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

by Thomas R. Lynch PhD, FBPsS

Overview

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 with 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, The Skills Training Manual for Radically Open Dialectical Behavior Therapy (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.

Product Details

ISBN-13:	9781626259287
Publisher:	New Harbinger Publications
Publication date:	02/15/2018
Edition description:	Comprehens
Pages:	520
Product dimensions:	7.00(w) x 10.10(h) x 1.50(d)

About the Author

Thomas R. Lynch, PhD, FBPsS, is professor emeritus of clinical psychology at the University of Southampton school of psychology. Previously, he was director of the Duke Cognitive-Behavioral Research and Treatment Program at Duke University from 1998-2007. He relocated to Exeter University in the UK in 2007. Lynch’s primary research interests include understanding and developing novel treatments for mood and personality disorders using a translational line of inquiry that combines basic neurobiobehavioral science with the most recent technological advances in intervention research. He is founder of radically open dialectical behavior therapy (RO DBT).

Lynch has received numerous awards and special recognitions from organizations such as the National Institutes of Health-US (NIMH, NIDA), Medical Research Council-UK (MRC-EME), and the National Alliance for Research on Schizophrenia and Depression (NARSAD). His research has been recognized in the Science and Advances Section of the National Institutes of Health Congressional Justification Report; and he is a recipient of the John M. Rhoades Psychotherapy Research Endowment, and a Beck Institute Scholar.

Table of Contents

Acknowledgments vii
Key Terms xi
Introduction 1
Overview of Core RO DBT Tenets 1
Overview of the Book’s Contents 2
In RO DBT, Silliness Is No Laughing Matter 4
1. Radical Openness and Disorders of Overcontrol 7
Self-Control: Can You Have Too Much of a Good Thing? 7
Basic Postulates of RO DBT 11
Treatment Development and Efficacy Research 19
2. A Neurobiosocial Theory for Disorders of Overcontrol 33
A Novel Neuroregulatory Model of Socioemotional Functioning 33
A Biosocial Theory for Disorders of Overcontrol 46
Social Signaling: A Novel Mechanism of Change 66
3. Assessment Strategies 69
Assessing Overcontrol: A Conceptual Framework 69
Common Errors and Problematic Assumptions 70
The OC Diagnostic Protocol: Diagnosing Overcontrol, Step-by-Step 76
Future Directions 83
4. Overview of Therapy Assumptions, Structure, and Targets 85
RO DBT Core Assumptions 86
Overview of Treatment Structure and Targets 88
5. Maximizing Client Engagement 97
Enhancing Client Engagement via the Physical Environment 97
Enhancing Client Engagement via Orientation and Commitment 100
Commitment Problems Unique to Overcontrol 137
Enhancing Engagement Through Sequencing 140
6. Social Signaling Matters: Micromimicry, Mirror Neurons,
and Social Connectedness 145
Social Bonds, Mimicry, and Mirror Neurons 146
One Size Does Not Fit All 149
Eye Contact 149
The “Deer in the Headlights” Response 151
Heat-Off Strategies 153
Heat-On Strategies 155
Therapeutic Use of Cooperative Social Signaling 156
The Therapist as Tribal Ambassador 161
Managing Maladaptive OC Social Signaling 170
Tribe Matters 175
7. Radical Openness and Self-Enquiry: Personal Practice,
Therapeutic Modeling, Supervision, and Team Consultation 177
Openness Is Tribal Glue 178
Openness, Collaboration, and Compliance 180
Openness, Tribes, and Learning 181
One Secret of Healthy Living Is the Cultivation of Healthy Self-Doubt 184
What Is Radical Openness? 186
Practicing Self-Enquiry and Outing Oneself 190
RO DBT Team Consultation and Supervision 192
Using a Consultation Team to Enhance Supervision and Treatment Outcomes 198
8. The Therapeutic Alliance, Alliance Ruptures, and Repairs 209
The RO DBT Therapeutic Stance 209
The Therapeutic Alliance 211
Alliance Ruptures and Repairs 213
Prevention of Premature Treatment Dropout 223
9. Treatment Targeting and Intervention: Prioritizing Social Signaling 229
Kindness First and Foremost 230
Radically Open Living: Developing a Life Worth Sharing 232
Structuring Sessions with the RO DBT Treatment Target Hierarchy 233
Targeting In-Session Social Signaling: Basic Principles 240
Monitoring Treatment Targets with Diary Cards 257
Valued Goals, Themes, and Targets 267
From Targeting to Intervention: An Overview of Treatment Strategies 270
10. Dialectical and Behavioral Strategies 297
Why Dialectics? 297
Behavioral Principles and Strategies 327
11. Final Remarks, Practical Questions, and Treatment Adherence 371
Some Commonly Asked Questions 371
Final Remarks 373
Appendix 1: Assessing Styles of Coping: Word-Pair Checklist 377
Appendix 2: The Clinician-Rated OC Trait Rating Scale 381
Appendix 3: The Overcontrolled Global Prototype Rating Scale 385
Appendix 4: RO DBT Semistructured Suicidality Interview 401
Appendix 5: Targeting Indirect Social Signals: In-Session Protocol 405
Appendix 6: Setting the Stage for Effective RO DBT Chain Analysis:
In-Session Protocol 415
Appendix 7: Using RO DBT Chain and Solution Analysis: Principles
and In-Session Protocol 419
Appendix 8: RO DBT Adherence: A Self-Assessment Checklist 433
Endnotes 453
References 461
Index 493

Interviews

Lynch resides in the United Kingdom.

Editorial Reviews

“Radically open dialectical behavior therapy (RO DBT) is a truly innovative treatment, developed through translation of neuroscience into clinical practice, integrating various influences from dialectical behavior therapy (DBT), mindfulness-based approaches, emotion, personality and developmental theory, evolutionary theory, and Malamati Sufism. RO DBT is applicable to a spectrum of disorders characterized by excessive inhibitory control or overcontrol (OC). This is the first treatment that directly targets social signaling and nonverbal aspects of communication not only in clients but also in therapists. ... This book on the theory and practice of RO DBT, together with the skills training manual that describes the content of skills classes, are excellent guides for clinicians who want to embark in delivering transdiagnostic treatments based on science and clinical practice.”
—Mima Simic, MD, MRCPsych, joint head of the child and adolescent eating disorder service, and consultant child and adolescent psychiatrist at the Maudsley Hospital in London, UK

Mima Simic

“RO DBT offers an intriguing reconceptualization of traditional views of internalizing and externalizing disorders, and provides the clinician with valuable new tools to address a number of problems that have been particularly resistant to standard CBT approaches. I will definitely include RO DBT theory and techniques in my graduate-level intervention class. I know beginning clinicians in particular will be grateful to have a systematic way to approach these slow-to-warm-up clients who are difficult to establish rapport with. Their early termination from therapy and failure to respond to traditional approaches often leaves clinicians befuddled and critical of their own skills. RO DBT provides a compassionate way for clinicians to view this type of resistant client, as well as to work on some areas that are likely to benefit them. A very welcome addition to any clinician’s toolbox.”
—Linda W. Craighead, PhD, professor of psychology and director of clinical training at Emory University, and author of The Appetite Awareness Workbook

Linda W. Craighead

“A new and comprehensive statement from one of the more creative minds in evidence-based clinical intervention today, RO DBT brings together a contemporary focus on a limited set of key transdiagnostic processes, with new assessment and intervention techniques for moving them in a positive direction. Emphasizing flexibility, openness, connection, and attention to social signaling, RO DBT specifies the details that can matter, from how you arrange your consulting room furniture to how nonverbal cues signal social information. RO DBT seems destined to make an impact on evidence-based care in many corners of clinical work. Highly recommended.”
—Steven C. Hayes, PhD, codeveloper of acceptance and commitment therapy (ACT); Foundation Professor of psychology at the University of Nevada, Reno; and author of Get Out of Your Mind and Into Your Life

Steven C. Hayes

Reviewer: Gary B Kaniuk, PsyD (Cermak Health Services)
Description: The book applies radically open dialectical behavior therapy to clients experiencing excessive self-control or overcontrol, with diagnoses such as eating disorders, depression, and obsessive-compulsive disorder.
Purpose: As noted in the introduction, the purpose is to present "a new transdiagnostic treatment, radically open dialectical behavior therapy (RO DBT), which targets a spectrum of disorders characterized by excessive inhibitory control, or overcontrol (OC)."
Audience: The intended audience is "clinicians treating clients with such chronic problems as refractory depression, anorexia nervosa, and obsessive-compulsive personality disorder." The author, a professor emeritus at the University of Southampton, developed radically open dialectical behavior therapy.
Features: The author discusses the hypotheses underlying RO DBT, especially in light of three randomized controlled trials addressing resistant depression and maladaptive overcontrol. The highest priority is on life threatening behaviors. Assessment involves a three-step protocol: 1) client completes self-report measures; 2) therapist performs a semistructured interview; and 3) therapist completes two measures independently. In order for therapy to begin, the client must display sufficient motivation to engage in the process. Client participation can be enhanced by structuring the physical environment in a specific way, making therapy interactive, and dealing with self-harm behaviors early on. Therapists have to be attuned to the wide range of verbal and nonverbal social signals that clients present and be open to new ideas and opinions, which is the core philosophy of RO DBT. Difficulties in the working relationship are to be expected so that critical issues can be confronted. This therapeutic orientation explores dialectical thinking, helping clients see different viewpoints, in order to break through rigid thinking styles. There are eight different appendixes with clinical forms that can be downloaded as well. The book is easy to read and very practical. Each chapter ends with a shaded box, "Now You Know...," which provides a brief summary of key points. The book also includes clinical vignettes, so readers can see how the theory is applied in specific cases.
Assessment: This excellent book provides a step-by-step approach to using radically open dialectical behavior therapy, written by the developer of the approach. The book will be a great addition to the libraries of both new and seasoned therapists.

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