Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study

Abstract

Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre–post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. Trial registration Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453

Mentalisierungsbasierte Therapie über Deliberate Practice lernen

“…B. [7]). Ferner fühlen sich Therapeut*innen nach dem Training oft unzureichend vorbereitet, ihr neues Wissen im Arbeitsumfeld anzuwenden [8].…”

Antisocial personality disorder and therapeutic pessimism – how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals?

“…In terms of future research, it would be useful to extend the current findings by examining what implications this could have for the prevention of ASPD and early intervention for individuals with conduct disorder. A recently published feasibility study in MBT for conduct disorder has demonstrated significant clinical changes for youth with conduct disorder, in MB-CD psychopathy and antisocial PD traits are both included ( Hauschild et al, 2023 ) which provides therapeutic optimism for this patient group. Different clinical pathways were recommended by De Visser et al (2023) with emphasis on trauma focused interventions within psychotherapeutic settings for those with attachment related disturbances and ASPD.…”

“…Currently, there is an ongoing multicenter RCT in London investigating MBT-ASPD’s effectiveness for male offenders compared to probation as usual ( Fonagy et al, 2020 ). MBT has also developed a program for youth with conduct disorder (MBT-CD), promising results have been published from the feasibility study ( Hauschild et al, 2023 ) and there is an ongoing RCT on MBT-CD in Germany ( Taubner et al, 2021 ).…”

“…And the newer developments on conduct disorder and MBT, for instance in a feasibility study on MBT for conduct disorder (MBT-CD), suggest that psychopathy can be understood in a continuum from conduct disorder. They do not differentiate between psychopathic and antisocial traits ( Hauschild et al, 2023 ). The disagreement on whether psychopathy and ASPD are dimensions of the same disorder or different conditions is of clinical interest.…”

Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder

“…Within MBT for adolescents with CD (MBT-CD), a particular focus is put on the development of an understanding of interpersonal situations and emotions, as well as understanding specific triggers and mentalization breakdowns associated with antisocial and aggressive behavior ( Taubner et al, 2021 ). MBT-CD aims to achieve a promotion of adolescents’ emotion regulation and increase their scope of action through enhancing effective mentalizing ( Hauschild et al, 2023 ). However, how effective mentalizing can be promoted during therapy sessions still remains an open question.…”