A one year study of adolescent males with aggression and problems of conduct and personality: A comparison of MDT and DBT.

Abstract

Abstract This study examines the effectiveness of Mode Deactivation Therapy, (MDT) and Dialectical Behavior Therapy, (DBT) in a Residential Treatment Center for adolescent males. All clients were admitted to the same Residential Treatment Center. Clients presented with physical aggression, suicidal ideation, with mixed personality disorders/traits. One group of clients was treated with MDT, while the other group received DBT treatment. Keywords: Mode Deactivation Therapy (MDT), Dialectical Behavior Therapy (DBT), Treatment Adolescents, Conduct Disorder, Personality Disorders, Aggression, Suicidal Ideation. Introduction Mode Deactivation Therapy, (MDT) was developed by Apsche (2004,2006) to treat issues among adolescent clients that were not successfully addressed in previous treatment events. These adolescents had complex topologies and were heterogeneous in their complex problems. In numerous studies, Linehan (1993) has shown that DBT can be effective in treating Borderline Personality Disorder in adult females. In a one year randomized study, Linehan, et. al., (1991), (who recently reported that DBT is effective in treating suicidal adolescents) found that DBT significantly reduced psychiatric inpatient stays and lessened parasuicidal behavior. Its use also encouraged treatment compliance. Miller, et. al., (2006) found DBT effective in reducing suicidal ideations in adolescents being treated in an inpatient setting. Apsche, Siv & Matteson, (2005) presented a case study comparing the effects of MDT and DBT. It appeared that MDT reduced physical aggression and self injurious behavior; whereas DBT, in this case, had been less than effective. Apsche & Bass, (2006) presented a study comparing 40 adolescent males presenting with aggression and suicidal ideations. MDT was significantly more effective than DBT treatment in this study. For a complete review of MDT, see Apsche, (2006). For a complete review of DBT, see Linehan, (1993). The sample size for each group type, MDT and DBT, was calculated based on the potential residential length of stay. Each group participant was randomly assigned to groups based on a census of 30. Since this was a clinical study, there were no study drop-outs. Also, due to the nature of the residential treatment center, the clients in the study were not homogenous and presented with more severe behavioral problems than target populations in typical research therapy. Kazdin & Weisz (2003). Written informed consent was obtained from all of the clients' parents or guardians. The sample was composed of twenty adolescent males, ten for each group, within ages ranging from 15-18, (mean=16.1 MDT 15.9 DBT.) Method Participants The sample was comprised of 20 male adolescents at a residential treatment center. All subjects were referred to the residential treatment center for anger, aggressions, and externalizing problem behaviors. The clients were referred to their treatment group randomly. The first client assignment was to the DBT group and was determined by a coin toss. The second assignment was to the MDT group, followed by DBT client assignment on an alternating basis, until each group was filled. The DBT group therapists were all trained in DBT at the official DBT training center. The MDT group therapists were trained by the creator and developer of MDT (the first author of the paper). Dialectical Behavior Therapy A total of ten male adolescents were assigned to the DBT group. The group consisted of African Americans, 3 European Americans and 1 Hispanic American, the principal Axis I diagnosis was conduct disorder (5), Oppositional Defiant Disorder (4) and Post Traumatic Stress Disorder (6). Axis II diagnoses for the group included Mixed Personality Disorder (3), Borderline Personality traits (3), and Narcissistic Personality Traits (2), and Dependent Personality Disorder (2). …