Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection process step with elements from acceptance and commitment therapy, dialectical behavior therapy, and mindfulness to bring about durable behavior change.
Theory Mode deactivation therapy (MDT) was developed by Jack A. Apsche who recognized shortcomings of cognitive theory and cognitive-behavioral therapies, especially for the treatment of populations with complex psychological problems. Cognitive behavioral therapy (CBT) was primarily conceptualized through an integration of behavior therapy with cognitive psychology that were formulated by Aaron T. Beck. As such, the CBT approaches focus primarily on the present rather than the past, behavioral change as the main goal, and current processes that are maintaining the problem rather than the root causes. Traditionally CBT views problem manifestation as brought about by dysfunctional thinking, which is disputed as irrational beliefs and replaced with the use of logical arguments. Eventually some practitioners realized that in some cases dysfunctional cognitions should not be disputed. As a result, a new wave of cognitive-behavioral therapies began to form, which was termed the "third wave" by Steven C. Hayes, who went on to develop Relational frame theory and Acceptance and commitment therapy. (Behaviour therapy was the first wave and Cognitive therapy was the second.) Jack A. Apsche agreed in general with this principle, but also believed that there is value in exploring the origins of maladaptive thought processes in addition to validating their existence as reasonable given an individual's past experiences upon which his or her core beliefs are based. Aaron T. Beck asserted that how people feel and behave are largely determined by their thought processes or cognitions, which may make us vulnerable to psychological distress. These vulnerabilities are related to personality structures—a person's fundamental beliefs about themselves and the world around them. Personality structures largely develop as a result of responding to environmental stimuli and experiences. When these are distressing and deprive a person of psychological needs, the coping mechanism may be viewed as maladaptive compared with normal circumstances. The personality structures are referred to as cognitive schemas, which—in combinations—inform a person how to behave in a certain situation. Cognitive schemas are often automatically activated and group together to form cognitive modes that are deep-seated and durable behavioral manifestations such as depression and aggression. In MDT these modes and their associated core beliefs are validated and normalized in the client's perspective by cultivating awareness and acceptance rather than disputing any belief as irrational or "bad". The proposition is that awareness and acceptance improves the therapist-client bond, client cooperation, commitment and motivation, which enables an effective and durable therapeutic change process.
Practice The application of MDT integrates the unique validation–clarification–redirection process step with selected elements from Acceptance and commitment therapy, Dialectical behavior therapy, and mindfulness (psychology) through a systematic and collaborative case conceptualization and implementation process.
Assessment The case conceptualization forms the blueprint of the MDT planning and implementation process, and is based on a systematic assessment procedure that is aimed at identifying, clarifying, and formulating the core beliefs → fears → thoughts and feelings → behavior sequence. First, a semi-structured clinical interview is conducted to form the foundation of further psychometric testing. The client typology survey is completed by the therapist with inputs from the client, parent/guardian, family members, and other records, including arrest and medical where relevant. It includes family information, substance abuse, medical, neglect, physical and sexual abuse and offending history, educational, emotional, behavioral, physiological, and interpersonal information. The expectations of treatment and willingness to cooperate are also noted. Second, the Strength of Fears Questionnaire is completed and scored. The 60-item 4-point Likert scale responses is scored to examine five sub-categories of fear, namely personal reactive-external, personal reactive-internal/self-concept, environmental, physical, and abuse. The test is sensitive to the detection of trauma and identifies and rates specific fear and associated situations. Life-interfering fears are also identified. Then, the client completes the Compound Core Beliefs Questionnaire (CCBQ), a 96-item 4-point Likert scale form (short version). The score primarily informs the therapist of the client's personality traits and structure, as well as potential life-threatening and treatment-interfering beliefs. Hereby, the CCBQ helps identify the client's underlying beliefs and thoughts that guide his or her behavior. Each belief is clarified and completed with examples.
Case conceptualization The results and analyses of the client typology, Fear Assessment and Compound Core Beliefs Questionnaire are used to compile the Triggers, Fears, Avoids, and Compound Core Beliefs Correlation (TFAB) and the Conglomerate of Beliefs and Behaviors (COBB) worksheets. A situational analysis associate the problem beliefs, fears, and behaviors with triggers to identify the mode activation processes that have to be deactivated. The collaborative case conceptualization process is completed with the Functional Treatment Development Form, which informs and monitors the treatment planning and progress. The TFAB form is used to link specific triggers with fears and core beliefs, while the COBB takes the process one step further by associating each core belief with a specific behavior. Now functional alternative beliefs, healthy alternative thoughts and compensatory strategies are identified, which is developed and reinforced through the validation–clarification–redirection process.
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