Signaling Matters: Radically Open-Dialectical Behavior Therapy for Anorexia Nervosa

Lynch, Thomas R.; Hempel, Roelie

doi:10.1007/978-981-287-104-6_163

Cited by 23 publications

(66 citation statements)

References 25 publications

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“…RO DBT is a transdiagnostic therapy designed to address a spectrum of disorders that are difficult to treat, notably chronic depression. 9 It differs from other psychotherapies, notably by encouraging social bonding through emotional expression. At the time of the trial RO DBT comprised 29 weekly individual therapy sessions each lasting an hour and 27 skills training classes each lasting 2.5 h. 9,12 The RO DBT lesson plan (supplementary Table 1 available at ) included new RO DBT lessons 9 and standard DBT lessons.…”

Section: Methodsmentioning

confidence: 99%

“…Radically open dialectical behaviour therapy (RO DBT), a novel transdiagnostic psychotherapy, aims to address this rigid coping style. 9 Earlier versions of RO DBT showed promise in two pilot randomised trials of patients with refractory depression and comorbid personality disorders. 10,11 This trial aimed to assess the efficacy of RO DBT for refractory depression, 12 and whether RO DBT causes identifiable harms.…”

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confidence: 99%

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Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms

et al. 2019

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BackgroundIndividuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.AimsTo compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).MethodRO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.ResultsAfter 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.ConclusionsThe RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.

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Section: Methodsmentioning

confidence: 99%

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Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms

et al. 2019

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“…RO DBT is a transdiagnostic therapy designed to address a spectrum of disorders that are difficult to treat, in particular chronic depression. 8 It differs from other psychotherapies most notably by encouraging social bonding through emotional expression and ‘social signalling’, defined as any behaviour that an individual performs in the presence of another person, regardless of intention or awareness. At the time of the trial, RO DBT comprised 29 weekly individual therapy sessions each lasting 1 h and 27 skills training classes each lasting 2.5 h. 3,8 Although participants continued to receive antidepressant medication as prescribed, we strongly discouraged them from seeking additional psychotherapy during RO DBT.…”

Section: Methodsmentioning

confidence: 99%

Refractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial

Shearer

Lynch

Chamba³

et al. 2019

BJPsych open

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BackgroundRefractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.AimsTo estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627).MethodWe undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life.ResultsThe additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE £30 000 threshold.ConclusionsIn its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.Declaration of interestR.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor & Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.

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“…In the field of psychotherapy research, the distinction between over- and underregulated emotional states and its relevance to psychotherapy have been made explicit [ 8 , 10 , 15 , 26 ]. According to Corcoran and colleagues [ 27 ], “one way to classify psychiatric disorders is to consider the degree to which emotions, reported within their syndromal presentation, are over or underregulated.” Greenberg [ 28 ] states that one guiding factor for integrative psychotherapy interventions may be the type of affect dysregulation involved (too little or too much emotion).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, more recently, radically open dialectical behavior therapy was developed for individuals with disorders characterized by overcontrol [ 26 , 31 , 32 ]. Emotional loneliness is seen as an important problem in disorders characterized by overcontrol [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial

et al. 2020

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Background Emotion regulation has been identified as an important transdiagnostic factor relevant to the treatment of mental health disorders. Many empirically validated psychotherapeutic treatments incorporate elements targeting emotion regulation. Most of these treatment approaches are conceptualized as standard face-to-face treatments not as blended treatments, which include an internet-based intervention. Objective The aim of this study is to examine, for the first time, a new internet-based intervention—REMOTION—that will be provided transdiagnostically, as an add-on to psychotherapy, to provide a blended treatment format. Methods A total of 70 participants will be assigned (1:1 allocation ratio) to either the intervention group (REMOTION + psychotherapy) or the treatment-as-usual group that receives psychotherapy alone. To maximize external validity, a typical outpatient treatment sample of patients diagnosed with a range of disorders such as depression, anxiety disorders, and adjustment disorder will be recruited from a university outpatient clinic. Patients with bipolar disorder, psychotic disorders, or acute suicidality will be excluded from the study. The feasibility and potential effectiveness of the intervention will be examined by assessing data at baseline, 6 weeks (post), and 12 weeks (follow-up). The primary outcome is general symptom severity, assessed with the Brief Symptom Inventory. Secondary outcomes are emotion regulation, depressive symptoms, anxiety symptoms, health related quality of life, well-being, and a variety of feasibility parameters. Quantitative data will be analyzed on an intention-to-treat basis. Results Participant recruitment and data collection started in February 2020, and as of November 2020, are ongoing. Results for the study are expected in 2022. Conclusions This pilot randomized controlled trial will inform future studies using transdiagnostic blended treatment. Trial Registration ClinicalTrials.gov NCT04262726; http://clinicaltrials.gov/ct2/show/NCT04262726 International Registered Report Identifier (IRRID) DERR1-10.2196/20936

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Signaling Matters: Radically Open-Dialectical Behavior Therapy for Anorexia Nervosa

Cited by 23 publications

References 25 publications

Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms

Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms

Refractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial

REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial

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