A literature review and analysis of mode deactivation therapy

Jack A. Apsche
2010 International Journal of Behavioral Consultation and Therapy  
This article is a review of articles, chapters and current research examining Mode Deactivation Therapy. Current applications of MDT suggest that mindfulness is a core component of MDT, as well as acceptance, defusion and validation, clarification and redirection of the functional alternative beliefs. These components are the core of MDT and a recent study has evaluated each of them as to how it affects the target or outcome goals. The evolution of MDT is reviewed from case studies to a
more » ... n and meta-analysis. The purpose of this article is to review the foundation of MDT and current articles that elucidate the efficaciousness of MDT as an evidenced -based methodology. IJBCT Volume 6, No. 4 297 Acceptance and Commitment Therapy and MDT both also address the individual's experiential avoidance of difficult or painful thoughts and emotions, by implementing both cognitive and emotional defusion. Cognitive and emotional defusion are the processes that humans learn to avoid painful stimuli, either in thought or emotion. In short, if something elicits pain, often we tend to avoid it, in thought or feeling. Hayes (2004) suggests that we often pair feelings with conditions, such as, "I was happy once, prior to my abuse", " I cannot enjoy the sunset anymore, Since I was abused." Hayes suggests that the coercive stimuli (psychological pain) of the past cannot be reduced through simple situational solutions. We avoid that which is painful. Acceptance and Commitment Therapy (ACT) (Hayes, 2004) and MDT also are both deeply rooted in mindfulness. However, MDT's mindfulness practices are significantly from ACT, as they are designed specifically for adolescents and include mindfulness, meditation and imagery . MDT also uses an assessment and Case Conceptualization method that combines elements from Beck's (1996) case conceptualization and the Problem Solving Cognitive Behavioral Therapy model of Nezu, Nezu, Friedman and Haynes (1998) . Third, MDT and FAP engage in in-session reinforcement immediately following the client response and continue to reinforce in-session and out of session responses. MDT also has similarities to ACT, (Hayes, Strosahl, Wilson, 1999) . Both ACT and MDT implement the concept of acceptance of one's self as you are in the moment, then moving forward with all of the thoughts, feelings, and issues, instead of trying to change their distorted thinking. The assessment and case conceptualization procedure concentrates on core beliefs, fears and avoidance behaviors that are reflective of the Post-Traumatic Stress Disorder and developing personality disorders (Apsche and Ward Bailey, 2003 , 2004b , 2004c . Therefore, MDT should also be classified as a trauma informed methodology. MDT and Trauma MDT treats trauma by addressing the underlying fear, avoids paradigm individuals avoid what they fear (Apsche, & DiMeo, 2010) as follows: x Mindfulness: This component of MDT reduces the strength of the behavioral manifestations of fear and anxiety. Apsche (2010) in a mediation analysis/meta-analysis article demonstrates this as youth in this study had significant reduction in fear as evidenced by the Strength of Fears Assessment. x Acceptance/Defusion: These components of MDT reduce the youth's avoidance scores and the Anxiety Control Questionnaire (ACQ). Acceptance and defusion in MDT are implemented together and allow the youth to experience and accept his/her pain as part of the human condition and by doing so he/she cognitively and emotionally defuses the strength of the avoidance. x Validate-Clarify-Redirect the Functional Alternative Beliefs: This component of MDT allows the youth to address personality beliefs. These beliefs are measured by the Compound Core Beliefs Questionnaire (CCBQ). The personality beliefs are part of the individual's response to trauma. These components of MDT have been shown to reduce the specific mediators of fears, avoidances and personality beliefs in youth exhibiting behaviors including: verbal and physical aggression, sexual reaction, and self-harm. Theoretical Constructs The theoretical constructs of MDT are based on Beck's Mode Model (1996), which suggests that people learn from unconscious experiential components and cognitive structural processing components (Apsche, Ward, & Evile, 2003). Therefore, to change the behavior of individuals there must be a restructuring of the experiential components and a corresponding cognitive reformation of the structural components. Mode Deactivation Therapy is an empirically based methodology that systematically assesses and restructures compound core beliefs (Apsche & Ward, 2003). Beck suggests that his model of individual schemas (linear schematic processing) does not adequately IJBCT Volume 6, No. 4 298 address a number of psychological problems; as a result, he proposes a system of modes. He describes modes as a network of cognitive, affective, motivational, and behavioral components; indicating that modes consist of integrated sectors of sub-organizations of personality that are designed to deal with specific demands to problems. These suborganizations help individuals solve problems such as the adaptation of adolescents with a history of abuse to strategies of protection and mistrust. Beck (1996) also states that these modes are charged, thereby explaining the fluctuations in the intensity gradients of cognitive structures. The modes are charged by fears and dangers that set off a system of modes to avoid the fear. Modes are then activated by charging related to the perceived danger in the "fear ļ avoids" paradigm setting off a chain of reactions in the individual: a) the orienting schema signals danger, and activates or charges all systems of the mode; b) the affective system signals the onset and increasing levels of anxiety; c) the beliefs are activated simultaneously reacting to the danger, fear ļ avoids, and physiological system; and, d) the motivational system signals the impulse to the attack and avoids (flight or fight) system. Understanding modes is important in treating the population served by MDT, especially juvenile sex offenders, since these youth are particularly sensitive to danger and fear, which charge their modes; this includes an awareness of conscious and unconscious fears being charged, and the activation of the mode system. It explains the level of emotional dysregulation and impulse control issues indicated in the typology of these young clients (Apsche & Ward, 2003). Core Components In MDT the core beliefs (or schemas) of the individual are not perceived or challenged as dysfunctional because this action invalidates the person's life experience. The client's Functional Alternative Beliefs (FAB) is accepted as truths in the client's life by the therapist and the client. Functional Alternative Beliefs are consistently validated as legitimate and are seen as developing as a result of the person's life experiences -no matter how irrational, and even if the reality of the belief is imperceptible to observers. It is presumed that the client's belief system is not distorted, and although perhaps unbalanced, it is derived from a "grain of truth" in his perception. These beliefs are consequently "balanced" through a collaborative therapeutic process with the goal of deactivating the maladaptive mode responses or life interrupting behavior(s). An integral part of MDT is the concept of Validate, Clarify, and Redirect (VCR). Validation was defined by Linehan (1993) as the therapist's ability to uncover the validity within the client's belief. MDT uses the balance the FAB technique to remediate the youth's emotional dysregulation. VCR employs unconditional acceptance and validation of the youth's cognitive unconscious or out-of-awareness learning experience. Given the youth's background and history, MDT espouses that the youth is exactly where and how he should be as a person with his experiences. The clarification offers an alternative explanation of the youth's circumstances and history, and the redirection measures the "possible acceptance" of a slightly different belief. MDT incorporates DBT concepts in its use of balancing the dichotomous or dialectical thinking of the client. These modalities teach a client who often engages in dichotomous "all or nothing" thinking that his perception can fall within the range of a continuum, rather than only a 1 or a 10 (all or nothing). The resulting validation and learning process are the basis for positive redirection toward a new awareness for the client (Apsche & DiMeo, 2010). By readdressing client-endorsed beliefs, MDT explores underlying perceptions that may set in motion the mode related charge of problem schemas, thus enabling further behavior integration of DBT principles in treating sex offending or aggressive behaviors (Linehan, 1993) . Many of Linehan's teachings describe radical acceptance and examining the "truth" in each client's perceptions. As previously mentioned, this methodology of finding the "grain of truth" in the perception of the adolescent is crucial to the effectiveness of MDT. Its effectiveness can be measured as an empirically-based and driven treatment, and it is designed to assess and treat a conglomerate of personality traits and beliefs, as well as to remediate aggression and sexual offending. The redirection component of VCR assists the client to consider responses to other views, or alternative possibilities on his continuum of truths. There are
doi:10.1037/h0100914 fatcat:ui6rxumywzby7lgyurt742mfa4