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

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

Antisocial personality disorder and therapeutic pessimism – how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals?

“…Mentalization has been found to have a mediating effect on aggression ( Schwarzer et al, 2021 ), which is a common characteristic among individuals with a psychopathic personality ( Dolan and Doyle, 2000 ; Monahan et al, 2001 ; Hare and Neumann, 2008 ; Leistico et al, 2008 ). In the MBT trial on conduct disorder in Germany, psychopathy is not an exclusion criterium ( Taubner et al, 2021 ). Perhaps focusing on mentalization can be beneficial when treating individuals with psychopathy too.…”

“…Currently, there is an ongoing multicenter RCT in London investigating MBT-ASPD’s effectiveness for male offenders compared to probation as usual ( Fonagy et al, 2020 ). MBT has also developed a program for youth with conduct disorder (MBT-CD), promising results have been published from the feasibility study ( Hauschild et al, 2023 ) and there is an ongoing RCT on MBT-CD in Germany ( Taubner et al, 2021 ).…”

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

“…This single-arm feasibility study was conducted between September 2016 and December 2021 at outpatient departments in Heidelberg (Institute for Psychosocial Prevention of the University Hospital Heidelberg, Centre for Psychosomatic Medicine) and Mainz (Rheinhessen Fachklinik, Department of Child and Adolescent Psychiatry and Psychotherapy of the University Medical Centre Johannes Gutenberg University Mainz), Germany. The study design and procedure are outlined in detail in the study protocol [ 25 ]. MBT-CD was delivered by therapists who were in or already finished psychotherapy training and who participated in an MBT-CD training conducted by the last author in Heidelberg (ST) and by the last and first author (ST & SH) in Mainz.…”

“…Adolescents received a total of 50€ for taking part in the scientific assessments. An overview of study flow and measures can be found in the study protocol by Taubner et al [ 25 ] (Fig. 1 ).…”

Editorial: Unlearning of Aggressive Behavior and Mechanisms of Change

“…Less perceptual, but more complex, mental approaches focused on procedural and executive mental functions and social skill trainings to control impulsive behaviors ( 10 ). Talia et al followed an approach based on emotional empathic skills, such as epistemic trust and its role in the understanding of aggression in conduct disorder.…”