A literature review and analysis of mode deactivation therapy.

Abstract

Introduction In the process of treatment research trials and development of MDT, this methodology (MDT) has been compared to the alternative methodologies such as: Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT) and Social Skills Training. This review examines the literature of MDT in treating adolescent clients with reactive emotional dysregulation, who presented with behaviors including parasuicidal acts, verbal and physical aggression and sexually aberrant behavior. Case studies in this article involved clients with complicated histories of sexual, physical, or emotional as well as neglect and multi-axial diagnoses. Data indicates that MDT is effective in reducing the rate of physical and sexual aggression in addition to symptoms of Post Traumatic Stress Disorder. Given the prevalence of conduct disorders and its major contribution to juvenile anti-social behavior, societal violence, sexual violence and delinquency, there appears to be an urgent need for empirically based treatment methods for such youth. There were several interventions implemented to reduce antisocial behavior in disruptive disorders. Because many clinicians conducted therapy in a more eclectic fashion, the problem encountered was difficulty identifying efficient treatments which could be effective in many treatment environments. Other researchers conducting a review of treatments for children and adolescents were they identified 82 studies carried out between 1966 and 1995 involving 5,272 youth. Of the 82 studies, they discovered that many were not well established with empirical validation, and many more did not indicate efficacious treatment. There were problems with identifying a comprehensive treatment approach that showed suitability, reliability and external validity. Unlike findings involving treatment provided by clinicians who worked primarily in inpatient settings using structured empirically validated treatments, the finding of empirically validated studies that examined outpatient therapeutic practices with conduct disordered adolescents were scarce. While it was noted that some evidence-based treatment practices existed for children with Conduct Disorder, it was not established that for adolescents over 14 years of age. This article presents a complete overview of MDT, delineating its origin from CBT, ACT, DBT and Functional Analytic Psychotherapy Therapy (FAP) as well as reviewing the current adaptation of mindfulness techniques of MDT that are soon to be published. A brief review of the mindfulness manual is included as well. Elements from Several Behavior Therapies Originating from CBT, ACT and DBT, MDT also incorporates principles from FAP (Kohlenberg and Tsai, 1993; Tsai, Kohlenberg, Kantner, Kohlenberg, Follette, Callaghan, 2009). First, MDT aligns with FAP in examining how change is made in a therapy session, specifically the notion that behavior is shaped and often maintained by contingencies of reinforcement. This learning happens out of the consciousness of the client and therapist or experientially, while often they focus in the now, didactic type of cognition. Acceptance and Commitment Therapy and MDT both also address the individual's experiential avoidance of difficult or painful thoughts and emotions, by implementing both cognitive and emotional defusion. Cognitive and emotional defusion are the processes that humans learn to avoid painful stimuli, either in thought or emotion. In short, if something elicits pain, often we tend to avoid it, in thought or feeling. Hayes (2004) suggests that we often pair feelings with conditions, such as, was happy once, prior to my abuse, I cannot enjoy the sunset anymore, Since I was abused. Hayes suggests that the coercive stimuli (psychological pain) of the past cannot be reduced through simple situational solutions. We avoid that which is painful. Acceptance and Commitment Therapy (ACT) (Hayes, 2004) and MDT also are both deeply rooted in mindfulness. …