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

Radically Open-Dialectical Behavior Therapy (RO-DBT) is a transdiagnostic treatment designed to address a spectrum of difficult-to-treat disorders sharing similar phenotypic and genotypic features associated with maladaptive over-control-such as anorexia nervosa, chronic depression, and obsessive compulsive personality disorder. Over-control has been linked to social isolation, aloof and distant relationships, cognitive rigidity, high detailed-focused processing, risk aversion, strong needs for structure, inhibited emotional expression, and hyper-perfectionism. 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. RO-DBT also significantly differs from other treatment approaches, most notably by linking the communicative functions of emotional expression to the formation of close social bonds and via skills targeting social-signaling and changing neurophysiological arousal. The aim of this paper is to provide a brief overview of the core theoretical principles and unique treatment strategies underlying RO-DBT.

KEYWORDS: Radical openness; dialectical behavior therapy; social signaling; psychological flexibility; emotion inhibition

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. …

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