Mode Deactiviation Therapy Introduction

“On the shoulders of giants…”

The idea of Mode Deactivation Therapy (MDT) was derived from Beck (1996) and Alford & Beck (1997) and their decision to expand the tenets of cognitive behavioral therapy into more global constructs they called ‘modes’.

The process of moving MDT from theory to practice included an adaptation of Linehan's (1993) Dialectical Behavioral Therapy (DBT). MDT approaches the child's beliefs and behaviors through techniques similar to Linehan's notion of finding the grain of truth and validating them rather than challenging the cognitive distortions. The other major similarity between DBT and MDT is the use of balancing the dichotomous or dialectical thinking of the client.

Functional Analytic Psychotherapy (FAP) (Kohlenberg & Tsai, 1993) theory states that people act based on reinforcement contingencies. Although FAP takes into consideration that cognitions are involved, the focus is on the deeper unconscious motivations that were formed as a result of past contingencies. Perception is based on past contingencies, therefore reality and the concept of reality reflect what has been experienced in the past. Considering reinforcement history in the context of a person provides the MDT-informed clinician with a more complete assessment of the specific behaviors of that person.

“But designed specifically for the complex children we treat…”

Cognitive Behavioral Therapy (CBT) often fails with these youngsters as it is viewed by “arguing”. They do not respond to being in a perceived one-down position, no matter how aligned they are with their therapist. They perceive the therapist as another person attempting to change them from a system of defenses that has been developed to protect them.

Dialetical Behavioral Therapy is often too unstructured to be developmentally appropriate for younger adolescents, or children and adolescents who have cognitive or neurological impairments. When emotionally activated, the adolescents have difficulty “un-charging” their emotions enough to self-soothe or use distraction.

Acceptance and Commitment Therapy (ACT) is an empirically based intervention that uses acceptance and mindfulness along with commitment and behavior change strategies to help clients learn how to make healthy contacts with thoughts, feelings, memories and physical sensations that caused them fear or discomfort. ACT is based on Relational Frame Theory, which was developed by Steven Hayes and colleagues. ACT techniques such as, acceptance, mindfulness and defusion are cornerstones of current MDT practice.

Clearly an adaptation is necessary. The children we treat have long histories of sexual, physical, and/or emotional abuse. Often they respond in ways that are interpreted as characteristic of personality and/or conduct disorders. These are youngsters that may respond by committing sexual offenses, aggressive acts, and/or other aberrant behaviors. MDT is a methodology that addresses dysfunctional schemas through systematically assessing and restructuring underlying compound core beliefs - beliefs that often found their genesis in trauma experiences.

“More about ‘modes’…”

The theoretical underpinnings of MDT are based on the concept ‘modes’ which specifically suggest people learn from unconscious experiential and cognitive structural processing components. To change behavior of individuals there must be a restructuring of the experiential components and a corresponding cognitive restructuring of the structural components. The dysfunctional experiential and structural learning (conscious and unconscious) develop dysfunctional schemas that generate high levels of anxiety, fear, general irrational thoughts and feelings, as well as aberrant behaviors. This system is self-reinforcing and protected by the development of a conglomerate multiple clustered compound core beliefs - often interpreted as burgeoning personality disorders.

Mode Deactivation Therapy includes centering, imagery and relaxation techniques (mindfulness) to facilitate cognition. This is followed by balance training, which teaches the youngster to balance his perception and interpretation of information and internal stimuli. MDT is built on the mastery system for youngsters. They move through a workbook at the rate of learning that accommodates their individual learning style. The system is designed to allow the youngster to experience success prior to undertaking more difficult materials.