Contextualist Perspectives in the Treatment of Antisocial Behaviors and Offending: A Comparative Review of FAP, ACT, DBT, and MDT

Abstract

This article presents a comparative review of the application of four contextualist therapies in the treatment of antisocial behavior and offending. The therapies reviewed are functional analytic psychotherapy (FAP), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mode deactivation therapy (MDT). A descriptive and comparative review was conducted through a search carried out in both general and specific databases related to each therapy. We included a total of 44 studies treating any type of antisocial behavior or offending. Results show that these interventions have been used to treat challenging behavioral patterns, inmates’ institutional behaviors, exhibitionism, at-risk adolescents’ aggressive conducts, and offending behaviors performed by juveniles who committed robbery and/or serious sexual offenses. The main conclusions are that the four therapies show very positive outcomes: Although FAP and ACT have been used more sparsely, DBT and MDT have been employed in a larger number of interventions and using more controlled comparative designs. The therapeutic components that seem to be relevant to understanding in a transversal way how changes in behavior are achieved are acceptance/validation of clients’ histories of neglect and abuse and clients’ commitment to behaving toward their valued directions in life.

START NOW: a cognitive behavioral skills training for adolescent girls with conduct or oppositional defiant disorder – a randomized clinical trial

“…Even though we were not able to conduct a mediation analysis investigating underlying mechanisms of observed improvement, in line with Visdomine‐Lozano (2022) we would like to emphasize that the following elements (all core elements of START NOW) are essential in the treatment of aggressive and antisocial behavior: Analyzing consequences of aggressive and antisocial behavior (functional behavior analysis), improving emotion regulation (identifying/accepting or regulating painful emotions), validating the personal history and understanding problematic behavior as a coping attempt, reducing hostile attribution bias and replacing problematic with functional behavior, practicing social competency, establishing positive attitudes, individual values and goals, building‐up/strengthening skills to live according to values, and to reach goals.…”

“…Hence, especially in case of severe or chronic aggressive behavior multimodal approaches focusing on both, adolescents and staff working in the welfare institutions, are urgently needed, training professionals how to motivate adolescents to change maladaptive behavior and teach them evidence‐based skills to better cope with emotional and stressful demands in daily life (NICE, 2017). Dialectical behavioral therapy (DBT) integrating methods beyond traditional behavioral and cognitive concepts such as mindfulness or emotion regulation skills is discussed as a promising intervention approach for externalizing, antisocial or offending behavior (Visdomine‐Lozano, 2022). A recent systematic review and meta‐analysis indicates that DBT significantly reduces anger and additionally, a non‐significant trend in reducing aggression was shown (Ciesinski, Sorgi‐Wilson, Cheung, Chen, & McCloskey, 2022).…”