An Empirical Comparison of Cognitive Behavior Therapy (CBT) and Mode Deactivation Therapy (MDT) with Adolescent Males with Conduct Disorder And/or Personality Traits and Sexually Reactive Behaviors

By Apsche, Jack A.; Bass, Christopher K. et al. | The Behavior Analyst Today, Fall 2004 | Go to article overview
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An Empirical Comparison of Cognitive Behavior Therapy (CBT) and Mode Deactivation Therapy (MDT) with Adolescent Males with Conduct Disorder And/or Personality Traits and Sexually Reactive Behaviors


Apsche, Jack A., Bass, Christopher K., Murphy, Christopher J., The Behavior Analyst Today


This research study was initiated to illustrate the efficacy of two different treatment approaches on aggression and sexually acting out or sexually reactive behaviors. It is also intended to compare said approaches to one another. The rationale of the comparison approach was to attempt to validate and further understand the differences in outcomes of the two different treatment applications. The treatment models compared were as follows: cognitive behavior therapy (CBT) and mode deactivation therapy (MDT).

Keywords: conduct disorders; MDT; personality traits

Cognitive Behavioral Therapy (CBT)

Thought Change as a CBT methodology was designed to treat a conglomerate of personality disorders. The treatment of the higher risk, aggressive sex offender focuses on specific deviant sexual arousal and antisocial sub-structure. For the same-sex offender of young children who continues to show deviant interest in young victims, Thought Change addresses the specific indices of this subgroup. Thought Change explores deficits in self-esteem, social competency, and frequent depression. Many of these youths display severe personality disorders with psychosexual disturbances and high levels of aggression and violence; therefore, Thought Change also focuses on the specific individual indices of these issues by identifying and modifying the complex system of beliefs.

The Thought Change curriculum consists of a structured treatment program, which addresses the dysfunctional beliefs that drive sex offending behaviors. Topics in the Thought Change curriculum include the following: Daily Record of Negative Thoughts, Cognitive Distortions, Changing Your Thoughts, Sexual Offense System, System of Aggression and Violence for Sex Offenders, Moods (how to change them), Beliefs (how it all fits together), Responsibility, Health Behavior Continuum, Beliefs and Substance Abuse, Beliefs and Empathy, The Beliefs of the Victim/Offender, The Victim/Victimizer, and the Mental Health Medication System. The sections of the Thought Change Workbook are designed to progress sequentially through therapy. It is a record of dysfunctional beliefs prior to, during, and following the sexual offense.

Mode Deactivation Therapy (MDT) as a Cognitive Behavioral Therapy (CBT)

The focus of MDT is based on the work of Aaron Beck, M.D., particularly his recent theoretical work, the system of modes (Beck, 1996, Alford & Beck, 1997). Other aspects of MDT have been included in the Behavior Analytic literature, such as Kohlenberg and Tsai (1993), Functional Analytic Psychotherapy (FAP), as well as, Dialectic Behavior Therapy (DBT) (Lineham, 1993). The specific application of MDT and applied methodological implications for MDT with specific typologies is delineated by Apsche, Ward, and Evile (2002). The article also provided a theoretical study case study that illustrates the MDT methodology.

Beck, Freeman and Associates (1990) suggested that cognitive, affective and motivational processes are determined by the idiosyncratic structures or schema that constitutes the basic elements of personality.

This is a more cognitive approach suggesting that the schema is the detriment to the mood, thought, and behavior. Beck (1996) suggested that the model of individual schemas (linear schematic processing) does not adequately address a number of psychological problems; therefore the model must be modified to address such problems. Working with adolescents who present with complex typologies of aberrant behaviors, it was necessary to address this typology of youngsters from a more "global" methodology, to address their impulse control and aggression.

Alford and Beck (1997) explain that the schema typical of personality disorder is theorized to operate on a more continuous basis; the personality disorders are more sensitive to a variety of stimuli than other clinical syndromes.

Further study of cognitive therapy emphasizes the characteristic patterns of a person's development, differentiation, and adaption to social and biological environments (Alford & Beck, 1997).

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An Empirical Comparison of Cognitive Behavior Therapy (CBT) and Mode Deactivation Therapy (MDT) with Adolescent Males with Conduct Disorder And/or Personality Traits and Sexually Reactive Behaviors
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