Academic journal article The International Journal of Behavioral Consultation and Therapy

A Review and Empirical Comparison of Two Treatments for Adolescent Males with Conduct and Personality Disorder: Mode Deactivation Therapy and Cognitive Behavior Therapy

Academic journal article The International Journal of Behavioral Consultation and Therapy

A Review and Empirical Comparison of Two Treatments for Adolescent Males with Conduct and Personality Disorder: Mode Deactivation Therapy and Cognitive Behavior Therapy

Article excerpt

This research study compared the efficacy of two 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 Cognitive Behavioral 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. The results also showed that MDT was superior to CBT in reducing external and internal psychological distress as measured by DSMD and CBCL.

Keywords: CBT, MDT, Conduct Disorder, Aggression

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Adolescents with conduct disorders and personality traits have proven to be extremely difficult to conceptualize and treat effectively. Many of these youth typically come from deprived environments with multiple stressors and often extensive histories of physical, emotional and sexual victimization and neglect. As a group, conduct disordered youth present with an 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 aggressive" youth show extremely strong emotional responses to perceived threats and then react aggressively. The second type, "proactive aggressive" 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., emotional 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. …

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