Integrative and Multimodal CBT
A BRIEF SYNOPSIS OF
INTEGRATIVE AND MULTIMODAL COGNITIVE-BEHAVIOR THERAPY
- Author: Professor, Ph.D., Daniel David
- Acknowledgement: IM-CBT is one of the psychological paradigms studied/used by the International Institute (e.g., together with other classical cognitive and behavioral therapies like ACT, BT, CT, DBT, REBT, ST, etc.), but not the only one. However, IM-CBT is seen by Dr. David (but not necessary by the whole International Institute) as a meta/generic approach, beyond various “CBT Schools/Waves/Specific Protocols”.
- Citation of the article: David, D. (2018). A brief synopsis of the Integrative and Multimodal Cognitive-Behavioral Therapy (IM-CBT). International Institute, accessible online (March 2018) at http://psychotherapy.psiedu.ubbcluj.ro/multimodal-integrative-cbt/
I. INTRODUCTION TO IM-CBT
Integrative and Multimodal CBT (IM-CBT) is not a new form of psychotherapy (or a new form of CBT), but a technologically immersed and a comprehensive approach of various “CBT Schools” and “CBT Waves” (i.e., a meta/generic approach), based on clinical cognitive neurogenetic and cross-cultural sciences (see for a general educational view: “A Brief History of Psychotherapy Movie“).
IM-CBT has been developed recently (see below the selected references – more specifically see David et al., 2010; David & Freeman, 2015) and it was stimulated by the Declaration of the 9th Congress of the International Association of Cognitive Psychotherapy in 2017 (See HERE for the Declaration and HERE for the Congress ).
IM-CBT is part of a more general movement towards a meta/generic science and practice of CBTs, beyond fragmentation in various “CBT Schools”, “CBT Waves”, and specific CBT protocols. In this movement, other representative meta/generic frameworks are Barlow’s Unified CBT Treatment Approach, Beck’s Generic CBT Model, Ellis’ Generic ABC Model (including Wessler, 1986), Hayes & Hofmann’s Process-Based CBT, Mennin’s Emotion Regulation CBT, etc. (and the movement is developing continuously, with more new meta/generic approaches). IM-CBT is mainly developed from the Beck and Ellis’ generic models, immersed with technology and clinical cognitive neurogenetic and cross-cultural sciences, thus being able to unite various schools/waves/protocols of CBTs.
IM-CBT is Integrative (see Figure 1), because, based on clinical cognitive neurogenetic sciences, various behavioral and cognitive theories are brought together in a coherent (often transdiagnostic) theoretical framework. Based on such an integration, comprehensive theory-driven cognitive case conceptualizations can be elaborated, guiding a more personalised psychological intervention. Also, the IM-CBT framework can stimulate research in the field, (1) to better understand the mechanisms described in Figure 1, following a multilevel framework, as presented by the Human brain: From cell to society Report of the European Science Foundation (see Figure 2) and (2) testing both the theory and the efficacy/effectiveness of specific IM-CBT psychological protocols (based on the model described in the Table 1 – see also David et al., 2018). Moreover, the new developments in clinical cognitive neurogenetic and cross-cultural sciences (and technology) are continuously assimilated and/or accommodated in IM-CBT.
IM-CBT is Multimodal (see Figure 1), because, based on a coherent integrated theory, various techniques could be used, based on a comprehensive theory-driven cognitive case conceptualization, in personalized evidence-based clinical psychological protocols (and such IM-CBT psychological treatments could be tested for their efficacy/effectiveness, based on the logic presented in Table 1):
- First wave: behavioral techniques (e.g., functional analysis of behavior, exposure/systematic desensitization);
- Second wave: cognitive restructuring techniques (e.g., logical/empirical/functional-pragmatical/metaphorical/spiritual/humor/behavioral);
- Third wave: cognitive defusion/acceptance/mindfulness techniques;
- Varia: techniques from other psychotherapy modalities and/or creatively generated by the therapist in clinical practice (considering patients’ safety and therapy’s ethics).
Figure 1. The Integrative and Multimodal CBT Model, which can be used for (1) human optimization/development, (2) health promotion/prevention of health problems, and/or (3) treatment of subclinical (e.g., life problems) and clinical conditions. Notes: (1) The dysfunctional Schemas could be compensated by various defence mechanisms, which further induce biases; (2) The model can explain both health and illness.
Figure 2. A multilevel approach of human mind. (Dr. David was a contributor, part of the Steering Committee, of the Strategic Report “The human brain: From cell to society“, elaborated in 2012, under the umbrella of the European Science Foundation).
The basic clinical strategies of the IM-CBT are (see Figure 1):
- First, target metaprocesses.
- If there is a crisis situation, use any intervention (often Coping techniques).
- If the problem is mainly behavioral, use behavioral techniques (e.g., functional analysis, exposure/desensitization) and cognitive techniques (e.g., rule-based).
- If the problem is mainly emotional, use (1) first interventions at B [cognitive restructuring for conscious processes (first targeting hot cognitions and then cold cognition; if it doesn’t work, try the reversed order) and behavioral techniques for unconscious information processes] and (2) then interventions at A (e.g., problem solving).
- Biases should be targeted by cognitive bias modification techniques (e.g., attention bias modification/attentional retraining, interpretation bias modification, concreteness training); attention should be paid to the evolution of this field, as in the present the results are mixed.
- For complex/difficult cases, consider a dynamic IM-CBT approach (as described in Figure 3).
Figure 3. A dynamic approach of IM-CBT (based on David & Freeman, 2015).
Table 1. Psychotherapy Classification Framework (based on David & Montgomery, 2011).
Notes:
- (a) Well-supported theories are defined as those with evidence based on (a) experimental studies (and sometimes additional ⁄ adjunctive correlational studies) and ⁄ or (b) component analyses, patient ・ treatment interactions, and ⁄ or mediation ⁄ moderation analyses in complex clinical trials (CCTs); thus, the theory can be tested independently of its therapeutic package (e.g., in experimental studies and sometimes their additional ⁄ adjunctive correlational studies) and ⁄ or during a CCT; ‘‘well supported’’ within this framework means that it has been empirically supported in at least two rigorous studies, by two different investigators or investigating teams.
- (b) Equivocal evidence for therapeutic package and ⁄ or theory means No (data not yet collected), Preliminary (there is collected data, be they supporting or contradictory, but they do not fit the minimum standards), or Mixed Data (MD; there is both supporting and contradictory evidence).
- (c) Strong contradictory evidence (SCE) for therapeutic package and ⁄ or theory means that it has been empirically invalidated in at least two rigorous studies, by two different investigators or investigating teams.
- (d) Well-supported therapeutic packages are defined as those with randomized clinical trial (or equivalent) evidence of their efficacy (absolute, relative, and ⁄ or specific) and ⁄ or effectiveness; ‘‘well supported’’ within this framework means that it has been empirically supported in at least two rigorous studies, by two different investigators or investigating teams.
II. IM-CBT – PRESENTATIONS/CONFERENCES/TRAINING/WORKSHOPS/PRACTICUM
IM-CBT is part of the curriculum in the International Institute for the Advanced Study of Psychotherapy and Applied Mental Health and its affiliated International Coaching Institute.
Various workshops/trainings in IM-CBT have been already presented and/or planned in Australia, Greece, Moldavia, Romania, Russia, Turkey, USA, etc.
- IM-CBT workshops/trainings (minimum 4-6 hours) would be best implemented, if the participants have already a full comprehensive training in one of the major CBT modalities (e.g., behavior therapy, problem solving, cognitive behavior modifications/stress inoculation training, rational emotive behavior therapy/REBT, cognitive therapy, ACT, DBT, schema therapy etc.). If applied to a specific psychological condition, the workshop/training should last for minimum 8 hours.
- IM-CBT workshops could be used for health professionals with clinical training, but no specific training in CBT or psychotherapy, in which case the workshop should last for minimum 2 days (3 days if applied to a specific clinical condition).
- Other specific conditions regarding IM-CBT workshops/trainings should be discussed and planned based on the local needs.
- For a full comprehensive training in IM-CBT, the program should be discussed and planned based on the regulations in each specific country.
Those interested in presentations/workshops/trainings in IM-CBT should contact Professor, Ph.D., Daniel David (daniel.david@ubbcluj.ro).
III. SELECTED REFERENCES RELATED TO THE DEVELOPMENT OF IM-CBT:
- Cristea I.A., Montgomery G., Szamoskozi S., David D. (2013). Key constructs in “classical” and “new wave” cognitive behavioral psychotherapies: relationships among each other and with emotional distress. Journal of Clinical Psychology, 69(6), 584-599. doi: 10.1002/jclp.21976
- Cristea, I.A., Szentagotai Tatar, A., Nagy, D., & David, D. (2012). The bottle is half empty and that’s bad, but not tragic: Differential effects of negative functional reappraisal. Motivation and Emotion.
- Cristea, I.A., Valenza, G., Scilingo, E.P., Szentágotai Tătar, A., Gentili, C., & David, D. (2014). Autonomic effects of cognitive reappraisal and acceptance in social anxiety: Evidence for common and distinct pathways for parasympathetic reactivity. Journal of Anxiety Disorders, 28(8), 795–803. doi:10.1016/j.janxdis.2014.09.009
- David, D., Cristea, I.A., & Hofmann, S.G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9:4. 3389/fpsyt.2018.00004.
- David, D. & Freeman, A. (2015). Overview of Cognitive-Behavioral Therapy of personality disorders. In Beck, A.T., Davis, D.D., & Freeman, A. (Eds.). Cognitive Therapy of personality disorders, third edition. The Guilford Press: New York.
- David, D., Lynn, A., & Ellis, A. (Eds. 2010). Rational and irrational beliefs in human functioning and disturbances; Implication for research, theory, and practice. Oxford Universty Press: London.
- David, D., Lynn, S.J., & Montgomery, G.H. (Eds. 2018). Evidence-based psychotherapy: The state of science and practice: John Wiley & Sons, Inc: New York.
- David, D., Matu, S. A, & David, O. A. (2013). New directions in Virtual Reality-Based Therapy for anxiety disorders. International Journal of Cognitive Therapy, 6(2), 114-137. doi: 10.1521/ijct.2013.6.2.114
- David, D., Matu, S., & David, O. A. (2014). Robot-Based Psychotherapy: Concepts development, state of the art, and new directions. The case of Robot-Based Cognitive Behavior Therapy. International Journal of Cognitive Therapy, 7(2), 192-210. doi: 10.1521/ijct.2014.7.2.192
- David, D., Matu, S., Mogoașe, C., & Voinescu, B. (2016). Integrating cognitive processing, brain activity, molecules and genes to advance evidence-based psychological treatment for depression and anxiety: From cognitive neurogenetics to CBT-based neurogenetics. Journal of Rational-Emotive & Cognitive-Behavioral Therapy, 34(3), 149-168.
- David, D. & Montgomery, G.H. (2011). The scientific status of psychotherapies: A new evaluative framework for evidence-based psychosocial interventions. Clinical Psychology: Science and Practice, 18, 89-99.
- Mogoase, C., David, D., & Koster, E. H. (2014). Clinical efficacy of attentional bias modification procedures: An updated meta-analysis. Journal of Clinical Psychology.
- Podina, I., Popp, R., Pop, I., & David, D. (2015). Genetic correlates of maladaptive beliefs: COMT VAL 158 MET and irrational cognitions linked depending on distress. Behavior Therapy, 46(6), 797- 808.
- Podină, I.R., Koster, E.H.W., Philippot, P., Dethier, V., & David, D. (2013). Optimal attentional focus during exposure in specific phobia: A Meta-analysis. Clinical Psychology Review, 33, 1172-1183.
- Wessler, R. L. (1982). Varieties of cognitions in the cognitively-oriented psychotherapies. Rational Living, 17, 3-10.