Mode deactivation therapy meta-analysis: Reanalysis and interpretation.

IN THE LATE 1990S THERE was a realization that existing cognitive behavioral therapies appeared to be ineffective for an adolescent population with behavioral and multiple comorbid problems. In particular, the common practice of disputing dysfunctional beliefs was considered to be counterproductive in the treatment of adolescents with deep-seated issues as it tends to cause increased resistance, attrition, and relapse. In reality, there seemed to be no treatment program that were particularly effective in treating this population successfully. The problem, and associated cost, of youth behavioral problems has taken on staggering proportions, which desperately needs redress. Boyle et al. (2011) estimated that over 15% of American youth have a clinical level behavioral problem, which is associated with experiences of violence in the home. Sousa, Herrenkohl, Moylan, Tajima, Klika, Herrenkohl, and Russo (2011) estimated that 3 million U.S. children are exposed to domestic violence annually. The yearly costs to society of adolescent behavior problems was calculated as us$ 435 billion in 1998 (Miller, 2004). In current money value this comes to us$ 625 billion, or 2.6 times the projected total U.S. national expenditure on mental health and substance abuse. Here, Miller did not include the costs that would continue beyond 1998 due to that problem behavior, which is multitudes higher in the overall picture as these problems often extend into adulthood. Franklin D. Roosevelt said in 1940: "We cannot always build a future for our youth, but we can build our youth for the future" This is exactly what MDT set out to achieve. * The status of MDT as a treatment for adolescents with behavioral problems Adverse experiences in childhood commonly result in poor regulation of affect and impulses, somatization, low self-esteem, dysfunctional attachments, guilt, shame, and maladaptive worldviews. This distress is externalized as aggression, violence, or criminal behavior, or internalized, causing depression, anxiety, substance abuse, and social withdrawal. Rather than focusing on problems and dysfunction of the adolescent in a pathological model, the mode deactivation theoretical framework was developed to accept dysfunctional thoughts and feelings as reasonable in the personal context, and realign and deactivate their modes by exploring the roots of the problems, but also being aware of their current manifestation in the present moment without self-judgment or avoidance. Mode Deactivation Therapy (MDT) was developed from these concepts, specifically for the treatment of multi-problem adolescents, and has proved effective in many studies since its conceptualization. In 2010, Apsche, Bass, and DiMeo compiled a comprehensive meta-analysis of MDT research studies that were available at the time. They concluded the following: "This finding supports the notion that Mode Deactivation Therapy as a superior form of cognitive behavioral therapy addresses not just the acting out behavior, but internal states as well. MDT had a large effect size in all areas of the CBCL and STAXI. As symptoms of externalizing disorders are addressed, internalizing disorders can be addressed. The results of this data--from the [pre- and post-treatment CBCL and STAXI] assessments--confirm the hypothesis that MDT reduces internalizing disorders. It further supports the idea that these internalizing disorders are the behavioral function of the reduced externalizing disorders. Thus, as symptoms of externalizing disorders decrease, internalizing disorders may appear as co-morbid behavioral issues" (p. 180). It is the objective of this analysis to review and update the original selection of research studies in order to eliminate duplicate and redundant data, as well as adding recent studies to the synthesis. The different approach in the selection and combination of the data sets is intended to improve, clarify, and add to previous conclusions by analyzing the (1) consistency between the individual result sets, statistical significance of change effects--both in the (2) effectiveness of MDT in achieving behavioral outcome goals, and (3) performance in comparison with CBT-based treatment protocols--as well as the (4) statistical strength of the change in an outcome after MDT experimental intervention. …