A Comparison of MDT and DBT: A Case Study and Analysis

By Apsche, Jack A.; Siv, Alexander M. et al. | The International Journal of Behavioral Consultation and Therapy, Fall 2005 | Go to article overview

A Comparison of MDT and DBT: A Case Study and Analysis


Apsche, Jack A., Siv, Alexander M., Matteson, Susan C., The International Journal of Behavioral Consultation and Therapy


Abstract

This case study examines a 13 year old adolescent male who engages in severe aggression, self-injurious and impulsive behaviors. He was treated with Dialectical Behavior Therapy (DBT) for thirteen months. DBT had limited success in reducing his problem behaviors. He was treated with Mode Deactivation Therapy (MDT) for four months and his problem behaviors were reduced significantly. It appears that in this case study MDT was more effective than DBT in reducing his severe behaviors. Keywords: MDT, DBT, physical aggression, self injurious behaviors, adolescents, personality disorders.

Introduction

In this case study a thirteen-year-old adolescent male was treated successfully after MDT was implemented. He had previously been treated for thirteen months, unsuccessfully, with DBT. The DBT therapist was trained in the ten day intensive training offered by the developer of DBT. The MDT therapist was trained by the first author of this case study in an intensive MDT training.

DBT was developed by Linehan (1993) to treat people with Borderline Personality Disorder. Since the inception of DBT, it has been shown to be an effective methodology in treating a variety of disorders. Trupin, Stewart, Beach, and Boesky (2003) demonstrated the effectiveness of DBT with female juvenile offenders. Lynch, Morse, Mendlesen, and Robbins, (2003) demonstrated the effectiveness of DBT with older populations. In these studies DBT has demonstrated its effectiveness with populations other than Borderline Personality Disorder cases.

MDT was shown to be more effective than Cognitive Behavior Therapy and Social Skills Training with aggressive adolescent males with conduct and personality disorders. MDT has been demonstrated to be effective in reducing aggression, personality disorders, beliefs and symptoms of Post Traumatic Stress Disorder (Apsche, Bass, Murphy 2004; Apsche & Ward 2004).

This appears to be the first case study that examines the effects of MDT with a youngster who was not successful with DBT.

Case Summary

This case study is a step-by-step case study, with a corresponding theoretical analysis based in mode deactivation therapy (MDT). The methodology known as MDT suggests potential for effective treatment of youngsters with similar backgrounds as William. William is a thirteen-year-old Caucasian American male. He has been diagnosed with Post Traumatic Stress Disorder, Impulse Control Disorder, Reactive Attachment Disorder, Obsessive Compulsive Disorder and Personality Disorder Traits.

William had demonstrated a pattern of continuous disruptive behaviors, lying, social phobias, hoarding, aggressive and threatening behaviors, property destruction, academic performance problems and school behavior problems, difficulties with peer relationships, enuresis with purposeful urination on furniture and clothing, and sexually inappropriate behaviors, including attempting to have sex with his sister, excessive masturbation with stolen undergarments from his mother and sister, masturbating with animals and in front of other children, early sexual experiences and touching other children.

Client Family History

William had struggled behaviorally since he was a young boy, and some reports indicate he was as young as a year and a half. William had minimal care as a youngster and grew up in an invalidating environment where he and his sister were responsible for their own care. William's mother was diagnosed with Hodgkin's disease during her pregnancy with William and reportedly refused treatment. William was born prematurely and then incubated for one month after his birth to aid in his respiratory development. William's mother died in 1998. William and his sister visited with a family for approximately one and a half years prior to their adoption in 2001. Although William had behavioral problems prior to adoption, when the adoption was finalized, his behaviors deteriorated rapidly.

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