The recent rapid proliferation of "new wave" treatments, also loosely referred to as the third wave cognitive-behavioral therapies, has renewed interest in their comparative performance, scientific validity, and theoretical and methodological integrity. However, critics are also expressing concerns that these therapies are not well enough supported and "getting ahead of the data". This article engages the literature on a small selection of modern therapy approaches, namely Mode Deactivation Therapy (MDT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT), and more specifically compared to Cognitive Behavioral Therapy (CBT). On the one hand, it challenges the assumption that third wave therapies in general, but more specifically in reference to MDT, ACT, and DBT, have little new to offer by way of superior performance, often in reference to populations that are usually deemed as difficult-to-treat in traditional approaches such as CBT. While, on the other hand, it investigates claims that third wave treatments are more part of a CBT family of approaches rather than distinct treatments. It draws from the conceptualizations, practices, and experiences of the respective developers themselves to argue for the distinct value and prospects that these third wave therapies offer in terms of scientifically established treatment outcomes. For example, it is difficult and unwise to dismiss the superior results that MDT has established in treating severe multi-problem adolescents, a population that has inarguably an extremely high human and economic impact in the long run. By an improved understanding and differentiation of the third wave therapies, their proliferation can be accelerated without compromise to harness their potential more effectively and focused.

To date, there are no empirically validated treatments of good quality for adolescents showing suicidal ideation and behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study: that Mode Deactivation Therapy (MDT) is an effective treatment for these patients. MDT has been developed by Jack Apsche especially for the individual or family-based residential or outpatient treatment of adolescents with problem behaviors and complex comorbid conditions. The efficacy of MDT was measured by a pre-and post-treatment comparison with the aid of standardized instruments (CBCL, STAXI-2, BDI-II, and SIQ) and compared to the results of a treatment-as-usual (TAU) control group. The comparative results confirmed that MDT is a consistent effective treatment for suicidal adolescents that appear to outperform other therapy approaches.

Mode Deactivation Therapy (MDT) was developed based on the cognitive theory of Prof. Aaron Beck, and incorporated elements from Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and mindfulness with the novel change effect process-Validation, Clarification, and Redirection (VCR)-that is the crux of the mode deactivation concept. MDT has the objective to overcome shortcomings of other cognitive-behavioral therapies in the treatment of adolescents with trauma-based multiple Axis-I conditions and Axis-II personality constellations that have proved difficult to treat. As the most recent of more than 20 MDT research studies to be reported, this study confirms the effectiveness of MDT in treating this population. A sample of 143 participants were treated at an inpatient facility and randomly assigned to an experimental MDT group or a standard Cognitive-Behavioral Therapy (CBT) (Treatment as Usual, TAU) group. Across the assessment measures applied, MDT achieved a higher than 40% average improvement from baseline at treatment completion. An average improvement of 5% was reported for the TAU group. Results are consistent with previous studies and provide evidence of the validity and utility of MDT to treat adolescents with behavior problems cost-effectively.

Youth behavioral disorders are not only considered widespread and costly in terms of financial, human, and societal impact into adulthood, but also resistant to interventions, especially when related to childhood trauma and accompanied by continued social distress and comorbid conditions such as personality, mood, and substance use disorders. Mode Deactivation Therapy (MDT), a third wave contextual therapy approach derived from cognitive therapy principles, was developed in recognition of the need for this population. The MDT theoretical framework and methodology contains elements of mindfulness, Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT), but it is the unique Validation-Clarification-Redirection process (VCR) step that sets it apart from other contextual approaches. VCR is considered to be the core process component in MDT to affect therapeutic change by validating core beliefs as reasonable responses to past experiences, but exploring functional alternative beliefs. The main objectives of this study is to review evidence of the effectiveness of family-based MDT (FMDT) compared to standard treatment, and provide a preliminary randomized controlled group study of the mediation effects that VCR and other components have on the overall treatment mechanisms and outcomes. Recommendations for further study conclude the current scope.

Mode Deactivation Therapy (MDT) was conceptualized in recognition that the available therapy approaches were not effective in treating adolescents with behavioral problems and comorbid conditions. By combining unique assessment and process components with the acceptance and mindfulness elements of Acceptance and Commitment Therapy and Dialectical Behavior therapy as well as family systems theory, the MDT methodology was formulated. This study is the most recent in a series that establishes an evidence base of the effectiveness of MDT as a treatment protocol for adolescents with conduct issues. Eighty-four (84) male adolescents between 14- and 17-years-old were randomly assigned either a Cognitive Behavioral Therapy control group or a Mode Deactivation Therapy experimental group and received structured treatment for six to eight months. Pre- and post-treatment STAXI-2, CBCL, and other test results reconfirmed the effectiveness of MDT as a superior treatment for this population. Target behavioral outcome effects improved consistently by an average of 36%, while the control group only achieved improvements of around 5% in treatment. These results reconfirm and expand the existing evidence base of the superior effectiveness MDT for an adolescent population with multi-problem psychopathology, especially reactive aggression and internalized affective difficulties.