Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol

by Thomas R. Lynch

Based on over twenty years of research, radically open dialectical behavior therapy (RO-DBT) is a breakthrough, transdiagnostic approach for helping people suffering from extremely difficult-to-treat emotional overcontrol (OC) disorders, such as anorexia nervosa, obsessive-compulsive disorder (OCD), and treatment-resistant depression. Written by the founder of RO-DBT, Thomas Lynch, this comprehensive volume outlines the core theories of RO-DBT, and provides a framework for implementing RO-DBT in individual therapy.

While traditional dialectical behavioral therapy (DBT) has shown tremendous success in treating people emotion dysregulation, there have been few resources available for treating those with overcontrol disorders. OC has been linked to social isolation, aloof and distant relationships, cognitive rigidity, risk aversion, a strong need for structure, inhibited emotional expression, and hyper-perfectionism. And yet perhaps due to the high value our society places on the capacity to delay gratification and inhibit public displays of destructive emotions and impulses problems linked with OC have received little attention or been misunderstood. Indeed, people with OC are often considered highly successful by others, even as they suffer silently and alone.

RO-DBT is based on the premise that psychological well-being involves the confluence of three factors: receptivity, flexibility, and social-connectedness. RO-DBT addresses each of these important factors, and is the first treatment in the world to prioritize social-signaling as the primary mechanism of change based on a transdiagnostic, neuroregulatory model linking the communicative function of human emotions to the establishment of social connectedness and well-being. As such, RO-DBT is an invaluable resource for treating an array of disorders that center around overcontrol and a lack of social connectedness such as anorexia nervosa, chronic depression, postpartum depression, treatment-resistant anxiety disorders, autism spectrum disorders, as well as personality disorders such as avoidant, dependent, obsessive-compulsive, and paranoid personality disorder.

Written for mental health professionals, professors, or simply those interested in behavioral health, this seminal book along with its companion, Radically-Open Dialectical Behavior Therapy Skills Training Manual (available separately) provides everything you need to understand and implement this exciting new treatment in individual therapy including theory, history, research, ongoing studies, clinical examples, and future directions.

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Genres: Psychology, Nonfiction, Mental Health, Reference, Self Help, Textbooks, Social Work

600 pages, Hardcover

Published February 15, 2018

Reviews

[Thomas · Rating 3 out of 5]

Overall appreciated this book’s novel take on issues of overcontrol, for clients who struggle with cognitive rigidity, always needing structures and plans, and relentless perfectionism that may inhibit relational satisfaction and overall wellbeing. I liked how the author took into account how society can glorify overcontrol such as through rewarding people who delay gratification and who invest so much of themselves in work. I research eating disorders and see how the themes of overcontrol especially relate to anorexia nervosa.

The main downside which other reviewers have also noted is that the book is extremely long and I’m not sure all the content actually related to the central issues of overcontrol. I also thought the lack of attention paid to issues of culture and social oppression and how those factors may motivate or affect a desire for control was a bit egregious. Finally, there was an amatonormative assumption that desiring romance is indicative of honoring one’s true desires which felt off-putting to me. An interesting extension of traditional DBT nonetheless.

[Shelley Diamond · Rating 3 out of 5]

This book is not what I thought it was going to be. I assumed that his concept of "overcontrol" referred to people who overthink everything and try to control everything and everyone in their lives. That's sort of/part of what he is describing but he's really focusing on people who overcontrol their emotions, are shut down emotionally, and cut off from social interaction that would regulate the way they think and feel.

This book is over 500 pages. The author seems to overthink everything himself because the minutiae in this book is overwhelming. The first 7 chapters (200 pages) are overly elaborate and unnecessarily long. Chapters 8, 9, and 10 and the appendices are the most useful. But I suspect most of what he presents would be rejected by many patients who have this problem. It's just too impractical in practice to do what he suggests is necessary.

I'm sure there are some therapists who could follow through with his approach. However, I think many therapists and patients would ultimately be frustrated by this complicated system. I suspect it took him years to write this book and he probably put far more effort into this than most people are going to get out of it.

[Shane Moore · Rating 4 out of 5]

I was reading about therapeutic styles a few years ago and came across "Radically Open Dialectical Behavioral Therapy," a relatively new type of treatment that focuses on disordered emotion overcontrol.

This book was written for therapists, not laypeople, but I still found it very interesting and comprehensible.

I don't feel like I have a serious problem in this area, as I don't suffer from the worst symptoms described. I definitely associate more with the problems of overcontrolled emotions (like discomfort with unexpected risks, difficulty identifying feelings, diminished emotional response followed by losing control, and difficulty forming meaningful social bonds.)

Here are the excerpts from the book that I found worth copying for future reference:

Some people are more naturally detail focused - they see the trees over the forest. This often goes hand-in-hand with seeing the potential for harm over the potential for reward in any given situation.

Overcontrolled coping comes from the ideas that mistakes are intolerable, achievement is essential, and you must have perfect self-control. If I mask my inner feelings I can avoid making mistakes or appearing out of control. Overcontrolled coping has hidden costs. Avoidance of unplanned risks interferes with learning, masking inner feelings makes it harder for others to know you, and behaving in an aloof and distant manner makes it more likely for people to avoid you. Plus, maintaining excessive self-control is exhausting.
Radically open living impacts how we see the world (we are more receptive to critical feedback) and how others see us (people like people who are open-minded).
Radical openness has three elements:
Receptivity to new experience and disconfirming feedback, in order to learn.
Flexible self-control, in order to adapt to changing environmental conditions.
Intimacy and connectedness with at least one other person.
Practice self-enquiry: Ask yourself, Is there something here for me to learn? Temporarily turning toward the discomfort and asking what we might need to learn, rather than automatically regulating, distracting, explaining, reappraising, or accepting.
Self-enquiry considers an unwanted emotion, thought, or sensation in the body a reminder to practice self-enquiry by redirecting our attention to the challenging or threatening experience and asking, is there something to learn here?
Flexibly responding with humility by doing what’s needed in the moment to effectively manage the situation or adapt to changing circumstances in a manner that accounts for the needs of others.
Radical acceptance means letting go of the fight with reality, and turning intolerable suffering into tolerable pain, whereas radical openness challenges our perceptions of reality. Radical openness posits that we are unable to see things as they are but instead see things as we are. Thus RO encourages the cultivation of self-enquiry and healthy self-doubt in order to signal humility and learn from what the world may have to offer.
Urge-surfing mindfulness (compulsive desires to control, fix, or correct are like a wave, and will ebb if given time)
If you feel perfectionist urges, try to love and appreciate how they motivate you and help you to perform and accomplish tasks, rather than feeling guilt about being a perfectionist. By embracing your perfectionism as a part of yourself that you aren’t trying to improve you are no longer being a perfectionist.
Defensive arousal, tension in the body, or unwanted emotions helpful because they can alert us to areas in our lives where we may need to change or grow.
Openness is a powerful social safety signal. It helps ensure that cooperative intentions are perceived as intended, especially during times of potential conflict. It is the cure for arrogance, selfishness, and lack of empathy, and it helps curb our ego by placing the needs of others on an equal footing to our own.
During a conversation, we may be unaware that we are speaking more rapidly, failing to provide time for the other person to speak, or frequently talking over or interrupting the other person, and we are more likely to overestimate our own capabilities and underestimate the capabilities of others.
Radical openness: Receptivity to new experience and disconfirming feedback, in order to learn.

[Spencer H · Rating 4 out of 5]

As a treatment manual I felt this one was well laid out and comprehensive. Some parts were a bit repetitive but given the length of material to be covered that was actually helpful for getting things to stick. I found there was a lot of sample dialogue (my favourite part of manuals because it gives me a sense of what the therapy actually sounds like) and clinical examples. As with most novel psychotherapy modalities, there is a sense of dogma that pervades the book and makes you feel like a monster if you don't plan to follow the proscribed format exactly as it is in the book. I could have done without that, but I can appreciate the reasoning behind it. Though the authors make a good case for having a specific type of therapy for overcontrolled patients, some of the concepts were so similar to DBT as to be a bit redundant, and there were a few times where I actually thought straightforward DBT got it better (for example I think the concept of wise mind is still a far easier model for most clients, and can easily be adapted to those who spend more time in rational mind).

I think this will be a helpful framework for some of my narcissistic and OCPD clients and I hope I can find a training course in the next few years to actually solidify some of the techniques for practical use.

[Hugh Simonich · Rating 5 out of 5]

Lynch does a thorough job in explaining what RO DBT is and how it is practiced. His main points are emphasized and repeated throughout. He has assessments in the back for both the client and the therapist, and the book is coupled with the Skills Training Manual, just as thick, but equally as important. He explains theory and practice with detail and clarity.

This is for clinicians who treat disorders related to over-controlled (OC) tendencies, but the underlying basic assumption - that we evolved as a hyper-cooperative species in tribes that use various verbal and non-verbal social signals to convey nuanced and meaningful emotional expressions to establish and maintain cooperative relationships with others, particularly those who are non-related - can be applied to all therapeutic modalities. RO DBT focuses treatment on maladaptive social signaling and ties treatment with the client’s personal values and goals. It is in line with all other empirical and process based therapies with the emphasis on social signaling (defined as basically any overt behavior done in a social setting) and with an understanding to the OC personality type.

I enjoyed reading this and would recommend, even if you don’t intend to practice to the letter, exactly how it is written and structured for each session. It’s deepened my theoretical understanding and has good practical tips for treatment-resistant clients who tend to strongly avoid.

[Chantelle J. · Rating 4 out of 5]

This week was a very upsetting time in my life personally. Honestly, I can't remember the last time I had a panic attack so bad I dropped to the floor, unable to control my breathing. I was so utterly disappointed on a Friday afternoon that my brain felt so eclipsed by the harassment I had to experience. Leading to google searching ways to stop myself from "overthrowing" pathetic I know. Anyway, I stumbled upon many articles about the word "overthinking" and, of course, this book 500ish pages later. As my mind seemed to feel calmer this now noon hour Iam given alot to think about. For in the past, I have felt that way of having someone bully me & I felt as if I was like a victim. Reminding myself to return to the present day the here and now moment Iam simply greatful for such a wonder of a read.

[Little Moon · Rating 5 out of 5]

I read this and applied the practices and activities in it during the hardest time of my life and it helped me a ton. I can't recommend it enough especially if you meet the criteria for being overcontrolling

[Fergar · Rating 5 out of 5]

I assume, without having verified, that the somewhat low scores that some readers have assigned are from people without training as clinical psychologists, therapists or psychiatrists; for the right people, the book is excellent.

[Kasandra · Rating 5 out of 5]

Nobody enjoys a manual but they are very important to read and this one is groundbreaking. Looking forward to piloting an RO DBT program in my practice.

[Caroline · Rating 5 out of 5]

Not the easiest therapy not the easiest of books but essential if you provide RO. Sometimes this is the therapy that is so effective I am so glad it’s available.

[Nay · Rating 5 out of 5]

the best therapy I have ever had!

[Joana Pancada · Rating 3 out of 5]

Intense. Lots of information to digest.

[Betsy Myers]

I won this book via Goodreads First Reads. I am an ECE administrator and I look forward to adding this book to the lending library for parents and staff at my school.