Radical Openness DBT for Excessive Control Individuals

Last updated: May 21, 2019 at 0:36 am

 

In this podcast episode, we explore a novel therapeutic modality known as Radically Open DBT with its founder, Dr. Thomas Lynch. This episode outlines the features of overly controlled individuals and how this modality can help.

Your host is Dr. Wegdan Rashad.

Highlights

  • Radically-Open DBT is a transdiagnostic treatment that can treat chronic depression, anorexia nervosa, and obsessive-compulsive personality disorders.
  • Overcontrolled individuals tend to avoid new situations, be hyper-perfectionistic, show inhibited or incongruent ways of self-expression and have distant social relationships.
  • This therapy lasts for 30 weeks and involves individual therapy, skills training class, and telephone consultations.

Below we provide a text version of the audio. This transcript has been edited for clarity.

Introduction

Hello! I’m Dr. Wegdan Rashad and you are listening to the Psychotherapy Academy podcast!

This is our second episode and we are very excited to launch this podcast because we believe that therapists do an incredibly important job and we would like to help you practice psychotherapy even better. So, if your work involves providing psychotherapy or counseling to clients, this is the podcast for you.

Today we have lined up for you, everything you need to know about Radically Open Dialectical Behavioral therapy, or RO DBT. We have with us the founder, Dr. Tom Lynch from the University of Southhampton and his wife and collaborator, Dr. Erica Smith.

Let’s find out more!

Defining Radically-Open DBT

Well basically, it is an evidence-based type of behavioral therapy. It was developed by Dr. Thomas Lynch for disorders of overcontrol. We will talk about what “overcontrol” actually means, but the core principle behind this therapy is implied in its name, radical openness.

So, that sounds pretty…. radical. RO DBT is about three important aspects of emotional well-being; one, openness, two, flexibility, and three, social connectedness.

Overcontrol: A Key Concept

But what IS overcontrol, speaking from a diagnostic angle?

Dr. Lynch:

If you use the Diagnostic and Statistical Manual, Fifth Edition, then you’re probably going to be looking at things like obsessive-compulsive personality disorder, paranoid personality disorder, avoidant personality disorder, schizoid and schizotypal personality disorders. Also, anorexia nervosa, autism spectrum disorders, and treatment-resistant anxiety. And that’s opposed to the under-control problems which would be borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, conduct disorders, and bipolar disorder. I mean, the treatment itself is transdiagnostic so we don’t think so much in a diagnostic way.

This is very interesting and I’m sure we have come across patients with issues like that. But this makes me wonder…having self-control is at some level, a virtue. It helps us thrive in life and achieve goals. So where do we draw the line? When do we consider it overcontrol?

We did some researching and found 4 pillars of overcontrol. First, an overcontrolled individual has a tendency to avoid new, unexpected or unplanned situations. Second, they tend to be overly concerned with the ‘right way’ of doing things and hyper-perfectionism. They tend to plan and rehearse in an almost compulsive manner. Third, the way they express themselves could be very inhibited or incongruent. Like, showing a flat-face when complimented or smiling when distressed. Which brings us to the fourth point, in which their relationships tend to be distant characterized by social comparison and high envy.

So, that about sums up the features of overcontrol traits. This makes me thoughtful, though, about just when does this all start?

The Beginnings of Overcontrol

Dr. Lynch:

It starts at about age 4 or 5. So an overcontrolled child is going to be shy, timid, kind of risk-averse. They’re going to often have difficulty joining in with others and they can be excluded from their peers. They don’t want to be the center of attention. They have superior inhibitory capacity. So, these kids can self-control. They’re well-behaved kids but because of their temperament— which is again the genetics about emotional expression or emotions— they have heightened threat sensitivity. If they walk into a rose garden, they’re going to see the thorns. They’re not going to see the flowers. And that’s how their brain is hardwired. And so, what happens because they have superior inhibitory control, is they can control how they express things. They can be very anxious on the inside but not show it on the outside.

Dr. Smith:

We’re just starting to do some research with a couple of universities in the United States with university students and what they’re finding is that a large proportion of their students lean towards overcontrol because if you think about all of the words that Tom has just used, to do well at university, you have to be persistent. You have to be able to delay gratification. You’ve got to study for five or six years before you get a job. You’ve got to be disciplined. You’ve got to apply yourself. And if we kind of go up the age range, the under controlled populations or borderlines, over their age, the numbers of people that have that kind of disorder decrease. Whereas, what we see with the overcontrols is that they get worse and the numbers increase because they’re not getting the treatment.

Dr. Lynch implies that overcontrol tendencies are hardwired, and while it is beyond the scope of this podcast to go into the psychodynamics, the spark of hope is that this intervention can help people with overcontrol to open up and lead a less distressing life.

RO DBT Teachings

So, what does RO DBT teach clients?

Dr. Lynch:

There’s mindfulness training but the mindfulness training we do is very different. If people are familiar with standard DBT, which is for under-controlled populations, that is kind of supported by Zen Buddhism. But the tradition that radical openness comes from is of Malamati Sufism which is really more of a collectivist way of thinking about human experience. So, the idea in that perspective is the only way you can really understand humans and ourselves is to understand that we are dependent. We are influenced by other people. And so, there’s more of an emphasis on practices related to revealing vulnerability I guess you might say. We spent more on self-inquiry which is a mindfulness practice we teach which really stems from this tradition I guess in some ways and is the essence in many ways of radical openness which is teaching a person to recognize that. And so radical openness is developing or creating a passion to go to the place you don’t want to go to or want to look at or you might want to avoid. And so, openness is actually a core – as you can tell, it’s a big part of the treatment. We just teach a lot of skills that kind of connect with teaching people how to be open and how to do that which is kind of fun I think in some ways.

This makes sense. Understanding that we are dependent and allowing ourselves to peek out and open up to novel experiences, and with passion too.

Relationship Skills

We spoke about how overcontrolled individuals tend to be aloof and distant in relationships. How does RO-DBT help with this?

Dr. Lynch:

There are a lot of other skills on relationship stuff. So, we teach people how to make friends. There’s a skill called match plus one. For overcontrolled clients like those with autism spectrum disorder, and for a lot of our patients, they don’t really have a sense about how to do what other people do kind of naturally, that is form these social bonds. I mean, you might see it as basic but it’s basically saying, okay, if you want to go and meet someone, you have to go up and actually talk to them and reveal some personal information. And so, then you kind of watch. Then the other person you talk to — if they match your level of personal disclosure — gives you a social signal which says I kind of like you too. Then all you’ve got to do is go up one and reveal a little bit more personal information and watch what the other person does. If they match your level of disclosure and go up one, they’re signaling to you that they like you. And before you know it, you’re married. And this is how people get close. So, we teach all those types of things to our clients.

I chuckled a bit at the “before you know it, you’re married” part. But this is quite an important point to raise because individuals with overcontrol can have quite a bit of social anxiety.

What About Social Anxiety?

Dr. Smith:

Social anxiety is a big problem for most OC individuals. And that’s one of the reasons that we have a lot of focus on relationships and how to form relationships. Social signaling comes into that as well.

Dr. Smith just mentioned social signaling which brings me to the targets of RO DBT. One of the targets is to address the deficits in the client’s social signaling. Also, it targets to reduce life-threatening behavior, if any.

Duration and Effectiveness of RO DBT

Practically, RO DBT lasts for about 30 weeks and is somewhat similar to regular DBT in that it involves weekly individual therapy, weekly skills training class and telephone consultations. The last part of this therapy is specific to the therapist in which they can participate in consultation meetings. And like most therapies, the first few sessions are designated to orient and educate the client on the theory behind their condition and the therapy itself.

Now, we are nearing the end of today’s podcast but it would not be complete without knowing just how effective this therapy is. It sounds good in theory but just how practically effective is it?

Apparently, the evidence base for RO DBT is growing. Full recovery from depression has been found in more than 70% of depressed individuals. As of 2017, most research supports that RO DBT can be effectively used in patients with chronic depression, anorexia nervosa and maladaptive personality disorders of overcontrol.

The evidence-base is still growing and there are even some research examining how effective RO DBT can be for violent offenders, young children, and adolescents.

So, watch this space. Perhaps soon you’ll be able to train for and practice this type of therapy in your clinical setting.

I enjoyed today’s topic and I hope you did too. Now here come the key points!

Key Points

  • Radically-Open DBT was developed by Dr. Thomas Lynch for disorders of overcontrol.
  • Radically-Open DBT is a transdiagnostic treatment that can treat chronic depression, anorexia nervosa, and obsessive-compulsive personality disorders.
  • Overcontrolled individuals tend to avoid new situations, be hyper-perfectionistic, show inhibited or incongruent ways of self-expression and have distant social relationships.
  • RO DBT teaches clients skills to open up to new experiences and to socially connect.
  • This therapy lasts for 30 weeks and involves individual therapy, skills training class, and telephone consultations.

Did you enjoy this podcast? Stay tuned for more episodes and be sure to check out our website psychotherapyacademy.org. When you go there, you’ll find that we’ve just released a new module on DBT basics, covering dialectical behavioral therapy from step one.

The following people participated in this episode: Drs. Jessica Diaz and Flavio Guzman as content advisors, Mark Young as the audio engineer, Pamela Gonzalez as the project manager, and myself Dr. Wegdan Rashad as the host. We’d also like to thank Dr. Tom Lynch and Dr. Erica Smith for being with us.

Thank you for tuning into Psychotherapy Academy. We hope to see you soon, bye!

References:

  1. Self-control: Can you have too much of a good thing? (n.d.). Retrieved from http://www.radicallyopen.net/self-control/
  2. Lynch, T. R. (2018). Tribe matters: An introduction to radically open dialectical behavior therapy. the Behavior Therapist, 41(3), 116-125.