Empirical comparison of three treatments for adolescent males with physical and sexual aggression: Mode deactivation therapy, cognitive behavior therapy and social skills training.

Abstract

This research study compared the efficacy of three treatment methodologies for adolescent males in residential treatment with conduct disorders and/or personality dysfunctions and documented problems with physical and sexual aggression. The results showed that Mode Deactivation Therapy, an advanced form of cognitive behavioral therapy based on Beck's theory of modes, was superior to traditional Cognitive Behavioral Therapy and Social Skills Therapy in reducing both physical and sexual aggression. At the same time, Mode Deactivation Therapy was the only treatment of the three that significantly reduced sexual aggression for these youth. Keywords: Treatment Effectiveness, Conduct Disorders, Adolescent Sex Offenders, Cognitive Behavioral Therapy, Mode Deactivation Therapy, Personality Disorders INTRODUCTION Youth with conduct disorders and personality dysfunctions are extremely difficult to conceptualize and treat effectively. Such youth typically come from deprived environments with multiple stressors and often extensive histories of physical, and sexual victimization and neglect. As a group, conduct disordered youth present with a complex array of recurrent behavioral problems, including aggression, bullying, violence, intimidation, delinquency, rule violations, recklessness, property destruction, callous disregard for others, substance abuse, sexual abuse and other disruptive and anti-social behaviors (Kazdin and Weisz, 2003). In fact, the prevalence rate for conduct disorder is 6% to 16% for males under age 18 and it is one of the most frequent problems diagnosed in outpatient and inpatient mental health programs. Moreover, 80% of these youth are likely to meet criteria for psychiatric disorders in the future (Kazdin and Weisz, 2003). For example, a longitudinal study by Johnson, Cohen, Brown, Smailes, and Bernstein (1999) showed a clear connection between childhood maltreatment and the development of cluster B personality disorders in later adolescence. Moreover, conduct disorder is by far the most frequent psychiatric diagnosis given to youth involved in the juvenile justice system with rates as high as 81% to 91% of incarcerated youth (Boesky, 2002). Dodge, Lochman, Harnish, Bates and Petti (1997) have contributed a useful distinction between two types of conduct disordered youth: Reactive youth show extremely strong responses to perceived threats and then react aggressively. The second type, proactive youth, initiate or use violence and aggression in an instrumental fashion to gain an objective or pay-off. The former category appear to share a common characteristic pattern of emotional dysregulation, in which the youth is overwhelmed by a sudden surges of intense emotions, sensations and irrational thoughts that are occur in combination and are disproportionate to the situation. Koenigsberg, Harvey, Mitropoulou, Antonia, Goodman, Silverman, Serby, Schopick and Siever (2001) found that many types of aggression, including self-destructive behavior, are linked to the personality disordered traits of affective instability and impulsivity (i.e., dysregulation). Our research and clinical experience with violent and sexually aggressive youth suggests that this common phenomenon of emotional dysregulation is the same process that Aaron Beck (1996) has described as modes and that treatment must be modified to accommodate and address this process in order to be effective. Need for Effective Treatment Given the prevalence of conduct disorders and its major contribution to juvenile crime, societal violence, delinquency and sexual violence, there is a urgent need for effective treatment methods for such youth. While Kazdin and Weisz (2003) delineates some evidence-based treatment practices for children with Conduct Disorder, the same has been not achieved for adolescents over 14 years old. In recent years, Multisystemic Treatment has shown promise for antisocial youth (Henggeler, Schoenwald, Borduin, Rowland and Cunningham, 1998) and for adolescent sex offenders (Swenson, Henggeler, Schoenwald, Kaufman, and Randall, 1998), but it requires a resource-rich combination of services, one of which is psychotherapy, and it is not a realistic option for most such youth. …