationships... Besides the fact that it it overlooks the biological aspects of the individual, which, although they do not explainwhich, although they do not explain all their behavior, help to understand it better.

Theoretical foundations

Multimodal therapy is nourished by the principles and procedures of experimental psychology and also by Albert Bandura's social learning theory. This theory holds that behaviors, whether healthy or pathological, are created, maintained and modified through the action of environmental events. In other words, stimuli external to the person and coming from the environment, especially the social environment, influence his or her behavior.

The first behavioral theories were based on animal models, the clearest case being the behaviorist theories.the clearest case being the behaviorist theories. This type of approach explained animal behavior in a somewhat mechanical way, based mainly on the stimulus-response principle, but without going into the details of how the animal felt before a certain event. Since they could not get inside the animal's mind, they could hardly extrapolate their behavior to human behavior beyond that which was directly observable.

From the more Skinnerian behaviorism, we have evolved to the theories of cognitive-behavioral approachThe cognitive-behavioral approach, which takes into account the cognitive aspects of the person, 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 current therapies do not focus on a single aspect of the person, most of them are limited to addressing the person's state in a tri-modal way: cognition, emotion and behavior. In the multimodal model, seven modalities are analyzed, which allow a deeper approach to the individual's reality, the characteristics of the problem and how it affects other dimensions of the person.

Multimodal therapy never forgets the idea that human beings are biological organisms, i.e. biochemical and neuropsychological entities that behave (act and react), feel emotions, sensations, imagine, think (have opinions, values, attitudes, beliefs) and interact with other people.

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

The biological processes of the patient must be taken into account first of all because, in the event that the problem is due to some kind of drug intoxication, brain injury or genetic problem, it will be necessary to direct the therapy in a different way, and under the supervision of a psychiatrist or a physician. There are many cases of people who, after suffering a brain injury, have shown a significant behavioral and personality change, the best known case being that of Phineas Gage.

As for interpersonal relationships, it is very important to know how the network of family and friends surrounding the individual is working, since, if it is dysfunctional, it will hinder recovery. Toxic family dynamics may be the origin of the patient's discomfort, and if this is the case, it is very important to know how the family and friends' network is functioning.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 several questions that touch upon each of the seven modalitiesThe patient should be asked to ascertain which aspects of the patient's life are most adversely affected, and how these interact with, or are a cause or consequence of, the main problem. Some questions that can be asked, ordered in each of the modalities, are the following.

1. Behavior

What is the individual doing that contributes to his or her happiness? What is causing him or her harm? Self-defeating actions, maladaptive behaviors? What should the patient stop doing?....

2. Affect

What emotions does the patient manifest? Is he/she anxious, depressed, angry... or a combination of different negative emotions? What makes him/her feel this way? How does he/she respond when he/she feels this way?

3. Sensations

Does the patient complain of any sensory deficit or discomfort (chronic pain, tremors, sensation of needles in the body...)? What positive sensations does he/she feel? What emotions are associated with these bodily sensations, both bad and good?

4. Imagination

What fantasies and images are predominantly displayed in his mind? Are they positive or negative, do they represent the patient's self-concept, does he/she visualize flashbacks, have nightmares, catastrophic thinking...?

5. Cognition

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

6. Interpersonal relationships

Who are the most important people in the patient's life? What does he/she expect from others? Which relationships are beneficial and which are detrimental to his/her mental health?

7. Biology and drug use

Is the patient physically healthy? does he/she have any medical complaints? does he/she use any substances? does he/she play sports? what kind of diet does he/she have? is he/she overweight or underweight?

Tools to use

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 to guide treatment, provided the patient completes it. a 15-page questionnaire that helps to 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 makes it possible to pinpoint the typology of the 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 capacity, interpersonal relationships and concerns of biological origin.

The SPI is especially useful in couples therapy.The differences in the perception of the problem between the two spouses can generate friction.

Discussing them in consultation and recording them more or less objectively by means of the SPI facilitates the elaboration of a therapy that contributes to produce a constructive therapeutic context.