A comparative treatment efficacy study of conventional therapy and mode deactivation therapy (MDT) for adolescents with conduct disorders, mixed personality disorders, and experiences of childhood trauma.

Abstract

Mode Deactivation Therapy (MDT) is a Cognitive-Behavioral Therapy (CBT) derivative that was developed to overcome specific problems in treatment of adolescents with dysfunctional behavior. This population typically has a history of abuse that developed into DSM Axis-I disorders such as Conduct and Oppositional Defiant Disorder, mood disorders, PTSD, and comorbid substance abuse, and Axis-Ii disorders that are commonly a constellation of personality disorder criteria. The MDT theoretical framework leans heavily on shoulders of work done by Prof. Aaron Beck in areas of negative automatic thoughts and cognitive schemas. Elements of Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and mindfulness were combined with a novel change effect component to provide effective treatment for adolescents with behavioral problems. The Validation-Clarification-Redirection step is crux of MDT and based on concepts of awareness, validation, and acceptance of problems and their roots, rather than disputing them. In 15 years or so that MDT has been practiced, about 20 developer-conducted and independent research studies, including current study, consistently provided evidence of effectiveness of MDT in treating this adolescent population. * Literature review In work done by Aaron Beck, he focused on negative automatic thoughts as initiating mechanism of dysfunctional behavior (Beck, 2005). The automatic thoughts are activated by a trigger that can be associated with underlying experience-based core beliefs. Although he initially concentrated on study of depression, a broad variety of adolescent behavior problems are also widely associated with cognitive schemas that ACT as coping mechanisms in response to chronic distress. Such beliefs commonly result in poor regulation of affect and impulses, somatization, low self-esteem, dysfunctional attachments, guilt, shame, and dysfunctional worldviews. According to Luxenberg, Spinazzola, and Van der Kolk (2001), these are results of extreme deprivation during childhood and represent a complex adaptation to trauma. Based on extensive field work, they devised DESNOS symptomatology, and arranged a list of 27 symptoms associated with disorders of extreme stress not otherwise specified (DESNOS) into seven categories (see Table 1 on page 24): Dysregulation of (a) affect and impulses, (b) attention or consciousness, (c) self-perception, (d) perception of perpetrator, (e) relations with others; (f) somatization, and (g) systems of meaning. This constellation of symptoms was found to be very consistent and statistically correlated with PTSD. Among groups with different types of trauma, and early and late onset of symptoms, it was found that children below 14-years who experienced high-magnitude interpersonal violence endorsed most DESNOS items. In fact, the younger age of onset of trauma, more likely one is to suffer from cluster of DESNOS symptoms, in addition to PTSD (Van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005, p. 395). Therefore, such interpersonal trauma that is prolonged and first occurs at an early age, can have significant effects on psychological functioning beyond ptsd symptomatology. Childhood abuse also has an impact on personality development with constellations of personality traits common among adolescent abuse victims. Different personality constellations have been identified in this context. The first is a four-array classification with Internalizing Dysregulated, High Functioning Internalizing, Externalizing Dysregulated, and Dependent as distinct personality constellations with statistically different diagnostic and adaptive functioning (Bradley, Heim, & Westen, 2005). These groups represent different in- or outwards expressions as a response to childhood trauma, which is meaningful in determining underlying belief schemas. A second personality cluster classification, devised by Blagov, Bradley, and Westen (2007), also has four diagnostic groupings that resemble clinical concept of neurotic styles instead of internalizing and externalizing dimensions of behavior, namely depressive, hostile-competitive, obsessive, and hysterical. …