Radically Open Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) has been found to be particularly effective for disorders and symptoms characterised by undercontrol (impulsivity) , such as:

• Cluster B personality disorders such as Borderline Personality Disorder
• Emotion lability (intense and fluctuating emotions)
• Complex PTSD
• Impulsive behaviours
• Self-harm and suicide attempts
• Binge Eating Disorder and Bulimia Nervosa
  

In 2018, Thomas Lynch published a modified version of DBT called Radically Open Dialectical Behaviour Therapy (RO-DBT) that was developed and tested to treat diagnoses and symptoms of overcontrol (excessive self-control), such as:

• Anorexia Nervosa
• Treatment resistant depression
• Treatment resistant anxiety
• Autism Spectrum Disorder
• Cluster A personality disorders such as Paranoid Personality Disorder
• Cluster C personality disorders such as Avoidant Personality Disorder

Key Differences Between DBT and RO-DBT

DBT is skills based therapy that covers four key topics: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness (communication skills). In contrast, RO-DBT focuses on Interpersonal Effectiveness as a means to wellness, and as such is primarily a social therapy. RO-DBT emphasises gradually opening oneself up to experiencing emotions, communicating these emotions to others, and exploring playfulness and silliness in social settings, all as a way to connect to others to feel part of a tribe.

Why treat overcontrol? Isn’t self-control good?

While self-control in itself not problematic, some individuals excessively use self-control as a coping strategy to the point that it is a compulsion. This excessive rigid and overcontrolled coping often reflects chronic anxiety and a deep fear of losing control. According to Thomas Lynch, when self-control is based in anxiety and fear, it can be understood as overcontrol.

Overcontrolled individuals:

• Are achievement oriented
• Have very high standards on themselves (and sometimes others)
• Avoid confrontation
• Tend to be very serious about life
• Tend to put others needs before their own

While excessive self-control can be useful when it comes to work or study, when it comes to relationships it is problematic. Overcontrolled individuals often feel completely at a loss as to how establish close relationships or become part of a group, and their behaviours of overcontrol tend to result in:

• Loneliness
• Depression
• Chronic emptiness
• Low emotional awareness
• Difficulty connecting with others in a meaningful way
• Difficulty communicating with others
• Difficulty coping with change
• Extreme fear of making mistakes
• Extreme avoidance of emotional expression
• Intense self-criticism
• Lack of cognitive flexibility
• Excessive need for structure
• Lack of receptiveness to feedback
• Unintentionally coming across to others as unapproachable or lacking warmth
• Preoccupation with social comparison and in some cases competitiveness, envy, bitterness, and even schadenfreude (delight in the downfall of others)
  

Here is a brilliant article on the problems that arise when good things (such as self-control) are taken to excess.

RO-DBT Principles

RO-DBT posits that there are three core components to psychological wellness:

1. Receptivity and Openness - This involves being receptive and open to new experiences as well as being receptive and open to disconfirming feedback in order to learn and grow as a person
2. Flexible Control  - Rather than rigid control, flexible control allows us to adapt to changing environments and conditions
3. Intimacy and Social Connectedness - This involves opening ourselves up to at least one other person based on the idea that species survival involves the ability to form long-lasting bonds and cooperate with others in a group setting

RO-DBT Skills

According to Lynch, in order to reduce the compulsion towards overcontrol, the individuals needs to feel safe, but that in order to feel safe we need to take risks (such as letting go of rigid rules or opening up to others) to reduce the fear of not being perfect. Lynch proposes three core skills:

1. Dialectics -  This involves finding a healthy balance between the extremes of ‘compassionate gravity’ (being serious) and playfulness & connection
2. Radical Openness - Developing a curiosity towards ones internal state, curiosity towards the internal state of others, and learning that there is no one right way to feel. It also involves being radically open to connecting to others
3. Self Enquiry - Moving away from the extremes of self-judgement or overconfident perfectionism towards healthy self-doubt in order to come to acceptance of imperfection

Is RO-DBT meant to be a group therapy?

Yes. Like DBT, RO-DBT was designed to be delivered in a 2.5 weekly group skills training session as well as a weekly 1 hour individual session. We do not offer group therapy at Exhale Psychology Centre, but can deliver RO-DBT in individual sessions. You and your therapist can work together to discuss if group therapy might be needed.

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