<p>Radically Open Dialectical Behavior Therapy: Social Signaling, Transdiagnostic Utility and Current Evidence</p>

Abstract

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.

Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series

“…The current conceptualisation of maladaptive overcontrol is defined by four core difficulties; a) low openness and tolerance of uncertainty b) cognitive and behavioural rigidity and inflexibility, c) pervasive inhibited emotional expression and emotional awareness, and d) low social connectedness and intimacy which is often manifested in aloof and distant relationships [35]. Other markers of overcontrol include low reward sensitivity, high threat sensitivity, high inhibitory control and high attention to detail [35,36]. Conversely, undercontrol is characterised by low inhibitory control (e.g.…”

“…Conversely, undercontrol is characterised by low inhibitory control (e.g. impulsivity, disinhibition, novelty seeking, affective lability) and a more chaotic pattern of relationships [35,36]. Overcontrol has been associated with internalising disorders, whereas undercontrol with externalising disorders [37].…”

Evaluation of radically open dialectical behaviour therapy in an adult community mental health team: effectiveness in people with autism spectrum disorders

“…2 However, NHS Digital reported that women made up only 45% of qualified doctors in the UK in 2018 and 64% of consultant posts were held by men. 3 This suggests that women are more likely to leave medicine or fail to progress to consultant grade than their male counterparts. Gender balance also varies between…”

“…2 Radically open dialectical behaviour therapy (RO DBT) has been developed as an adapted form of dialectical behaviour therapy to directly target overcontrol, and is now supported by several controlled clinical trials. 3 The therapy introduces strategies to improve social connectedness and intimacy and to reduce social isolation by improving emotional expression and the ability to respond more flexibly. The primary mechanism of change is through social signalling.…”

Radically Open Dialectical Behavior Therapy (RO DBT) in the treatment of perfectionism: A case study

“…RO DBT is a manualized, evidence‐based (see Gilbert et al, 2020 for a review of the outcome literature), transdiagnostic treatment for problems resulting from maladaptive overcontrol. The treatment involves weekly individual therapy with concurrent client participation in a weekly skills class initiated at the third session and continuing for 30 weeks.…”