Mode deactivation therapy: A look at two recent studies.

Abstract

OVER THE YEARS INCREASED need has developed for effective interventions in residential settings for conduct disordered and delinquent youth. In particular the adolescent population has been difficult and suffering high amounts of recidivism. One promising treatment to develop has been Mode Deactivation therapy. Jack Apsche originally formulated mode Deactivation Therapy (MDT) in response to the lack of effective therapies offered in residential treatment centers. Interventions are primarily verbal and involved validating the client's experiences, clarifying core beliefs and changing behavioral responses that are based on fear and improper attempts to cope. In developing the treatment, Apsche drew on recent work in cognitive behavior therapy in particular, Becks concept of modes and methods to deactivate triggered responses (Apsche & DiMeo, 2010). His treatment is similar to many of the current movements in clinical behavior analysis in that it is contextual in nature with a focus on the therapeutic relationship during the interaction to trigger and shape response, while attempting to balance ideas of both acceptance and change around complex behavioral problems involving trauma, psychopathology, beliefs, and personality factors (Apsche, 2010). A recent meta-analysis has shown mode deactivation therapy to be effective in the treatment of residential children with multiple behavioral and psychiatric difficulties (Apsche, Bass, & DiMeo, 2010) In addition, this meta-analysis found the effect size of the treatment to be greater than that of traditional cognitive therapies, dialectical behavior therapy and social skills training. Finally, some support was offered that externalizing problems such as aggression emerge from internalizing problems such as anxiety. Mode Deactivation theory has received a flurry of recent interest. This is evidenced by multiple journal articles written documenting the ineffectiveness of treatment as usual and the effectiveness of MDT (Apsche & Ward, 2002; Apsche, Bass, Murphy 2004; Apsche, Bass, Civ 2005) Thoder and Cautilli, 2011 succinctly described MDT: Mode deactivation therapy (MDT) is offshoot of CBT that examines aspects of personality that lead to criminality and delinquency and, ultimately, remediate problematic schemas. MDT is based on the work of Aaron Beck, M.D. Beck (1996) suggests that the model of individual schemas do not adequately address a number of psychological problems. Incorporating this premise, MDT addresses a more global methodology (Apsche & Ward, 2002; Beck, 1996). The concept of modes is defined as a network of cognitive, affective, motivational, and behavioral components that integrate sections of a personality (Beck, 1996). Modes consist of beliefs that contain the specific memories, the system on solving specific problems, and the experiences that produce memories, images, and language that form perspectives (Apsche & Ward, 2002). (p.42). In 2006 and in 2011 these writers evaluated the effectiveness of MDT. These evaluations were independent of each other. The second occurred 5 years after the first and 10 years after the introduction of the MDT model. The current status of the literature (insert bass, etc here) evidences a robust therapeutic model which provides a model of care for adolescents who have extensive abuse histories, have been in multiple placements and generally are avoided by providers due to their extreme behavior. Underwood, Baggett-Talbott, Mosholder, and Von Dresner (2008) found that many of the therapies utilized in residential treatment centers is normed on those with less intense problems and thus the difficulty in treating those in residential care. MDT provides an alternative for this shortcoming. MDT has provided sound if not superior results to Cognitive Behavior Therapy alone or Treatment as Usual (supportive therapy, crisis management only, or medication management alone). …