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383 – 385: “Attention should be focused on providing access to high – quality, multidisciplinary care; refining assessment; and clarifying endpoints that suggest improvement and quality care.
We believe there is a specific role for multimodal therapy…… ”
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Multimodal therapy (MMT) encompasses CBT, along with a whole load of other stuff that we don’t want either….
Funding for MMT research, anyone?
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http://en.wikipedia.org/wiki/Multimodal_therapy
http://en.wikipedia.org/wiki/Arnold_Lazarus
'From the late 1950s into the 1970s, at the same time that
Albert Ellis and
Aaron Beck were pioneering
cognitive therapy, Lazarus was developing what was arguably the first form of "broad-spectrum"
cognitive behavioral therapy. In 1958, he introduced the terms "behavior therapy" and "behavior therapist" into the professional literature (i.e., Lazarus, A. A. "New methods in psychotherapy: a case study". South African Medical Journal, 1958, 32, 660-664).'
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http://www.zurinstitute.com/multimodaltherapy.html
Multimodal Therapy: A Primer
By Arnold A. Lazarus, Ph.D., ABPP
Distinguished Professor Emeritus of Psychology
Rutgers University, Piscataway, NJ
It appears that most theoreticians and clinicians are now in favor of using a broad-spectrum approach to treating patients. For example, there is a current trend toward the use of holistic treatments that not only consider intraindividual, interpersonal and systemic factors, but also argue for the inclusion of a separate transpersonal (i.e., spiritual) dimension. Multimodal therapy (MMT) strives to combine a broad and interactive set of systematic strategies, and offers particular assessment tactics that enhance diagnosis, promote a focused range of effective interventions, and improve treatment outcomes.
As a psychotherapeutic approach, the theoretical underpinnings of MMT rest on a broad-based social and cognitive learning theory, while also drawing on effective techniques from many additional disciplines - without necessarily subscribing to their particular theories (i.e., it espouses
technical eclecticism). MMT is based on the assumption that most psychological problems are multifaceted, multidetermined and multilayered, and that comprehensive therapy calls for a careful assessment of seven dimensions or "modalities" in which individuals operate - Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal relationships and Biological processes. Given that the most common biological intervention is the use of psychotropic drugs, the first letters from the seven modalities can be combined to produce the convenient acronym "BASIC I.D." - although it must be remembered that the "D" modality actually represents a range of both medical and biological factors.
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Theoretical Bases
A. Social Learning Theory
As mentioned in the introduction, MMT is based on the principles and procedures of experimental psychology, most notably social and cognitive learning theory. In essence, social learning theory states that all behaviors (normal and abnormal) are created, maintained, and modified through environmental events. While initial behavioral theories rested on animal analogues and were decidedly mechanistic (offering rather simplistic analyses of stimulus-response contingencies), the advent of what is now termed cognitive-behavior therapy (CBT) is anchored to a much more sophisticated foundation. CBT is based on the finding that cognitive processes determine the influence of external events, and can in turn be affected by the social and environmental consequences of behavior. As such, the main focus is on the constant reciprocity between personal actions and environmental consequences.
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Multimodal Assessment And Treatment
A. The BASIC I.D.
B. Whereas many of the psychotherapeutic approaches used today are trimodal (addressing the familiar affect, cognition and behavior or "ABC"), the outcomes of several follow-up inquiries have pointed to the importance of therapeutic breadth if treatment gains were to be maintained. MMT addresses this problem by calling the clinician's attention to no less than
seven discrete but interactive modalities. At base, we are all biological organisms (biochemical/neurophysiological entities), who
behave (act and react), emote (experience
affectiveresponses),
sense (respond to tactile, olfactory, gustatory, visual and auditory stimuli),
imagine (conjure up sights and sounds and other events in our mind's eye),
think (hold beliefs, opinions, values and attitudes), and
interact (enjoy, tolerate, or suffer various interpersonal relationships).
Thus,
MMT provides clinicians with a comprehensive assessment template. By separating sensations from emotions, distinguishing between images and cognitions, emphasizing both intraindividual and interpersonal behaviors, and underscoring the biological substrate, MMT is most far-reaching. In addition, as was mentioned above, by referring to these seven modalities as
Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal, and Drugs/Biology, the interactive modalities can be easily recalled by taking the first letter of each one to form the acronym "BASIC I.D."
Using this assessment template will help to ensure that the clinician leaves no stone unturned.
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How does a clinician assess each of these modalities? Typically, through the use of a range of questions.
For example, to assess the client's behavior, the clinician may ask: "What is this individual doing that is getting in the way of his or her happiness or personal fulfillment (self-defeating actions, maladaptive behaviors)?" Or perhaps, "What does the client need to increase and decrease?" Or even, "What should he/she stop doing and start doing?"
To assess the client's affect the clinician may ask: "What emotions (affective reactions) are predominant?" Or, "Are we dealing with anger, anxiety, depression, or combinations thereof, and if so, to what extent (e.g., irritation versus rage; sadness versus profound melancholy)?" The clinician may ask, "What appears to generate these negative affects - certain cognitions, images, interpersonal conflicts?" And, "How does the person respond (behave) when feeling a certain way?" Remember, however, that in addition to assessing each modality separately, it is also important to look for interactive processes that occur between and among the modalities (i.e., the impact that various behaviors have on the client's affect and vice versa).
To assess the client's sensations, the clinician may ask: "Are there any specific sensory complaints (e.g., tension, chronic pain, tremors)?" Also, "What positive sensations (e.g., visual, auditory, tactile, olfactory and gustatory delights) does the person report?" Or, staying with the notion that one must also assess interactions among modalities,
the clinician may ask, "What feelings, thoughts and behaviors are connected to these negative sensations?" It should be noted that assessment of this modality should also include the individual as a sensual and sexual being and, when called for, treatment interventions should be aimed at the enhancement or cultivation of erotic pleasure.
To assess the client's imagery,
the clinician may ask: "What fantasies and images are predominant?" "What is this client's self-image?" The clinician may also assess for specific success or failure images that the client holds, and will certainly want to ask whether the client experiences any negative or intrusive images (e.g., flashbacks to unhappy or traumatic experiences). Of course, as with the other modalities, the clinician will also want to assess how the client's images are connected to ongoing cognitions, behaviors, affective reactions, etc.
To assess the client's cognitions,
the clinician may ask: "Can we determine the client's main attitudes, values, beliefs and opinions?" And, "Are there any definite dysfunctional beliefs or irrational ideas?" Or perhaps the clinician will assess the client's predominant "should statements" or try to detect any problematic automatic thoughts that undermine the client's functioning.
To assess the client's interpersonal functioning, the clinician may ask: "Who are the significant others in this client's life?" Or, "What does this client want, desire, expect and receive from others, and what does he or she, in turn, give to and do for them? The clinician may also ask, "What relationships give this particular client pleasures and pains?"
Finally, to assess the client's biological dimension, the clinician may ask: "Is this client biologically healthy and health conscious?" "Does he or she have any medical complaints or concerns?" And, "What relevant details pertain to diet, weight, sleep, exercise, and alcohol and drug use?"
While a client presenting for treatment may use one of the seven modalities as his or her entry point (e.g., behavior: "It's my compulsive habits that are getting to me" or interpersonal: "My wife and are not getting along"), it is more typical for people to enter into treatment with problems in two or more of the modalities (
e.g., "I have all sorts of aches and pains that my doctor tells me are due to tension, I worry too much, and I feel frustrated a lot of the time. I am also very angry with my father"). Initially then, it is usually advisable to engage the client by focusing on the presenting issues, modalities, and/or areas of concern that he or she presents. To deflect the emphasis too soon onto other matters that may seem more important is only inclined to make the patient feel invalidated. Once rapport has been established, however, it is usually easy to shift to more significant problems……..
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