Member Contributor — Margot Parker, LMFT

Radically Open Dialectical Behavior Therapy (RO-DBT)

Self-control is usually seen as a good thing, however excessive self-control, also known as over control (OC) is not and can cause difficulties for people. It can inhibit our ability to connect with others leading to painful emotional loneliness and social isolation. It can result in rigid responses and emotional inhibition thought to underlie many conditions such as chronic depression, treatment-resistant anxiety disorders, anorexia nervosa, avoidant, paranoid and obsessive compulsive personality disorders. Radically Open Dialectical Behavior Therapy (RO DBT) developed by Doctor Thomas Lynch over more than twenty years of clinical and experimental research is a new evidence-based treatment that targets over-controlled.

Radically-Open Dialectical Behavior Therapy (RO DBT) is sometimes confused with standard Dialectical Behavior Therapy (DBT). Although they share a similar emphasis on dialectics and behavior therapy, the target audience is very different. Dialectical Behavior Therapy (DBT) was designed for individuals who need to enhance constraint or inhibitory control, whereas RO DBT was designed for those individuals who must learn to relax rigid or inflexible inhibitory control. The RO DBT treatment strategies aim to build: 1) flexible responding to the demands of the moment, 2) authentic emotional expression to build positive interpersonal relationships, 3) self-enquiry into habitual responses, 4) ability to manage unexpected or challenging feedback. The diagram below delineates the major differences.

As a result of his research, Dr. Thomas Lynch posits a biosocial theory for disorders of overcontrol. He writes that maladaptive overcontrol is posited to result from a convergence of three broad factors: 1) Nature, bi-temperamental and genetic influences, 2) Nurture, influences having to do with the family, cultural and environmental factors and learning, 3) Coping, tendencies to exert excessive self-control under stress, to compulsively fix problems, and to have deficits in prosocial signaling. As children they present with heightened states of defensiveness, diminished experiences of spontaneous pleasure, superior capacities for self-control, distress tolerance, delay of gratification and attention to detail over more global processing. The nurture component of the OC biosocial theory encourages the development and maintenance of maladaptive OC, for example, early family experiences emphasizing mistakes as intolerable and self-control as imperative. The end result of transactions between the “nature” and “nurture” factors are hypothesized to lead to the development of an OC maladaptive coping style. The pre- OC individual learns that if they avoid unplanned risks, mask inner feelings, remain aloof and distant from others they can reduce the potential of making a mistake, appearing vulnerable or out of control. This learned behavior, coping style, limits opportunities to learn new skills and utilize positive social reinforcers.

RO DBT treatment for OC includes developing skills that activate neural substrates associated with social-safety and desire for connection, learning nonverbal social-signaling skills linked to the mirror neuron system, establishing trust, practicing forgiveness of self and others, learning self-enquiry and radical openness, and breaking-down over-learned inhibitory barriers. These skills take time and practice to learn and the treatment requires the client to have tolerance for their mistakes and faith in their progress, however slow. These self-compassionate traits are counter intuitive for these clients and they will need to practice skills that feel uncomfortable and “not right.” The treatment, therefore, is structured and is offered as a 30-week course of therapy which typically consists of a weekly individual session as well as a weekly RO DBT skills class. The client may continue another 30-week course, if desired, to reinforce skills and go deeper into the application of these skills to their specific challenges. The length of treatment is not rigid, but it is offered in 30-week segments to create safety by utilizing structure.

RO-DBT is now practised in the UK, Europe, and North America, and is increasingly recognised as effective for patients who exhibit emotional over-control. The efficacy of RO-DBT has been informed by experimental, longitudinal, and correlational research, including two randomized controlled trials (RCTs) of refractory depression with comorbid OC personality dysfunction that provided the foundation of the development of the RO-DBT treatment manual (Lynch et al., 2007; Lynch, Morse, Mendelson, & Robins, 2003), one non-controlled trial with adult anorexia nervosa inpatients (Lynch et al., 2013), a case series open-trial applying Radical Openness skills alone plus standard DBT with adult AN outpatients (Chen et al., 2015), and one non-randomized trial targeting treatment resistant overcontrolled adults (Keogh et al, 2016), while the mechanisms of change and efficacy for treatment of refractory depression and comorbid OC personality disorders are being investigated via the large multi-site RCT ‘REFRAMED’ (www.reframed.org.uk Lynch). For more information about RO DBT research, see http://www.radicallyopen.net/research-on-ro-dbt/.

For more information about RO DBT treatment please check out the website: http://www.radicallyopen.net/about-ro-dbt/.

Margot Parker, M.S., is a licensed Marriage and Family Therapist in the state of Californian. She has a private practice in Westlake Village. She is intensively trained in RO-DBT and teaches RO-DBT classes in Westlake Village. She earned her master’s degree in counseling psychology at California State University, Northridge. She has worked as a trauma sensitive yoga instructor at The New Beginnings Center and a grief counselor at Camarillo Hospice. For more information about RO DBT treatment contact Margot at wiseturtlecounseling@gmail.com. or 805.244.5351.