I’ve had an interest in using psychological approaches in occupational therapy for some time. Last year, I completed a six-month course in Cognitive Analytic Therapy skills – training that still influences my practice. This year, I’m learning something new: Radically Open Dialectical Behaviour Therapy (RO-DBT).

RO-DBT, developed by Professor Thomas Lynch, is an adaptation of standard DBT, designed for people with disorders of overcontrol (OC).

Self-control—inhibiting acting on urges, impulses, and desires—is highly valued in most societies, and failures in self-control characterize many of the personal and social problems afflicting modern civilization. However, too much self-control can be equally problematic. Overcontrol (OC) or excessive inhibitory control has been linked to social isolation, poor interpersonal functioning, hyper-perfectionism, rigidity, risk aversion, lack of emotional expression, and the development of severe and difficult-to-treat mental health problems, such as chronic depression, anorexia nervosa, and obsessive compulsive personality disorder. – Lynch et al. (2013)

Some of the differences I’ve encountered so far between RO-DBT and standard DBT are:

‘Emotional loneliness’ is the core problem for OC, rather than ’emotional regulation’ in standard DBT

RO-DBT is based on principles from Malamati-Suffism (rather than Zen Buddhism)

The goal of RO-DBT is to decrease overcontrol (rather than decreasing dyscontrol)

New states of mind: ‘Fixed Mind’, ‘Fatalistic Mind’ and ‘Flexible Mind’

A new skills module: ‘Radical Openness’ (this isn’t the same as ‘radical acceptance’)

An additional mindfulness “how” skill

Some modifications to interpersonal effectiveness skills

Additional emotional regulation skills targeting tendencies towards masking of inner feelings, envy, resentment, revenge, bitterness and social comparison

Communication strategies e.g. ‘smuggling’

The treatment hierarchy differs in that ‘therapeutic alliance ruptures’ are given higher priority than ‘therapy interfering behaviours’

Although I’m still in the early stages of my RO-DBT training, I’m really excited to learn more about it. I can see lots of applications and think it will be very valuable when interwoven with my occupational therapy practice.

Developing my skills in therapeutic use of self – for example in attending to and working through therapeutic alliance ruptures

Enhancing my ability to support individuals to work towards their occupational goals, for example through a structure for developing skills of engaging in novel behaviour, being more playful and spontaneous and forming more intimate relationships

Influencing my clinical reasoning for treatment priorities, in particular around working with individuals with high medical risk (this is discussed in more detail in Lynch et al.‘s 2013 article)

Giving me the language to express concepts that I already use in my work

Increasing my own openness through practicing these skills

I can’t wait to see how this list will grow as I learn more about RO-DBT and begin to apply it to my clinical work!

Reference

Lynch, T.R., Gray, K.L.H., Hempel, R.J., Titley, M., Chen, E.Y. and O’Mahen, H.A. (2013) ‘Radically Open-Dialectical Behavior Therapy for Adult Anorexia Nervosa: Feasibility and Outcomes from an Inpatient Program‘, BMC Psychiatry, 13, DOI: 10.1186/1471-244X-13-293 [Open Access]. (Accessed: 4 July 2014)