At the core of an overcontrolled personality and coping style is a tendency to have too much self-control, exhibiting as behavioral and cognitive inflexibility, high inhibition of emotion, high detail-focused processing and perfectionism, and a lack of social connectedness. Overcontrol underlies a wide variety of psychiatric illnesses and as such, an innovative transdiagnostic therapy called Radically Open Dialectical Behavior Therapy (RO DBT) has been developed to treat disorders characterized by overcontrol. RO DBT targets maladaptive social signaling in order to help individuals "rejoin the tribe," hypothesizing that increasing social connectedness by means of targeting social signaling is the central mechanism of change in treatment. Because RO DBT is used for individuals with an overcontrolled personality style, rather than individual disordered symptoms, it can be used transdiagnostically across a range of comorbid disorders, including treatment-resistant depression and anxiety, anorexia nervosa, and personality disorders such as obsessivecompulsive personality disorder. The current article introduces this novel treatment approach and discusses its emphasis on social signaling and its transdiagnostic nature. We then provide the first review of existing literature testing the efficacy of RO DBT across clinical populations, discuss issues related to assessment of overcontrol, and speculate on future directions for this novel therapy.
Acceptance and commitment therapy (ACT) for anxiety disorders is a type of cognitive behavioral therapy that focuses on decreasing the behavior regulatory function of anxiety and related cognitions, and has a strong focus on behavior change that is consistent with client values. In this case series, 3 consecutive referrals seeking treatment for anxiety disorders at a private practice were treated with 9-13 sessions of ACT. In-session exposure therapy was not included to determine the effects of ACT without the compounding effects of already proven treatment procedures. The treatment procedure was identical across disorders to test the use of a unified treatment protocol for anxiety disorders: panic disorder with agoraphobia, comorbid social phobia and generalized anxiety disorder, and posttraumatic stress disorder. All participants showed clinical improvement in their specific anxiety disorders as rated on multiple standardized assessments after treatment, with gains maintained at follow-up (8 months or more). Time series assessments, taken throughout treatment, of anxiety and avoidance behaviors showed large decreases in avoidance but not in anxiety, suggesting ACT was effective by changing the way participants responded to anxiety rather than anxiety itself.
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