Understanding RO-DBT: A Therapeutic Approach for Overcontrolled Clients
Develop a comprehensive understanding of Radically Open Dialectical Behavior Therapy (RO-DBT), a therapeutic approach created by Dr. Thomas Lynch for patients not benefiting from traditional DBT. RO-DBT focuses on enhancing receptivity, openness, flexible control, intimacy, and connectedness in overcontrolled individuals, contrasting with undercontrolled traits such as impulsivity and emotional expressiveness. Discover how RO-DBT differs and aligns with DBT, addressing core deficits and attachment styles specific to overcontrolled personalities. Grasp the distinctions in therapeutic strategies for undercontrolled and overcontrolled clients while exploring the markers of psychological health associated with RO-DBT.
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January 23, 2019 RO-DBT R A D I C A L L Y O P E N - D I A L E C T I C A L B E H A V I O R T H E R A P Y ALLISON DONOVAN, PSYD, LP SARAH MCCLAREN , MA, LMFT
WHAT IS RO-DBT? Created by Dr. Thomas Lynch For DBT patients not improving Theory: some patients were already overcontrolled RO-DBT markers of psychological health Receptivity and Openness Flexible Control Intimacy and Connectedness
UNDERCONTROLS Impulsive and dramatic Emotionally expressive as children More likely to develop externalizing disorders High reward sensitivity Low detail-focused processing Low inhibitory control OVERCONTROLS Emotionally constricted Risk averse Socially anxious Develop internalizing disorders Threat sensitive
OVERCONTROLS- 4 CORE DEFICITS Reciprocity and openness Flexible responding Emotional expression and awareness Social connectedness and intimacy
HOW IS RO-DBT DIFFERENT AND SIMILAR TO DBT? DBT RO-DBT Use behavioral principles and dialectic philosophy For undercontrolled clients: Cluster B dramatic erratic personality styles, mainly borderline and antisocial PD For overcontrolled clients: Clusters A and C overcontrolled personality styles (e.g., avoidant, obsessive compulsive, paranoid and schizoid PDs, but also chronic depression and anorexia nervosa)
HOW IS RO-DBT DIFFERENT AND SIMILAR TO DBT? DBT RO-DBT Anxious attachment style: Seeks attachment with therapist and fears abandonment Avoidant attachment style: Does not seek attachment with therapist and abandons relationship easily, especially when there is conflict Core problem: Emotion dysregulation, poor impulse control Core problem: Social signaling deficits, low openness, and aloofness
HOW IS RO-DBT DIFFERENT AND SIMILAR TO DBT? DBT RO-DBT Therapist recognizes undercontrolled clients need to do better, try harder, and/or be more motivated to change Therapist recognizes clients characterized by overcontrol need to let go of always striving to perform better or try harder
SUICIDE AND SELF-HARM RO-DBT OVERCONTROLLED DBT UNDERCONTROLLED Engage in self-harm and suicide at high rates Usually mood-dependent and unplanned Do not keep their self- harming behavior a secret Mood-dependent and impulsive Engage in self-harm and suicide at high rates Usually planned Self-harming behavior is usually a well-kept secret Self-harm and/or suicidal behavior is more likely to be rule-governed rather than mood-governed e.g., to restore their faith in a just world by punishing themselves for perceived wrongs
THERAPEUTIC STANCE RO-DBT OVERCONTROLLED DBT UNDERCONTROLLED Therapist uses external contingencies, including mild aversives, takes a direct stance in order to stop dangerous, impulsive behavior Therapist is less directive, encourages independence of action and opinion, emphasizes self-enquiry and self-discovery
PRIMARY THERAPEUTIC FOCUS RO-DBT OVERCONTROLLED DBT UNDERCONTROLLED Internal: Emotion regulation skills Gaining behavioral control Distress tolerance External: Social-signaling Openness Social connectedness skills
THERAPIST TEACHES RO-DBT OVERCONTROLLED DBT UNDERCONTROLLED How to avoid conflict Be more organized Restrain impulses Delay gratification Tolerate distress (skills already over learned or engaged in compulsively by most OC individuals) Increase openness Flexible responding Enhance social connectedness Vulnerable expression of emotion
EATING DISORDER SYMPTOMS FOR UC VS OC CLIENTS Can experience a variety of eating disorder symptoms Identify the intentionbehind the behavior Is client planning out the behavior or is impulsive when engaging in the behavior? Overcontrolled= planning VS Undercontrolled = impulsivity
DIAGNOSES OVERCONTROLLED UNDERCONTROLLED OCD Paranoid PD Avoidant PD Schizoid PD Anorexia nervosa Chronic depression Autism spectrum Treatment resistant anxiety Internalizing disorders Borderline PD Antisocial PD Narcissistic PD Histrionic PD Binge/Purge EDs Bipolar disorder Conduct disorders Externalizing disorders
OVERLY DISAGREEABLE & OVERLY AGREEABLE SUBTYPES OVERLY DISAGREEABLE OVERLY AGREEABLE Motivated to be perceived as competent but not compliant Motivated to be seen as competent and socially acceptable The pro-social persona can be exhausting because they feel as if they are preforming Display disingenuous or incongruent expressions to their actual emotion Pro-social behavior appears intimacy enhancing yet they fear personal disclosure May work hard to convince their therapist they are fine or ok Can be pro-social but are willing to be unfriendly in order to achieve an objective (even if it damages the relationship) Flat or inhibited emotional expressions when under stress May see themselves as a loner Tough exterior- insecure and anxious interior (rarely show these emotions)
SOCIAL SIGNALING Overcontrol has a problem of loneliness OC s are very threat sensitive Because of this, they often find themselves in fight or flight mode, SNS system activation causes bodily tension and inhibition of social signaling PROBLEM! -facial expressions and body language are a big part of how human beings form bonds Big 3 + 1 skill helps OC s activate the parasympathetic nervous system (PNS) so they are better able to socially signal and connect with people Lean back, take a low deep breath, half smile, and eyebrows up
STATES OF MIND Flexible Mind Fixed Mind Fatalistic Mind
FLEXIBLE MIND DEF(INITELY!) D- acknowledge Distress or unwanted emotions E- use self-Enquiry F- Flexibly-respond with humility
FLEXIBLE MIND ADOPTS OC s struggle with being open to critical feedback from others Fixed Mind: I don t need to be open because they re wrong and I m right Fatalistic Mind: Even if I were open it wouldn t matter because there s nothing I can do ADOPTS skill helps people: Prepare to be open to feedback both mentally and physically Decide whether feedback is valid and whether to accept it
FLEXIBLE MIND ADOPTS A- Acknowledge that feedback is occurring D- Describe and observe emotions, bodily sensations, thoughts O- Open to new information by cheerleading and fully listening P- Pinpoint what new behavior is being recommended by the feedback T- Try out the new behavior S- Self-sooth and reward yourself for being open and trying something new
FLEXIBLE MIND VARIES Once a patient is able to be open to feedback and identify that a change is needed, it is still a struggle to engage in the new behavior OC s worry about how they will be perceived by others, whether they will be good at the new behavior, and perfectionism and fear of failure often get in the way Flexible Mind VARIEs identifies the steps to initiating and evaluating the outcome of engaging in a novel behavior
FLEXIBLE MIND VARIES V-Visualize the new behavior and describe emotions, thoughts, and sensations A- check the Accuracy of hesitancy, aversion, or avoidance R-Relinquish compulsive planning, rehearsal, or preparation I- active one s social-safety and then Initiate the new behavior E- non-judgementally Evaluate the outcome
RESOURCES RO-DBT Website http://www.radicallyopen.net/ Manual (February 2018) Radically Open Dialectal Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol by Thomas R. Lynch, PhD The Skills Training Manual for Radically Open Dialectical Behavior Therapy: A Clinician's Guide for Treating Disorders of Overcontrol by Thomas R. Lynch, PhD melroseheals.com
