Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): protocol of a feasibility and pilot study

Svenja Taubner, Sophie Hauschild, Lea Kasper, Michael Kaess, Esther Sobanski, Thorsten-Christian Gablonski, Paul Schröder-Pfeifer, Jana Volkert, Svenja Taubner, Sophie Hauschild, Lea Kasper, Michael Kaess, Esther Sobanski, Thorsten-Christian Gablonski, Paul Schröder-Pfeifer, Jana Volkert

Abstract

Background: Conduct disorder (CD) is a complex mental disorder characterized by severe rule-breaking and aggressive behavior. 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 behavior 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 behavior. For this purpose, MBT was adapted for adolescents with CD (MBT-CD). This is a protocol of a feasibility and pilot study to inform the planning of a prospective RCT. The primary aim is to estimate the feasibility of an RCT based on the acceptability of the intervention and the scientific assessments by CD individuals and their families indicated by quantitative and qualitative data, as well as based on necessary organizational resources to conduct an RCT. The secondary aim is to investigate the course of symptom severity and mentalizing skills.

Methods: The bi-center 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. The primary outcome of the feasibility study (e.g., recruitment and adherence rates) will be descriptively analyzed. Multilevel modeling will be used to investigate secondary outcome data.

Discussion: Fostering the capacity to mentalize social interactions triggering non-mentalized, aggressive behavior 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.

Trial registration: ClinicalTrials.gov , NCT02988453 . November 30, 2016 SOURCES OF MONETARY SUPPORT: Dietmar Hopp Stiftung, Heidehof Stiftung RECRUITMENT STATUS: Recruitment complete and intervention complete, follow-up assessments ongoing (Heidelberg). Recruitment and assessments ongoing (Mainz). PRIMARY SPONSOR, PRINCIPAL INVESTIGATOR, AND LEAD INVESTIGATOR IN HEIDELBERG: Svenja Taubner is responsible for the design and conduct of MBT-CD intervention and feasibility and pilot study, preparation of protocol and revisions, and publication of study results.

Secondary sponsor and lead investigator in mainz: Esther Sobanski is responsible for the recruitment and data collection in the collaborating center Mainz RECRUITMENT COUNTRY: Germany HEALTH CONDITION STUDIED: Conduct disorder, oppositional defiant disorder INTERVENTION: Mentalization-based treatment for conduct disorder (MBT-CD): MBT-CD is an adaptation of MBT for Borderline Personality Disorder. This manualized psychodynamic psychotherapy focuses on increasing mentalizing, i.e., the ability to understand behavior in terms of mental states, in patients. MBT-CD includes weekly individual sessions with the patient and monthly family sessions.

Key inclusion and exclusion criteria: Included are adolescent individuals with a diagnosis of conduct disorder or oppositional defiant disorder aged between 11 and 18 years.

Study type: Feasibility and pilot study (single-group) DATE OF FIRST ENROLLMENT: 19.01.2017 STUDY STATUS: The trial is currently in the follow-up assessment phase in Heidelberg and in the recruitment and treatment phase in Mainz.

Primary outcomes: Acceptability of MBT-CD intervention (as indicated by recruitment rates, completion rates, drop-out rates, treatment duration, oral evaluation), acceptability of scientific assessments (as indicated by adherence, missing data, oral evaluation), and necessary organizational resources (scientific personnel, recruitment networks, MBT-CD training and supervision) to estimate feasibility of an RCT SECONDARY OUTCOMES: Adolescents' symptom severity and mentalizing ability PROTOCOL VERSION: 20.08.2020, version 1.0.

Keywords: Adolescents; Antisocial behavior; Conduct disorder; Feasibility; Mentalization-based treatment; Mentalizing; Oppositional defiant disorder.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart. Sequence of steps from eligibility assessment to data analysis in both settings
Fig. 2
Fig. 2
The process of MBT-CD in both settings

References

    1. American Psychiatric Association. APA DSM-5. Diagnostic Stat Man Ment Disord. 2013. .
    1. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60(8):839–44. 10.1001/archpsyc.60.8.837.
    1. Ridenour TA, Cottler LB, Robins LN, Compton WM, Spitznagel EL, Cunningham-Williams RM. Test of the plausibility of adolescent substance use playing a causal role in developing adulthood antisocial behavior. J Abnorm Psychol. 2002;111(1):144–55. 10.1037/0021-843X.111.1.144.
    1. Erskine HE, Norman RE, Ferrari AJ, Chan GCK, Copeland WE, Whiteford HA, Scott JG Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2016;55(10):841–50. 10.1016/j.jaac.2016.06.016.
    1. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder. Arch Gen Psychiatry. 2003;60(7):709–17. 10.1001/archpsyc.60.7.709.
    1. Jaffee SR, Caspi A, Moffitt TE, Dodge KA, Rutter M, Taylor A, et al. Nature X nurture: genetic vulnerabilities interact with physical maltreatment to promote conduct problems. Dev Psychopathol. 2005;17(01). 10.1017/S0954579405050042.
    1. Loeber R, Burke JD, Lahey BB. What are adolescent antecedents to antisocial personality disorder? Crim Behav Ment Heal. 2002;12(1):24–36. 10.1002/cbm.484.
    1. Moffitt TE, Caspi A, Harrington H, Milne BJ. Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Dev Psychopathol. 2002;14(1)179–207. 10.1017/S0954579402001104.
    1. Maughan B, Rutter M. Antisocial children grown up. Conduct Disord. Child. Adolesc., New York, NY, US: Cambridge University Press; 2001, p. 507–52.
    1. Lösel F, Bender D. Protective factors and resilience. Early Prev. Adult Antisocial Behav. 2003. 10.1017/CBO9780511489259.006.
    1. Fairchild G, Hawes DJ, Frick PJ, Copeland WE. Conduct disorder. Nat Rev Dis Prim. 2019;5(1):1–25. 10.1038/s41572-019-0095-y.
    1. Bakker MJ, Greven CU, Buitelaar JK, Glennon JC. Practitioner review: psychological treatments for children and adolescents with conduct disorder problems – a systematic review and meta-analysis. J Child Psychol Psychiatry Allied Discip. 2017;1:4–18. 10.1111/jcpp.12590, 1.
    1. Lipsey MW. The primary factors that characterize effective interventions with juvenile offenders: a meta-analytic overview. Vict Offenders. 2009;4(2):124–47. 10.1080/15564880802612573.
    1. Erford BT, Bardhoshi G, Ross M, Gunther C, Duncan K. Meta-analysis of counseling outcomes for youth with conduct disorders. J Couns Dev. 2017;95(1):35–44. 10.1002/jcad.12115
    1. Fonagy P, Luyten P. Conduct problems in youth and the RDoC approach: a developmental, evolutionary-based view. Clin Psychol Rev 2018;64:57–76. 10.1016/j.cpr.2017.08.010.
    1. Fonagy P, Bateman AW. Mentalizing and borderline personality disorder. J Ment Health. 2007;16(1):83–101. 10.1080/09638230601182045.
    1. Taubner S, Wiswede D, Nolte T, Roth G. Mentalisierung und externalisierende Verhaltensstörungen in der Adoleszenz. Psychotherapeut. 2010;55(4):312–20. 10.1007/s00278-010-0753-8
    1. Cropp C, Alexandrowicz RW, Taubner S. Reflective functioning in an adolescent community sample. Ment Heal Prev. 2019;14:200156. 10.1016/j.mph.2019.200156
    1. Taubner S, Zimmermann L, Ramberg A, Schröder P. Mentalization mediates the relationship between early maltreatment and potential for violence in adolescence TT - Mentalisierung vermittelt die Beziehung zwischen früher Misshandlung und Gewaltpotenzial in der Jugend. Psychopathology. 2016;49(4)236–46. 10.1159/000448053.
    1. Taubner S, Curth C. Mentalization mediates the relation between early traumatic experiences and aggressive behavior in adolescence. Psihologija. 2013;46(2):177–92. 10.2298/PSI1302177T.
    1. Ensink K, Bégin M, Normandin L, Fonagy P. Maternal and child reflective functioning in the context of child sexual abuse: pathways to depression and externalising difficulties. Eur J Psychotraumatol. 2016;7(1):30611. 10.3402/ejpt.v7.30611.
    1. Abate A, Marshall K, Sharp C, Venta A. Trauma and aggression: investigating the mediating role of mentalizing in female and male inpatient adolescents. Child Psychiatry Hum Dev. 2017;48(6):881–90. 10.1007/s10578-017-0711-6.
    1. Blair RJR. A cognitive developmental approach to morality: investigating the psychopath. Cognition. 1995;57(1):1–29. 10.1016/0010-0277(95)00676-P
    1. Dodge KA. Social-cognitive mechanisms in the development of conduct disorder and depression. Annu Rev Psychol. 1993;44(1):559–84. 10.1146/annurev.ps.44.020193.003015.
    1. Dodge KA. Do social information-processing patterns mediate aggressive behavior? Causes conduct disord. Juv. Delinq., New York, NY, US: The Guilford Press; 2003, p. 254–74.
    1. Crick NR, Dodge KA. Social information-processing mechanisms in reactive and proactive aggression. Child Dev. 1996;67(3):993–1002. 10.1111/j.1467-8624.1996.tb01778.x.
    1. Rossouw TI, Fonagy P. Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2012;51(12):1304–13.e3. 10.1016/j.jaac.2012.09.018.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WSM, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158(3):200–7. 10.7326/0003-4819-158-3-201302050-00583.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016:1–32. 10.1186/s40814-016-0105-8, 1.
    1. Deutsche Gesellschaft für Kinder-und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP). Leitlinienreport der evidenz-und konsensbasierten Leitlinie (S3). Störungen des Sozialverhaltens: Empfehlungen zur Versorgung und Behandlung; 2016. AWMF-Registernummer 028-020. Download: .
    1. Sheehan D, Harnett-Sheehan K, Shytle R, Janavs J, Bannon Y, Rogers J, et al. The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID): validity and reliability. J Clin Psychiatry. 2010;71(03):313–26. 10.4088/JCP.09m05305whi.
    1. Wittchen H-U, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV (SKID I und SKID II). Göttingen: Hogrefe; 1997 28, 1, 68, 70 10.1026//0084-5345.28.1.68
    1. Raine A, Dodge K, Loeber R, Gatzke-Kopp L, Lynam D, Reynolds C, Stouthamer-Loeber M., Liu J. The reactive-proactive aggression questionnaire: differential correlates of reactive and proactive aggression in adolescent boys. Aggress Behav. 2006;32(2):159–71. 10.1002/ab.20115.
    1. Alexandra Burt S, Brent Donnellan M. Development and validation of the subtypes of antisocial behavior questionnaire. Aggress Behav. 2009;35(5):376–98. 10.1002/ab.20314.
    1. Fonagy P, Luyten P, Moulton-Perkins A, Lee YW, Warren F, Howard S, Ghinai R, Fearon P, Lowyck B Development and validation of a self-report measure of mentalizing: the reflective functioning questionnaire. PLoS One. 2016;11(7):e0158678. 10.1371/journal.pone.0158678.
    1. Rutimann DD, Meehan KB. Validity of a brief interview for assessing reflective function. 2011;60(3):577–90. 10.1177/0003065112445616.
    1. Dziobek I, Fleck S, Kalbe E, Rogers K, Hassenstab J, Brand M, Kessler J., Woike J.K., Wolf O.T., Convit A. Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord. 2006;36(5):623–36. 10.1007/s10803-006-0107-0.
    1. Kaess M, Parzer P, Mattern M, Resch F, Bifulco A, Brunner R. Childhood experiences of care and abuse (CECA). Z Kinder Jugendpsychiatr Psychother. 2011;39(4):243–52. 10.1024/1422-4917/a000115.
    1. Hall RCW. Global assessment of functioning: a modified scale. Psychosomatics. 1995;36(3):267–75. 10.1016/S0033-3182(95)71666-8.
    1. Guy W. ECDEU Assessment manual for psuchopharmacology revised: clinical global impression. DHEW Publ 1976;no. (ADM):76–338.
    1. Franke GH. SCL-90-R. Die Symptom-Checkliste von Derogatis–Deutsche Version. Göttingen Beltz Test 1995.
    1. Goth K, Birkhölzer M, Schmeck K. Assessment of personality functioning in adolescents with the LoPF–Q 12–18 Self-Report Questionnaire. J Pers Assess. 2018;100(6):680–90. 10.1080/00223891.2018.1489258.
    1. Abler B, Kessler H. Emotion regulation questionnaire - Eine Deutschsprachige Fassung des ERQ von Gross und John. Diagnostica. 2009;55(3):144–52. 10.1026/0012-1924.55.3.144.
    1. Livesley WJ, Larstone R. The dimensional assessment of personality pathology (DAPP). Sage Publications Ltd: Thousand Oaks; 2008, p. 608–25. 10.4135/9781849200479.n29.
    1. Stadlin C, Pérez T, Schmeck K, Di Gallo A, Schmid M. Konstruktvalidität und Faktorenstruktur des deutschsprachigen Youth Psychopathic Traits Inventory(YPI) in einer repräsentativen Schulstichprobe. Diagnostica 2016;62(2):85–96. 10.1026/0012-1924/a000139.
    1. Lionetti F, Mastrotheodoros S, Palladino BE. Experiences in close relationships revised child version (ECR-RC): psychometric evidence in support of a Security factor. Eur J Dev Psychol. 2018;15(4):452–63. 10.1080/17405629.2017.1297228.
    1. Reitzle M, Metzke CW, Steinhausen HC. Eltern und Kinder: Der Zürcher Kurzfragebogen zum Erziehungsverhalten (ZKE). Diagnostica. 2001;47(4):196–207. 10.1026//0012-1924.47.4.196.
    1. Sheras PL, Konold TR, Abidin RR, Psychological Assessment Resources I. SIPA, Stress index for parents of adolescents: professional manual. PAR, Psychological Assessment Resources; 1998.
    1. Ehrenthal JC, Dinger U, Lamla A, Funken B, Schauenburg H. Evaluation der deutschsprachigen version des bindungsfragebogens “Experiences in close relationships - Revised” (ECR-RD). PPmP Psychother Psychosom Medizinische Psychol. 2009;59(06):215–23. 10.1055/s-2008-1067425.
    1. Roick C, Kilian R, Matschinger H, Bernert S, Mory C, Angermeyer MC. Die deutsche Version des Client Sociodemographic and Service Receipt Inventory. Psychiat Prax. 2001;28:84–90. 10.1055/s-2001-17790.
    1. General Data Protection Regulation. General data protection regulation (GDPR) – official legal text. Gen Data Prot Regul 2016.
    1. Weiß RH. Grundintelligenztest skala 2—revision CFT 20-R [culture fair intelligence test scale 2—revision] Göttingen: Hogrefe; 2006.
    1. Bateman A, Fonagy P. Mentalization-based treatment. Psychoanal Inq. 2013;33(6):595–613. 10.1080/07351690.2013.835170.
    1. Taubner S, Volkert J. Mentalisierungsbasierte Therapie für Adoleszente (MBT-A) Göttingen: Vandenhoeck & Ruprecht; 2016.
    1. Karterud S, Pedersen G, Engen M, Johansen MS, Johansson PN, Schlüter C, Urnes Ø, Wilberg T, Bateman AW The MBT adherence and competence scale (MBT-ACS): development, structure and reliability. Psychother Res. 2013;23(6):705–17. 10.1080/10503307.2012.708795.
    1. Jørgensen MS, Bo S, Vestergaard M, Storebø OJ, Sharp C, Simonsen E. Predictors of dropout among adolescents with borderline personality disorder attending mentalization-based group treatment. Psychother Res. 2021:1–12. 10.1080/10503307.2020.1871525.
    1. Salekin RT. Psychopathy and therapeutic pessimism: clinical lore or clinical reality? Clin Psychol Rev. 2002;22(1):79–112. 10.1016/S0272-7358(01)00083-6.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2(1):64. 10.1186/s40814-016-0105-8.
    1. Theule J, Germain SM, Cheung K, Hurl KE, Markel C. Conduct disorder/oppositional defiant disorder and attachment: a meta-analysis. J Dev Life-Course Criminol. 2016;2(2):232–55. 10.1007/s40865-016-0031-8.

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