Mentalization-Based Treatment for Adolescents with Conduct Disorder (MBT-CD): Protocol of a Feasibility and Pilot Study

Abstract

Background: Conduct disorder (CD) is a complex mental disorder characterized by severe rule breaking and aggressive behaviour. While studies have shown that several therapeutic interventions are effective in treating CD symptoms, researchers call for treatments based on etiological knowledge and potential patho-mechanisms. Mentalization-based treatment (MBT) may represent such a treatment approach: Studies have shown that individuals with CD show mentalizing deficits and that mentalizing might represent a protective factor against the development of the disorder. As MBT focuses on the understanding of social behaviour in terms of mental states, fostering mentalizing might help CD individuals to (re)gain an adaptive way of coping with negative emotions especially in social interactions and thus reduce aggressive behaviour. For this purpose, MBT was adapted for adolescents with CD (MBT-CD). This is a protocol of a feasibility and pilot study primarily investigating the acceptability of the intervention and the scientific assessments by CD individuals and their families based on quantitative and qualitative data as well as necessary organizational resources. Secondary aim is to investigate the course of symptom severity and mentalizing skills.Methods: The bi-centre study is carried out in two outpatient settings associated with University Hospitals (Heidelberg and Mainz) in Germany. Adolescents aged between 11 and 18 years with a CD or oppositional defiant disorder (ODD) diagnosis are included. Participants receive MBT-CD for 6 to 12 months. Primary outcome of the feasibility study (e.g. recruitment and adherence rates) will be descriptively analysed. Multilevel modelling will be used to investigate secondary outcome data.Discussion: Fostering the capacity to mentalize social interactions triggering non-mentalized, aggressive behaviour might help CD individuals to behave more adaptively. The feasibility trial is essential for gathering information on how to properly conduct MBT-CD including appropriate scientific assessments in this patient group, in order to subsequently investigate the effectiveness of MBT-CD in an RCT.

Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing

“…However, the positive processes of getting to know the patients better, being surprised by patients’ level of motivation and tolerance for differing perspectives and gaining more competence as clear and concise therapists leads us to carefully conclude, that even though there is uncertainty, there is also hope. We look forward to the first results from the RCT in London (Fonagy et al ., 2020 ), and the RCT on adolescents with conduct disorder in Germany (Taubner et al ., 2021 ). Hopefully, treatment pessimism on ASPD will look different during the coming decade.…”

“…However, the newer perspectives on ASPD as a developmental disorder related to attachment disturbances, bring hope for early intervention in families at risk and children with conduct disorder, as well as informing treatment for adults with the diagnosis (Yakeley & Williams, 2014 ). In Germany an RCT on MBT with adolescents with conduct disorder is under way and could provide positive results on early intervention for this patient group (Taubner et al ., 2021 ). The most effective treatments for ASPD are characterized by a focus on linking affect to actions, a focus on countertransference, take place in a physically secure setting, include individual therapy, and enforce strict rules and boundaries (Yakeley & Williams, 2014 ).…”

Introduction to Mentalization-Based Approaches for Parents, Children, Youths, and Families

“…Low retention rates were predicted by low mentalizing, meaning that especially for adolescents with very low reflective abilities, group therapy does not appear to be the setting of choice (33). This has now been acknowledged in the development of a new MBT treatment protocol for adolescents with conduct disorder (34,35). This treatment protocol comprises a very short psychoeducation followed by a combination of individual and family therapy using the core MBT model.…”