Multimodal Therapy For Interpersonal Relationships

Depression: An overview

It’s common to face challenges in life that can cause a person to feel sadness, grief, or exhaustion. However, depression is characterized by a sustained period of depressive symptoms lasting longer than two weeks. It is estimated that 16 million adults in America experience major depressive disorder (MDD) each year. MDD is often considered to be the leading cause of disability for people aged 15 to 44. 

There may be no one cause of depression; biological influences, personality type, brain and body chemistry changes, and stressful life events can all contribute to this diagnosis. However, depression can be very treatable—research shows that between 80% and 90% of people with depression respond well to treatment, and nearly all patients gain some relief from depression symptoms. While cognitive behavioral therapy tends to be a common treatment for depression, other types of therapy, such as multimodal therapy (MMT), can also be effective in improving cognition, interpersonal relationships, and various symptoms associated with the disorder.

What is multimodal therapy?

Multimodal therapy is a psychotherapeutic approach that assesses and treats individuals according to a broad range of criteria. Multimodal therapy often involves employing more than one treatment technique to address a person’s psychological, behavioral, and emotional well-being. Unlike cognitive behavioral therapy (a combination of cognitive therapy and behavior therapy), which usually focuses on a person’s thought processes and how they may affect an individual’s emotions and behavior, multimodal therapy brings in multiple treatment types.

Developed by psychologist Arnold Lazarus in the 1970s, multimodal therapy is founded on the idea that people are multifaceted and that mental health problems are often the result of several different aspects of a person’s life. As such, Arnold Lazarus generally believes that effective therapy should target all of these modalities. 

For example, a person may have experienced childhood trauma, grief from loss, challenges in interpersonal relationships, and financial hardship. The combined stress of these experiences may all be causal factors underlying their depression. Thus, a mental health professional might devise a treatment plan that helps the individual gain a deeper understanding of how those experiences affected them and work with them to overcome the everyday obstacles associated with depression.

The seven modalities of multimodal therapy, according to Arnold Lazarus

Multimodal therapy, according to Lazarus, recognizes seven distinct “modalities,” or aspects, of the human condition, known as BASIC ID. These are: 

• Behavior
• Affect (emotions)
• Sensation (body sensations)
• Imagery (mental images and visualizations)
• Cognition (thoughts and beliefs)
• Interpersonal relationships
• Drugs/biological factors

How does multimodal counseling improve mental health and interpersonal relationships?

Before beginning treatment, a multimodal therapist first assesses the patient based on the seven BASIC ID criteria (behavior, affect, imagery, cognition, interpersonal relationships, and drugs/biological factors). This typically involves working with them to complete the multimodal life history inventory, a questionnaire designed to give therapists a deep understanding of their clients. This intake process may also help the client and therapist begin a productive therapeutic relationship.

Then, the therapist might discuss the specific problems that the patient would like to address in therapy. With a clear understanding of the patient and a list of problems they are facing, the therapist would begin devising a treatment plan for the patient.

Multimodal therapists typically use a variety of techniques and therapeutic interventions tailored to each modality. The goal is to help the individual identify and change maladaptive patterns of behavior, thoughts, and emotions through self-awareness, enhanced coping skills, and improved overall well-being.

The following are some of the most common psychosocial therapies used by multimodal therapists:

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Cognitive restructuring
• Interpersonal psychotherapy
• Relaxation techniques

In addition, a therapist may refer their client to a psychiatrist for medication treatment. Because multimodal therapy typically combines multiple treatment processes, it may be more effective than a singular treatment approach.

Is multimodal therapy effective?

Because multimodal therapy typically addresses more than one aspect of a person’s well-being, it may be an effective treatment for a range of mental health problems, including:

• Depression
• Anxiety (including social anxiety disorder)
• Bipolar disorder
• Attention Deficit Hyperactivity Disorder (ADHD)
• Personality disorders
• Substance abuse
• Eating disorders

Multimodal therapy typically combines treatment strategies from different areas of clinical psychology. As such, it can offer therapists more flexibility in how they choose to treat clients. For example, a therapist may employ some elements of psychoanalysis to gain a better understanding of a client’s past while incorporating mindfulness strategies used in DBT. 

Additionally, multimodal therapy allows for a “broad spectrum” treatment approach that can help clients improve different areas of their lives that may be contributing to their mental health. For example, a therapist may help a client overcome social anxiety to help combat the loneliness often associated with depression. At the same time, they may work with the client to incorporate good habits aimed at improving physical health, such as sleep hygiene and exercise. This multimodal approach may lead to more positive therapeutic outcomes than more targeted treatments.

One study examined the efficacy of multimodal therapy on diabetic women experiencing anxiety, depression, and physical symptoms and found that it significantly reduced mental and physical symptoms.

Finding a multimodal therapist

If you are experiencing symptoms of depression, it may be worth considering multimodal therapy. You may begin your search online by searching for multimodal therapists in your area. Alternatively, you might consider online therapy. One study found that nearly 38% of participants experienced clinically significant improvement in depression symptoms after three months of using an online therapy platform. Other studies have suggested that online therapy can be as effective as traditional in-office therapy.

Online multimodal therapy may be the solution to traditional, in-person therapy limitations. Online therapy platforms typically offer therapy in multiple ways—through SMS texting, mobile phone conversations, video calls, and online chats, for example. This may be particularly helpful for clients undergoing multimodal therapy treatment as it allows for more treatment flexibility. 

Online therapy may be a preferable option for socially anxious people, and those who have busy schedules. Additionally, online therapy services can cost less than face-to-face therapy sessions.

Those unsure about online therapy may be concerned that an online therapist’s level of support and understanding may not be up to par with that of a traditional therapist as some people can find it hard to connect through a screen or over the phone. However, a 2014 study found that online therapy can be as effective as face-to-face therapy.

Current research: Multimodal therapy for adult depression

In the United States, up to 25% of adults could benefit from counseling for depression, but only 13.4% report receiving therapy services. 

Researchers generally focused on examining the ways gender, health status, financial status, and involvement in traditional therapy affected the results of this particular study.

Past studies have often been conducted to reveal the efficacy of online therapy. Researchers of this study aimed to examine the responses to online therapy by gender, health status, financial status, and previous exposure to traditional, in-person therapy treatment. 

Adult depression

For this study, a total of 318 BetterHelp clients (nearly 80% female) were recruited from a larger pool of BetterHelp users. Each participant was 18 years or older and reported using the platform to seek a better quality of life. Participants were excluded from the study if their pre-intervention levels of depression fell below the clinical standard of mild depression, meaning all participants were experiencing mild to severe depression. 

In addition, all participants self-reported feelings of overwhelming sadness, grief, or depression. The mean age of participants was 33 years old, and 37.4% met the eligibility criteria for mild depression, 28.6% for moderate depression, 23.6% for moderately severe depression, and 10.4% for severe depression.

Each participant reported their perception of the severity of their symptoms, and this information was compared between the first and second questionnaires to measure improvement.

Researchers’ hypothesis and goal

Researchers hypothesized that engagement with BetterHelp’s multimodal platform would significantly reduce the severity of adult depression symptoms. Additionally, researchers aimed to explore how multimodal therapy efficacy could vary by age, gender, financial status, physical health status, prior therapy experience, and engagement in therapy.

Before conducting this study, researchers expressed their current understanding of research on therapy outcomes by gender, age, financial status, health status, and prior therapy experience. Although research of the effects of gender on psychotherapy outcomes is often mixed, the researchers noted that women usually report an increased symptom reduction after traditional therapy. On the flip side, research on Web-based therapy suggests that men may experience an increased symptom reduction compared to women.

As far as age and therapy are related, some evidence suggests that younger clients may respond more quickly and report greater improvement in therapy. At the same time, older adults may be more likely to adhere to treatment. This study aims to see if these same findings are true for multimodal therapy.

Statistics on therapy acceptance by physical health status, economic status, and experience with therapy indicate that good health, better economic stance, and more therapy experience typically lead to better therapy outcomes. Along the same lines, the dose-response effect, or level of engagement in the therapeutic process, is normally positively correlated with mental health improvements. However, these considerations are often less understood in multimodal therapy; this study intended to shed light on these lesser-studied factors.

Study results