Radically Open Dialectical Behavior Therapy for Disorders of Overcontrol

Self-control, the ability to inhibit competing urges, impulses, or behaviors is highly valued by

most societies. However, excessive self-control has been linked to social isolation, aloof interpersonal

functioning, maladaptive perfectionism, constricted emotional expressions, and difficult-to-treat

mental health problems, such as anorexia nervosa, obsessive compulsive personality disorder and

refractory depression.

The aim of this workshop is to introduce clinicians to the theoretical foundations, treatment

strategies and new skills underlying Radically Open Dialectical Behavior Therapy (RO DBT) for

disorders of overcontrol (Lynch, 2018). RO DBT is fully manualized and supported by three

randomized controlled trials (RCTs) for refractory depression, two open-trials targeting adult anorexia

nervosa, and one non-randomized trial targeting treatment resistant overcontrolled adults.

Whilst RO DBT uses dialectical and behavioral strategies, the interventions used are

substantially different to those used in standard DBT. For example, RO DBT contends that emotional

loneliness represents the core problem for overcontrol, not emotion dysregulation. The biosocial

theory for overcontrol posits that temperamental biases for heightened threat sensitivity and

diminished reward sensitivity transact with early family experiences to result in an overcontrolled

coping style leading to social ostracism – secondary to low openness and social signalling deficit. A

novel thesis linking the communicative functions of emotional expression to the formation of close

social bonds will be introduced, as well as new clinical skills linking treatment targeting to social

signalling deficits. New approaches designed to activate a neurobiological-based social-safety system,

signal cooperation, and encourage genuine self-disclosure will be introduced using slides, handouts,

video clips, and role plays.

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