Mindfulness, mode deactivation, and family therapy: A winning combination for treating adolescents with complex trauma and behavioral problems

MODE DEACTIVATION THERAPY (MDT) was developed in the 1990s after recognizing the lack of suitable treatment approaches for adolescents with behavioral problems and multiple co-existing conditions, which was often related to childhood trauma. The theoretical basis of MDT was framed on Beck's cognitive theory, Ellis' rational emotive behavior theory, and Piaget's cognitive development theory and concept of schemata. This research study is the most recent in a series that has been reported on since 2002 and were recently synthesized as a meta-analysis (Apsche, Bass, & DiMeo, 2011; Bass & Apsche, 2014; Swart & Apsche, in press). Considered separately and together, these studies consistently provide support of the effectiveness of Mode Deactivation Therapy with the specific target population of male adolescents with behavioral problems. On all accounts, effect sizes were high for target behavioral outcome effects, with statistically significant improvements that outperformed treatment-as-usual control groups by a large margin. This study aims to provide additional support of the efficacy of MDT, thereby reconfirming its value in the treatment for a population that is widely considered as difficult-to-treat. The philosophy of mode deactivation therapy By taking a step back again to the roots of cognitive theory, while blending in psychoanalytic considerations and elements--specifically acceptance and mindfulness--of other third wave approaches such as Dialectical Behavior Therapy and Acceptance and Commitment Therapy, MDT was developed to overcome inefficiencies that were typically encountered with standard Cognitive Behavioral Therapy (CBT), such as resistance to treatment, ill suitability for adolescents with serious comorbid problems, and short-lived improvements (Apsche & DiMeo, 2012). MDT hypothesized that adolescent externalized problem behavior is the function of internalizing disorders (Bass & Apsche, 2014); acknowledging that each emotional disorder that underlie dysfunctional behavior can be characterized by cognitive content that is specific to its outward expression (Hofmann, Sawyer, & Fang, 2010). The philosophy of modes and schemata are at the crux of the MDT conceptualization. Schemata represent all levels of our experience, at all levels of abstraction. Mode states are mind states that cluster schemas and coping styles into a temporary "way of being" (Young, 2003, p. 37). In fact, already around 1600, Shakespeare proclaimed in Hamlet: "There's nothing good or bad but thinking makes it so." The way that thoughts and feelings relate to our core beliefs--our inherent view of ourselves, others, and the world that has helped us cope since childhood--and how they "bubble up" as behavior, is the essence of understanding and treating behavioral problems. Core beliefs are strongly-held, rigid, and inflexible ideas that developed from childhood and tend to focus on situations and experiences that support and reinforce it. By examining these dysfunctional beliefs that are often outdated in current circumstances, and their relation to unhelpful thoughts and feelings, the MDT methodology directly targets the underlying causes in an accepting and nonjudgmental way. The new insight and awareness is harnessed to strengthen the therapeutic bond and the unique formulation of elements is posited to be the basic seed of the success that MDT has demonstrated with the adolescent population. The original conceptualization of MDT already embodied the philosophy of mindfulness, i.e. present-focused attention and importance of attaching to thoughts and feelings. Also, adolescents are invariably part of a family system, which is often where the origins of distress and dysfunction can be found. Therefore, the principles of mindfulness and family systems theory were also eventually--from 2006 onwards--incorporated into the MDT methodology. According to Bowenian family systems theory: When anxiety is low, we are able to think about our situations and our very existence. …