Multimodal therapy (MMT) is an approach to psychotherapy devised by psychologist Arnold Lazarus, who originated the term behavior therapy in psychotherapy. It is based on the idea that humans are biological beings that think, feel, act, sense, imagine, and interact—and that psychological treatment should address each of these modalities. Multimodal assessment and treatment follows seven reciprocally influential dimensions of personality (or modalities) known by their acronym BASIC I.D.: behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biology.
Multimodal therapy is based on the idea that the therapist must address these multiple modalities of an individual to identify and treat a mental disorder. According to MMT, each individual is affected in different ways and in different amounts by each dimension of personality, and should be treated accordingly for treatment to be successful. It sees individuals as products of interplay among genetic endowment, physical environment, and social learning history. To state that learning plays a central role in the development and resolution of our emotional problems is to communicate little. For events to connect, they must occur simultaneously or in close succession. An association may exist when responses one stimulus provokes, are predictable and reliable, similar to those another provokes. In this regard, classical conditioning and operant conditioning are two central concepts in MMT.
BASIC I.D. refers to the seven dimensions of personality according to Lazarus. Creating a successful treatment for a specific individual requires that the therapist consider each dimension, and the individual's deficits in each.
Multimodal therapy addresses the fact that different people depend on or are more influenced by some personality dimensions more than others.Some people are prone to deal with their problems on their own, cognitively, while others are more likely to draw support from others, and others yet are likely to use physical activities to deal with problems, such as exercise or drugs. All reactions are a combination of how the seven dimensions work together in an individual. Once the source of the problem is found, treatment can be used to focus on that specific dimension more than the others.
MMT starts after the patient has been assessed based on his/her emotional responses, sensory displays and the manner in which he/she interacts with people around via behavior, affect, sensations, images, cognition, drugs and interpersonal activities. Based on this assessment, the therapist will introduce the patient to the first session. During this time, the therapist and the patient will create a list of problems and the suitable treatments that may suit him/her the most. Since the treatment is based upon individual cases, each remedial strategy is considered as an effective method for the patients.
Post the completion of the initial assessment, a more detailed diagnosis is done using questionnaires. The therapist shall diagnose both the actual profile as well as the structural profile of the patient. Such a diagnosis will define the target which both the therapist and the patient would want to achieve once the treatment is complete. Here, the therapist will evaluate different other ways to treat the patient. Often, relaxation tapes are used to calm down the patient. Besides psychotherapy, the therapist will try to include dietary measures and stress management programs to treat patient's associated psychiatric symptoms. The prime focus of the therapist would be to ease the pains of the patient and fulfill his/her needs by studying his/her behavior and mannerisms.
Upon the patient's prior consent, the therapist will tape all the sessions and furnish a copy of those tapes to the patient. These tapes act as a supporting resource when the therapist is evaluating the patient's behavior. MMT is a flexible mode of psychotherapy because each treatment plan is devised keeping all the possibilities in mind. In the case of a single patient, the duration of the session could last not more than few hours, depending upon the therapist's analysis of the concerned patient's behavior. However, if the patient shows a condition that needs multiple treatments, then the session could stretch farther so as to enable the therapist to analyse the patient further.
Multimodal therapy originated with cognitive behavioral therapy (CBT), which is a fusion of cognitive therapy and behavior therapy. Behavior therapy focused on the consideration of external behaviors, while cognitive therapy focused on mental aspects and internal processes; combining the two made it possible to utilize both internal and external factors of treatment simultaneously.
Arnold Lazarus added the idea that, since personality is multi-dimensional, treatment must also consider multiple dimensions of personality to be effective. His idea of MMT involves examining symptoms on each dimension of personality in order to find the right combination of therapeutic techniques to address them all. Lazarus retained the basic premises of CBT, but believed that more of the individual's specific needs and personality dimensions must be considered.
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Originally, it was designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety, alcohol and drug use problems, marital problems, and eating disorders. CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.
Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There are also numerous types of psychotherapy designed for children and adolescents, such as play therapy. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders. Others have been criticized as pseudoscience.
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.
Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm and substance abuse. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them, in a manner comparable to the philosophical dialectical process of hypothesis and antithesis, followed by synthesis.
Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on learning theory, such as respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method but it has a wide range of techniques that can be used to treat a person's psychological problems.
The Dodo bird verdict is a controversial topic in psychotherapy, referring to the claim that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes. It is named after the Dodo character in Alice in Wonderland. The conjecture was introduced by Saul Rosenzweig in 1936, drawing on imagery from Lewis Carroll's novel Alice's Adventures in Wonderland, but only came into prominence with the emergence of new research evidence in the 1970s.
Somatic experiencing is a form of alternative therapy aimed at relieving the symptoms of post-traumatic stress disorder (PTSD) and other mental and physical trauma-related health problems by focusing on the client's perceived body sensations. It was developed by trauma therapist Peter A. Levine.
Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.
The cognitive behavioral analysis system of psychotherapy (CBASP) is a talking therapy, a synthesis model of interpersonal and cognitive and behavioral therapies developed by James P. McCullough Jr [2000, 2006] of Virginia Commonwealth University specifically for the treatment of all varieties of DSM-IV chronic depression. CBASP is often mistakenly labeled a variant of cognitive therapy (CT) or cognitive behavioral therapy (CBT) but it is not. McCullough writes that chronic depression, particularly the type beginning during adolescence (early-onset), is essentially a refractory "mood disorder" arising from traumatic experiences or interpersonal psychological insults delivered by the patient's significant others. The chronic depression mood disorder, at the core, is fueled by a generalized fear of others resulting in a lifetime history of interpersonal avoidance. The disorder rarely remits without proper treatment. Some basic assumptions underlying McCullough's approach to chronic depression and its treatment as a mood disorder are briefly described below.
Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression.
Arnold Allan Lazarus was a South African-born clinical psychologist and researcher who specialized in cognitive therapy and is best known for developing multimodal therapy (MMT). A 1955 graduate of South Africa's CHIPS University of the Witwatersrand, Lazarus' accomplishments include authoring the first text on cognitive behavioral therapy (CBT) called Behaviour Therapy and Beyond and 17 other books, over 300 clinical articles, and presidencies of psychological associations; he received numerous awards including the Distinguished Psychologist Award of the Division of Psychotherapy from the American Psychological Association, the Distinguished Service Award from the American Board of Professional Psychology, and three lifetime achievement awards. Lazarus was a leader in the self-help movement beginning in the 1970s writing books on positive mental imagery and avoiding negative thoughts. He spent time teaching at various universities in the United States including Rutgers University, Stanford University, Temple University Medical School, and Yale University, and was executive director of The Lazarus Institute, a mental health services facility focusing on CBT.
Eating recovery refers to the full spectrum of care that acknowledges and treats the multiple etiologies of anorexia nervosa and bulimia, including the biological, psychological, social and emotional causes of the disorder, through a comprehensive, integrated treatment regimen. When successful, this regimen restores the individual to a healthy weight and arms him or her with the skills and resources needed to maintain a sustainable recovery. Although there are a variety of treatment options available to the eating disorders patient, the intensive and multi-faceted program followed in eating recovery is the appropriate option for individuals who require intensive support and are able to commit to treatment in an inpatient, residential or full-day hospital setting.
Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.
The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.
Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies. Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including cognitive behavioral therapy, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.
Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a “time-limited and focused approach” which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.
Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. The goal of TF-CBT is to provide psychoeducation to both the child and the non-offending caregivers and help them to identify and cope with emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced traumatic events.
Homework in psychotherapy is sometimes assigned to patients as part of their treatment. In this context, homework assignments are introduced to practice skills taught in therapy, encourage patients to apply the skills they learned in therapy to real life situations, and to improve on specific problems encountered in treatment. For example, a patient with deficits in social skills may learn and rehearse proper social skills in one treatment session, then be asked to complete homework assignments before the next session that apply those newly learned skills.
Eclectic psychotherapy is a form of psychotherapy in which the clinician uses more than one theoretical approach, or multiple sets of techniques, to help with clients' needs. The use of different therapeutic approaches will be based on the effectiveness in resolving the patient's problems, rather than the theory behind each therapy.
Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.