Multimodal therapy

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As a multimodal therapy [from Latin multus 'much, big, strong'; from Latin mode 'measure, aim, regulation, manner'; also interdisciplinary therapy ] is a general term for a therapeutic procedure in which different treatment approaches are combined with one another in order to achieve an optimal result.

Basics

One of the basic ideas of multimodal therapies is the complexity of the treatment and the bundling of the know-how of different groups of people and areas of knowledge. Accordingly, in multimodal therapy, people from different professions, disciplines or areas of a discipline work together on the therapy goal. With regard to another basic idea, it is now assumed that all areas of the human organism are in constant communication and interaction with one another. This results - in health and illness - in the changing psychophysiological constitution of the individual, who is also in continuous interaction with the respective environmental conditions. In this sense, every therapy in the individual patient can and should take this dynamic, holistic understanding of people into account and influence as many relevant factors as possible.

Application examples

Interstitial cystitis treatment regimen as an example

Regarding the use of multimodal methods in therapy, a distinction can be made between those diseases in which, due to the actual condition of a patient, the multimodality of treatment is inevitable and those in which this procedure is 'only' suitable or desirable, but not absolutely necessary. The multimodal approach is inevitable, for example in oncology , when chemotherapy [e.g. B. to destroy the smallest units of affected tissue] and surgery [e.g. B. to remove tumors] can be combined. Possibly suitable, desirable or beneficial here could be the additional combination, for example, with immunotherapy or with the medically supervised home intake of methadone for the most severe cancer diseases.

Another distinguishing feature in the use of multimodal procedures arises from the question of the origin of a disease. In multimodal pain therapy, for example, to treat the numerous symptoms of fibromyalgia , exercise therapy, physiotherapy , drug treatments and psychotherapy are combined. Multimodal therapies are also the most promising option for other diseases, the development of which is increasingly being gained, such as schizophrenia.

Sometimes multimodal therapy simply means the best possible use of different techniques or technologies in a discipline to pursue the therapy goal. One example of this is multimodal radiation therapy. In oncology, for example, this approach aims to use the indicated and available forms of radio and particle therapy for the best possible tumor control and with a reduced risk of side effects. Specialized software is required for optimization, which is also capable of multimodal imaging data [e.g. B. CT , MRI , PET ] from different times [e.g. B. before the beginning, after a few irradiations, during an irradiation unit] of the therapy compares and evaluates. Appropriate software can use the results obtained in this way to calculate respective adjusted values ​​with a view to increasing or reducing or aligning the radiation dose.

In connection with psychotherapy procedures, the term multimodal therapy sometimes explicitly refers to the design of cognitive behavioral therapy , as it is e.g. B. Arnold A. Lazarus suggested. Here, too, it is a matter of making the greatest possible use of all possible techniques within a discipline or of taking into account as many reference values ​​as possible relevant to the individual patient [here: areas of the patient's life]. Today this should be the standard.

Multimodal therapies play a special role in the treatment of children and adolescents with long-term illnesses. Here, the development aspect generally calls for a multimodal approach.

Sustainable restrictions on development due to a serious illness can only be reduced to a minimum by taking into account as many development factors as possible. The involvement of parents, possibly friends and often the school environment in therapeutic considerations and procedures also appears to be essential, apart from legal questions. In the field of child and adolescent psychotherapy, for example, various therapy programs were u. a. designed and published by Manfred Döpfner in collaboration with other people [THOP, THAV, SELBST, THAZ].

Also when treating people in special life situations, for example if the treatment options are limited in one area [e.g. B. medication treatment of pregnant women], these restrictions can be compensated by a multimodal approach.

Self-efficacy of the patient in the context of multimodal therapies

Multimodal forms of therapy optimally offer one or more ways to bring the patient closer to a certain degree of self-efficacy in relation to his illness or his recovery or alleviation of the symptoms . All too often people experience an illness as being at the mercy of the doctor and the illness itself. If, on the other hand, the patient is included in complex technical considerations and even learns specific options for action that he can carry out independently and on his own responsibility, this phenomenon is reduced [see also participatory decision-making ]. The self-efficacy experienced could thus contribute to recovery or to alleviate the symptoms [see graphic]. In this context, exercise or creative therapeutic parts of the therapy should be mentioned as examples, which the patient can possibly also carry out without continuous guidance.

The term multimodal therapy is not protected. In this respect, this 'label' is used a lot. The term may also come across when different procedures such as conventional and alternative medical treatments are combined, but there may not be an overarching concept for the use of the therapeutic components. In the optimal case, however, there is such a concept and the individual case [patient / client] is regularly discussed and documented [cf. also case management and possibly assistance plan procedure ]. The patient is included in the considerations wherever possible and suitable. In every therapy, professional casework forms the framework for therapeutic selection, evaluation, assessment and decision-making steps. However, with the complexity of an actually multimodal approach, it once again gains special significance. The inserted graphic for the treatment of interstitial cystitis serves as an example for the professional documentation of casework .

Importance in healthcare

The aim of therapy is a treatment that can achieve the optimal - i.e. the best possible - result. From a therapeutic point of view, one could formulate that multimodal therapy seems more appropriate the more factors there are for the causes of the development of a disease or its persistence and worsening or even cure or relief. Assuming a dynamic, holistic understanding of the human organism, a multimodal approach should basically be aimed for as a standard in each individual case.

For multimodal, as for all other therapeutic approaches, the corresponding “realities” must be available, i.e. time, space, positions and financial resources.

literature

  • Gerd Rudolf, Peter Henningsen: Psychotherapeutic medicine and psychosomatics: An introductory textbook on a psychodynamic basis . Georg Thieme Verlag, 7th edition 2013, ISBN 978-3-13-158387-1 , p. 222.

Individual evidence

  1. ↑ DWDS - Digital Dictionary of the German Language. Retrieved October 22, 2019 .
  2. ↑ DWDS - Digital Dictionary of the German Language. Retrieved October 22, 2019 .
  3. ↑ a b Ulrike Elert, Roland von Känel (ed.): Psychoendocrinology and Psychoimmunology . Springer, Berlin 2011, ISBN 978-3-642-16963-2 (preface).
  4. ↑ a b c d e Karl Köhle: "Integrated Medicine" . In: Karl Köhle, Wolfgang Herzog, Peter Joraschky, Johannes Kruse, Wolf Langewitz, Wolfgang Söllner (Eds.): Psychosomatic Medicine - Theoretical Models and Clinical Practice . 8th edition 2016, unchanged study edition 2018. Elsevier, Munich 2016, p. 3-22 .
  5. ↑ TM Srinivasan: Multimodal Therapy: Holistic Approach . In: International Journal of Yoga . tape 11 , no. 3 , 2018, ISSN  0973-6131 , p. 175–176 , doi : 10.4103 / ijoy.IJOY_53_18 , PMC 6134745 (free full text).
  6. ↑ Bschleipfer, Thomas et al .: S2K guideline: Diagnosis and therapy of interstitial cystitis (IC / BPS). (pdf) Long version, 1st edition, Version 1, 2018. In: https://www.urologenportal.de/%7Chrsg=Deutsche Gesellschaft für Urologie. September 30, 2018, accessed August 24, 2019 .
  7. ↑ Deutscher Ärzteverlag GmbH, editorial office of Deutsches Ärzteblatt: First clinical multicenter study on methadone in cancer therapy ... October 28, 2019, accessed on November 23, 2019 .
  8. ↑ MEFOX study: methadone plus chemotherapy for metastatic colon cancer | Ulm University Hospital. Retrieved November 25, 2019 .
  9. ↑ Pain Center. Retrieved October 30, 2019 .
  10. ↑ AWMF: detail. Retrieved November 23, 2019 .
  11. ↑ DR Müller, V. Roder, HD Brenner: Effectiveness of the Integrated Psychological Therapy Program for Schizophrenic Sufferers: A Meta-Analysis of 28 Independent Studies . In: The neurologist . tape 78 , no. 1 , January 2007, ISSN  0028-2804 , p. 62-73 , doi : 10.1007 / s00115-005-1974-x .
  12. ↑ Tilman Bostel, Jürgen Debus, Christian Karger, Nils Nicolay, Florian Sterzing: Joint project SPARTA: Software platform for adaptive multimodal radio and particle therapy with self-sufficient expandability: Final report Heidelberg University Hospital . [Heidelberg University Hospital, Radiological Clinic, Department of Radio-Oncology and Radiation Therapy], [Heidelberg] 2016 ( tib.eu [accessed on November 23, 2019]).
  13. ^ Kriz, Jürgen: Basic concepts of psychotherapy . 7., revised. and exp. Beltz, Weinheim 2014, p. 126; 156 f .
  14. ^ Pschyrembel Online. Retrieved November 23, 2019 .
  15. ^ Lieb, Klaus, Frauenknecht, Sabine, Brunnhuber, Stefan, Wewetzer, Christoph: Intensive course in psychiatry and psychotherapy . 8th edition. Urban & Fischer in Elsevier, Munich 2016, ISBN 3-437-42528-5 , p. 363 .
  16. ^ Daniel Walter, Manfred Döpfner: The treatment of adolescents with performance disorders with the therapy program SELF - concept and stability of changes during therapy . In: Journal for Child and Adolescent Psychiatry and Psychotherapy . tape 35 , no. 4 , July 2007, ISSN  1422-4917 , p. 281–290 , doi : 10.1024 / 1422-4917.35.4.281 (; exemplary evidence for the programs listed).
  17. ^ Menche, Nicole ,, Urban - & - Fischer-Verlag Munich: Biologie Anatomie Physiologie . 8th edition. Munich, ISBN 978-3-437-26803-8 .
  18. ↑ Markser, Valentin ,, Broocks, Andreas .: Sports and exercise therapy for mental illnesses Research status and practical recommendations; with ... 21 tables . Schattauer, Stuttgart 2015, ISBN 978-3-7945-2993-3 .