Family mode deactivation therapy (FMDT): A randomized controlled trial for adolescents with complex issues.

Abstract

There is an unquestionable need for psychotherapy interventions to effectively treat adolescents with aberrant behaviors, complex comorbid problems, and a history of abuse-a population that is widely considered as difficult-to-treat, but warranting attention due to their cost to society. In response, Family Mode Deactivation Therapy (FMDT) was developed with its roots in cognitive and behavior theories. By recognizing the need to explore and validate core beliefs in the family unit that underlie individual and collective dysfunctional cognitions, a unique Validation-Clarification-Redirection (VCR) process was combined with selected elements from Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and mindfulness. In this study 122 adolescents and their families were randomly divided into two groups, a control group treated with classical Cognitive Behavioral Therapy (CBT) techniques, and the experimental group treated with FMDT methodology. Child Behavior Checklist (CBCL) and State-Trait Anger Expression Inventory-2 (STAXI-2) tests were scored pre-and post-treatment. The average CBCL and STAXI-2 scores indicated a consistently significant improvement with FMDT treatment, which outperformed that of the control group noticeably. Incidents of physical aggression were also tracked pre-, post-treatment, and at 16-month follow-up. Again, FMDT outperformed the Treatment as Usual (TAU) control group, especially at follow-up, which suggests a much better durability of treatment effects in the time period. The positive results with this population in their family group warrant further research of FMDT.

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

“…The multiaxial system was removed in the DSM-5, and coding is now done on a single axis. Although the presence of personality disorders was not specifically noted during this study, similar previous MDT studies have shown a high prevalence, including multiple personality disorder diagnoses (Swart & Apsche, 2014a;Swart & Apsche, 2014b;Swart & Apsche, 2014c). These constellations of maladaptive personality traits that co-exist with mood, trauma, conduct, and substance use disorders are typical among problem youth.…”

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

“…Three records 580,591,611 were excluded because the focused was on parenting stress and parenting outcomes, rather than child-focused outcomes. Seven records 579,582,589,593,597,606,607 were excluded because participants were not recruited or selected on the basis of their maltreatment; instead they were recruited on the basis of problems including depression, PTSD, substance abuse and delinquency. Three records 585,587,603 were excluded because they focused on general services, such as general foster care and child protection service, and did not focus on a therapeutic intervention for maltreatment.…”

A multilevel meta-analysis on the effect of mindfulness-based interventions in reducing externalizing problem behavior in adolescents.

“…In seven of the 14 studies, parental involvement was detailed, but only three of these studies reported about the intensity of the involvement (how often parents were seen). Parental involvement was quite low in two and high in one of these studies (Swart & Apsche, 2014a, 2014b, 2014c). In the latter, the adolescent, parent(s), and other family members were offered weekly individual and group therapy (including mindfulness) for 8-12 months, depending on the level of cooperation of the family members.…”

“…After all, it is known that many adolescents who end up in forensic care have a troubled history (Dierkhising et al, 2013; Van Grinsven & Holdorp, 2015). In two of the seven included studies that involved parent(s) or guardian(s) in treatment, the adolescents reported to have experienced at least one form of child abuse during their childhood (Swart & Apsche, 2014b, 2014c). It can be assumed that this finding can be applied to a great number of studies.…”