Multimodal Behavior Therapy

Description of the Strategy

What constitutes a broad-based and perhaps all encompassing design for effective therapy? Clearly, there are essential behaviors to be acquired—acts and actions that are necessary for coping with life's demands. The control and expression of one's emotions are also imperative for adaptive living. It is important to correct inappropriate affective responses that undermine success in many spheres. Untoward sensations (e.g., the ravages of tension), intrusive images (e.g., pictures of personal failure and ridicule from others), and faulty cognitions (e.g., toxic ideas and irrational beliefs) also play a significant role in diminishing the quality of life. Each of the foregoing areas must be addressed in an endeavor to remedy significant excesses and deficits. Moreover, the quality of one's interpersonal relationships is a key ingredient of happiness and success, and without the requisite social skills, one is likely to be cast aside, or even ostracized.

The aforementioned considerations led to the development of multimodal behavior therapy. Emphasis was placed on the fact that at base, we are biological organisms (neurophysiological/biochemical entities) who behave (act and react), emote (experience affective responses), sense (respond to tactile, olfactory, gustatory, visual, and auditory stimuli), imagine (conjure up sights, sounds, and other events in our mind's eye), think (entertain beliefs, opinions, values, and attitudes), and interact with one another (enjoy, tolerate, or suffer various interpersonal relationships). By referring to the seven discrete but interactive dimensions or modalities as behavior, affect, sensation, imagery, cognition, interpersonal, and drugs/ biologicals, the convenient acronym BASIC I.D. emerges from the first letter of each one. The BASIC I.D. or multimodal framework rests on a broad social and cognitive learning theory.

The polar opposite of the multimodal approach is the Rogerian or person-centered orientation, which is entirely conversational and virtually unimodal. While, in general, the relationship between therapist and client is highly significant and sometimes “necessary and sufficient,” in most instances, the doctorpatient relationship is but the soil that enables the techniques to take root. A good relationship, adequate rapport, and a constructive working alliance are “usually necessary but often insufficient.” Many psychotherapeutic approaches are trimodal, addressing affect, behavior, and cognition—ABC. The multimodal approach provides clinicians with a comprehensive template. By separating sensations from emotions, distinguishing between images and cognitions, emphasizing both intraindividual and interpersonal behaviors, and underscoring the biological substrate, the multimodal orientation is most far-reaching. By assessing a client's BASIC I.D., one endeavors to “leave no stone unturned.”

Methods of Assessment and Intervention

The elements of a thorough assessment involve the following range of questions:

• B: What is this individual doing that is getting in the way of his or her happiness of personal fulfillment (self-defeating actions, maladaptive behav-iors)? What does the client need to increase and decrease? What should he or she stop doing and start doing?
• A: What emotions (affective reactions) are predominant? Are we dealing with anger, anxiety, depression, or combinations thereof, and to what extent (e.g., irritation versus rage, sadness versus profound melancholy)? What appears to generate these negative affects—certain cognitions, images, interpersonal conflicts? And how does the person respond (behave) when feeling a certain way? It is important to look for interactive processes: What impact do various behaviors have on the person's affect, and vice versa? How does this influence each of the other modalities?
• S: Are there specific sensory complaints (e.g., tension, chronic pain, tremors)? What feelings, thoughts, [Page 394]and behaviors are connected to these negative sensations? What positive sensations (e.g., visual, auditory, tactile, olfactory, and gustatory delights) does the person report? This includes the individual as a sensual and sexual being. When called for, the enhancement or cultivation of erotic pleasure is a viable therapeutic goal.
• I: What fantasies and images are predominant? What is the person's “self-image?” Are there specific success or failure images? Are there negative or intrusive images (e.g., flashbacks to unhappy or traumatic experiences)? And how are these images connected to ongoing cognitions, behaviors, affective reactions, and the like?
• C: Can we determine the individual's main attitudes, values, beliefs, and opinions? What are this person's predominant “shoulds,” “oughts,” and “musts”? Are there any definite dysfunctional beliefs or irrational ideas? Can we detect any untoward automatic thoughts that undermine his or her functioning?
• I.: Interpersonally, who are the significant others in this individual's life? What does he or she want, desire, expect, and receive from them, and what does he or she, in turn, give to and do for them? What relationships give him or her particular pleasures and pains?
• D.: Is this person biologically healthy and health conscious? Does he or she have any medical complaints or concerns? What relevant details pertain to diet, weight, sleep, exercise, alcohol, and drug use?

The foregoing are some of the main issues that multimodal clinicians traverse while assessing the client's BASIC I.D. A more comprehensive problem identification sequence is derived from asking most clients to complete a Multimodal Life History Inventory. This 15-page questionnaire facilitates treatment when conscientiously filled in by clients as a homework assignment, usually after the initial session. Seriously disturbed (e.g., deluded, deeply depressed, highly agitated) clients will obviously not be expected to comply, but most psychiatric outpatients who are reasonably literate will find the exercise useful for speeding up routine history taking and readily provide the therapist with a BASIC I.D. analysis.

...