Radically Open Dialectical Behaviour Therapy
Radically Open Dialectical Behavior Therapy (RO-DBT) is a new evidence-based therapy for people who are overcontrolled. It stems from the idea that it is possible to have too much self-control. This is something we see a lot in people with anorexia, and can also be seen in chronic depression or autistic spectrum disorders.
What is self-control?
Self-control refers to our ability to stop ourselves from responding to our urges or emotions, in favour of a longer-term goal. Whilst self-control can be very helpful and healthy, when it becomes extreme it can be damaging. An inability to relax control when required can lead to people being overly inhibited, perfectionist, or overly restrictive.
Where does overcontrol come from?
As with many things, overcontrol is seen as being a result of nature and nurture. Those who become overcontrolled are often born with a tendency to :
notice the difficult things in life
be more sensitive
be more anxious
feel fewer positive emotions
have higher capacities for self-control
be more detail focussed
These biological/temperamental factors combine with life experiences to cause overcontrol. Life experiences might include seeing family members act in an overcontrolled way, or receiving messages from family, friends or society that it’s very important to not make mistakes, that showing weakness or vulnerability is dangerous or bad or that it’s important to stay in control at all times.
What is overcontrol?
Overcontrol typically consists of a number of traits:
A difficulty relaxing emotional inhibition (being so practised at inhibiting emotions or behaviours that it becomes hard to be more uninhibited when it is required, e.g. at social events or when dating)
A lack of a sense of belonging and a sense of loneliness
Masking emotional expression (for example showing a flat facial expression when someone says something exciting, or laughing when they do not find something funny). This can be experienced as incongruent or ingenuine by others.
Being very rigid and rule driven, and finding feedback difficult
What does DBT-RO involve?
RO-DBT is typically delivered over 30 sessions of individual therapy and skills classes. It is an active, structured therapy with a focus on learning and practicing new skills.
The main three skills that RO-DBT teaches are:
Relating to other people
Being more open to what life can offer
Flexible control, allowing you to be more adaptable to your environment
The aim is to develop a sense of radical openness. Radical openness is a way of behaving and a state of mind, involving acknowledging things that are unexpected or incongruous (typically associated with distress), a sense of self-inquiry and and willingness to seek out unknowns, and an ability to respond flexibly by doing what is effective in the moment, including taking into account the needs of others.
Although RO-DBT is a new therapy, there are promising findings in the effectiveness of RO-DBT for those with anorexia.