Joan Swart · Christopher K. Bass Jack A. Apsche Treating Adolescents with Family-Based Mindfulness Treating Adolescents with Family-Based Mindfulness Joan Swart (cid:129) Christopher K. Bass (cid:129) Jack A. Apsche Treating Adolescents with Family-Based Mindfulness Joan Swart Christopher K. Bass Apsche Center North Spring Behavioral Department of Psychology Healthcare Clark Atlanta University Leesburg, VA , USA Atlanta, GA , USA Jack A. Apsche School of Psychology Walden University Shepherdstown, WV , USA ISBN 978-3-319-12699-9 ISBN 978-3-319-12700-2 (eBook) DOI 10.1007/978-3-319-12700-2 Library of Congress Control Number: 2015932648 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper S pringer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Contents Part I Theoretical Development of FMDT 1 Family Mode Deactivation Therapy for Youth: An Introduction ....................................................................................... 3 Overview ................................................................................................... 3 Adolescent Problem Behaviors by the Numbers ...................................... 5 Family-Based Mindfulness Therapy for Adolescents ............................... 10 Cost-Benefi t Analysis ............................................................................... 15 Cost of Adolescent Behavior Problems ................................................ 15 MDT Effectiveness ............................................................................... 17 Cost-Benefi t of MDT ............................................................................ 18 FMDT in a Nutshell .................................................................................. 19 FMDT Philosophy and Theory ............................................................. 19 FMDT Concepts .................................................................................... 21 FMDT Methodology ............................................................................. 22 FMDT Distinctiveness .......................................................................... 24 Conclusions ............................................................................................... 27 Key Points ................................................................................................. 28 References ................................................................................................. 28 2 Third-Wave Therapies for Children and Adolescents: Origins and Development ....................................................................... 31 Overview ................................................................................................... 31 First Wave: Psychoanalytic Therapy ......................................................... 32 Second Wave: Behavior Therapy .............................................................. 34 Third Wave: Cognitive Behavioral Therapies ........................................... 35 Cognitive Behavioral Therapy .............................................................. 36 Acceptance and Commitment Therapy ................................................. 41 Dialectical Behavior Therapy ............................................................... 42 Schema Therapy .................................................................................... 45 Mode Deactivation Therapy .................................................................. 47 v vi Contents Beyond the Third Wave............................................................................. 48 Conclusions ............................................................................................... 49 Key Points ................................................................................................. 50 References ................................................................................................. 51 3 FMDT Key Concepts .............................................................................. 53 Overview ................................................................................................... 53 Mindfulness ............................................................................................... 53 Cognitive Defusion ................................................................................... 55 Cognitive Realignment ............................................................................. 57 Emotional Defusion .................................................................................. 59 Emotion Regulation .................................................................................. 62 Externalizing and Internalizing Behaviors ................................................ 64 Reactive and Proactive Aggression ........................................................... 65 Continuum Concept .................................................................................. 66 Conclusions ............................................................................................... 67 Key Points ................................................................................................. 68 References ................................................................................................. 68 4 MDT Theoretical Framework and Comparison .................................. 71 Overview ................................................................................................... 71 FMDT Treatment Paradigm ...................................................................... 71 Schemas and Modes .................................................................................. 73 Theoretical Construct of MDT .............................................................. 73 Beck’s Construct of Modes ................................................................... 73 Development of Cognitive Theory ........................................................ 74 Schemas in MDT .................................................................................. 76 Concept of Modes in MDT ................................................................... 77 Disputation Versus Acceptance of Cognitions in MDT ........................ 79 MDT Redirection of Beliefs ................................................................. 81 Theoretical Considerations in Family-Based MDT .............................. 82 Comparison of MDT and Other Cognitive Approaches ........................... 84 Therapeutic Approach of MDT ............................................................ 84 Differences and Similarities in Third-Wave Therapies ......................... 85 Can Third-Wave Therapies Integrate? ...................................................... 92 Conclusions ............................................................................................... 94 Key Points ................................................................................................. 94 References ................................................................................................. 95 5 The Empirical Status of Mode Deactivation Therapy ......................... 99 Overview ................................................................................................... 99 Method ...................................................................................................... 100 Data Selection ....................................................................................... 101 Treatment Protocol ................................................................................ 102 Participant Profi les ................................................................................ 103 Assessment Instruments ........................................................................ 104 Data Management ................................................................................. 106 Contents vii Results ....................................................................................................... 107 Forest Plots ............................................................................................ 108 MDT Versus TAU Comparison ............................................................. 110 Effect Sizes ........................................................................................... 112 Results at Follow-Up ............................................................................ 114 Family-Based MDT Studies ................................................................. 115 Independent MDT Studies .................................................................... 116 Comparison to Other Studies ................................................................ 117 Conclusions ............................................................................................... 119 Key Points ................................................................................................. 120 References ................................................................................................. 120 Part II FMDT, from Case Conceptualization to Treatment 6 MDT Assessment Processes.................................................................... 125 Overview ................................................................................................... 125 Client Typology Interview ........................................................................ 126 Fear Assessment ........................................................................................ 127 Fear Assessment Development ............................................................. 127 Fear Assessment Questionnaire ............................................................ 128 Fear Assessment Scoring and Interpretation ......................................... 129 Compound Core Beliefs Questionnaire .................................................... 129 CCBQ Development ............................................................................. 131 CCBQ Questionnaire ............................................................................ 133 CCBQ Scoring and Interpretation ......................................................... 141 Administration of MDT Assessments ....................................................... 142 Conclusions ............................................................................................... 143 Key Points ................................................................................................. 143 References ................................................................................................. 144 7 FMDT Acceptance and Mindfulness ..................................................... 145 Overview ................................................................................................... 145 Buddhist Philosophy Underlying Mindfulness ......................................... 146 Suffering in Buddhism .......................................................................... 148 Attachment in Buddhism ...................................................................... 150 Self in Buddhism................................................................................... 151 Thoughts and Feelings in Buddhism..................................................... 153 MDT Application of Buddhist Principles ................................................. 154 Suffering in MDT.................................................................................. 154 Attachment in MDT .............................................................................. 156 Self in MDT .......................................................................................... 157 Thoughts and Feelings in MDT ............................................................ 158 Mindfulness in the MDT Process ......................................................... 159 Mindfulness Exercises .............................................................................. 160 Brief Focused Breathing ....................................................................... 161 Conscious Breathing Exercise .............................................................. 162 viii Contents Balancing Thoughts and Feelings ......................................................... 164 Applying Mindfulness in an MDT Session .......................................... 166 Conclusions ............................................................................................... 170 Key Points ................................................................................................. 171 References ................................................................................................. 171 8 Case Conceptualization .......................................................................... 173 Overview ................................................................................................... 173 Mode Deactivation Case Conceptualization Steps ................................... 174 Triggers, Fears, Avoids, and Beliefs Correlation (TFAB) .................... 177 Conglomerate of Beliefs and Behavior ................................................. 179 Mode Deactivation ................................................................................ 181 Situational Analysis .............................................................................. 182 Functional Treatment Development Form ............................................ 183 Case Study ................................................................................................ 185 Case Summary ...................................................................................... 185 Step I: Childhood Data and Abuse History ........................................... 186 Step II: Behavioral Data ........................................................................ 187 Step III: Diagnosis ................................................................................ 188 Step IV: Triggers, Fears, Avoids, and Compound Core Beliefs Correlation (TFAB) .................................................................. 188 Step V: Conglomerate of Beliefs and Behaviors .................................. 189 Step VI: Situational Analysis ................................................................ 191 Step VII: Mode Activation/Deactivation .............................................. 191 Step VIII: Functional Treatment Development Form ........................... 194 Conclusions ............................................................................................... 194 Key Points ................................................................................................. 196 References ................................................................................................. 196 9 Validation, Clarification, and Redirection ............................................ 197 Overview ................................................................................................... 197 VCR Concept ............................................................................................ 197 VCR Practical Application ....................................................................... 199 Validation .............................................................................................. 200 Clarifi cation ........................................................................................... 203 Redirection ............................................................................................ 204 Clinical Effect of VCR .............................................................................. 207 Conclusions ............................................................................................... 209 Key Points ................................................................................................. 210 References ................................................................................................. 211 Part III FMDT in Special Populations, Discussion and Case Studies 10 Treating Mood Disorders: Anxiety, Depression, and Suicidality ......................................................................................... 215 Overview ................................................................................................... 215 Prevalence, Causes, and Expressions of Mood Disorders ........................ 215 Contents ix Cognitive Theory of Mood Disorders ....................................................... 217 MDT Treatment Considerations ............................................................... 224 Mode Deactivation Theory and Mood Disorders.................................. 224 Mode Deactivation Therapy Methodology and Mood Disorders ......... 226 MDT Research with Adolescent Mood Disorders ................................ 228 FMDT Case Study .................................................................................... 231 Case Summary ...................................................................................... 231 Client Family History ........................................................................... 232 Clinical Diagnosis ................................................................................. 232 Mode Deactivation Therapy Case Conceptualization ........................... 233 Charles’ Fear Assessment Results ........................................................ 233 Case Summary and Final Words ........................................................... 237 Conclusions ............................................................................................... 238 Key Points ................................................................................................. 239 References ................................................................................................. 239 11 Treating Externalizing Disorders: FMDT for Adolescents with Aggressive Behavior ....................................................................... 243 Overview ................................................................................................... 243 Prevalence and Consequences of Adolescent Aggression ........................ 243 Etiology and Types of Adolescent Aggressive Behavior .......................... 244 Reactive and Proactive Aggression ....................................................... 245 Trait and State Anger ............................................................................ 248 Internalized and Externalized Anger .................................................... 251 MDT Treatment Considerations ............................................................... 252 Mode Deactivation Theory and Aggressive Behavior .......................... 253 Mode Deactivation Therapy Methodology and Aggressive Behavior ...................................................................... 254 Determining the Family Fears and Beliefs ........................................... 254 MDT Skills Application in the Family with Aggression ...................... 256 Continuum Scales and Dealing with Lapses in Aggressive Behavior ......................................................................... 258 MDT Research with Adolescent Aggressive Behaviors ....................... 259 FMDT Case Study .................................................................................... 262 Case Summary ...................................................................................... 263 Client Summary and Brief History ....................................................... 264 Family History ...................................................................................... 265 MDT Assessments ................................................................................ 266 Diagnosis ............................................................................................... 267 Case Conceptualization ......................................................................... 268 MDT Treatment Recommendations ...................................................... 268 Conclusions ............................................................................................... 269 Key Points ................................................................................................. 270 References ................................................................................................. 270