Academic journal article American Journal of Psychotherapy

Radically Open-Dialectical Behavior Therapy for Disorders of Over-Control: Signaling Matters

Academic journal article American Journal of Psychotherapy

Radically Open-Dialectical Behavior Therapy for Disorders of Over-Control: Signaling Matters

Article excerpt

INTRODUCTION

Until recently, the majority of treatment interventions targeting personality disorders (PDs), including standard dialectical behavior therapy (DBT), have tended to target borderline personality disorder (BPD)-a disorder characterized by low inhibitory control and dysregulated/impulsive behavior (see Dixon-Gordon, Turner, & Chapman, 2011 for review). In contrast, radically open-dialectical behavior therapy (RO-DBT), a new treatment approach with strong roots in standard DBT, targets a spectrum of disorders sharing similar genotypic and phenotypic features linked to excessive self-control or over-control (T. R. Lynch, in press; T. R. Lynch & Cheavens, 2008; T.R. Lynch, Hempel, & Clark, 2015; T. R. Lynch et al., 2013).

Over-control (OC) has been linked to social isolation, aloof and distant relationships, cognitive rigidity, high detail versus global processing, risk aversion, strong needs for structure, inhibited emotional expression, hyper-perfectionism, social-isolation, and the development of severe and difficult-to-treat mental health problems, such as chronic depression, anorexia nervosa, and obsessive compulsive personality disorder (Asendorpf, Denissen, & van Aken, 2008; Anderluh, Tchanturia, RabeHesketh et al., 2009; B.P.Chapman & Goldberg, 2011; A.L.Chapman, Lynch, Rosenthal, et al., 2007; Eisenberg, Fabes, Guthrie, & Reiser, 2000; Riso et al., 2003; Zucker et al., 2007). While resting on the dialectical underpinnings of standard DBT, the therapeutic strategies, core skills, and theoretical perspectives in RO-DBT often substantially differ. For example, RO-DBT contends that emotional loneliness secondary to low openness and social-signaling deficits represents the core problem of over-control, not emotion dysregulation as posited in standard DBT (Linehan, 1993). Individuals characterized by overcontrolled coping tend to be serious about life, set high personal standards, work hard, behave appropriately, and frequently will sacrifice personal needs in order to achieve desired goals or help others; yet inwardly they often feel "clueless" about how to join-in with others or establish intimate bonds. Thus, over-control works well when it comes to sitting quietly in a monastery or building a rocket; but it creates problems when it comes to social connectedness.

RO-DBT is supported by 20^ years of translational research; including two NIMH funded randomized controlled trials (RCTs) targeting refractory depression and comorbid OC personality dysfunction (T. R. Lynch et al., 2007; T. R. Lynch, Morse, Mendelson, & Robins, 2003), two opentrials targeting adult Anorexia Nervosa (Chen et al., 2014; T.R. Lynch et al., 2013), one non-randomized trial using RO-skills alone for treatment resistant adults with over-control (Keogh et al., in prep.), and a large ongoing multi-center RCT targeting refractory depression and over-controlled personality disorders (http://www.reframed.org.uk; Lynch chief investigator). The aim of this paper is to briefly outline the theoretical foundations of RO-DBT and to overview some of the unique structural or treatment strategies that differentiate the treatment from standard DBT and other treatment approaches targeting chronic and/or treatment resistant disorders.

A TRANSDIAGNOSTIC PERSPECTIVE: SELF-CONTROL AS AN OVERARCHING PRINCIPLE

RO-DBT posits that bio-temperamental deficits/excesses combined with cultural or family values for self-control functions to handicap openness, flexible responding, and cooperative social-signaling; resulting in habitual over-control or under-control of socio-emotional behavior (T. R. Lynch, in press; T.R. Lynch, Hempel, & Clark, 2015; T. R. Lynch et al., 2013)-sharing features with the well-established division between internalizing and externalizing disorders (Achenbach, 1966; Crijnen, Achenbach, & Verhulst, 1997). Broadly speaking self-control refers to the ability to inhibit emotional urges, impulses, and behaviors in order to pursue long-term goals. …

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