This class will teach you RO DBT skills and the underpinnings of RO to be able to teach clients RO DBT skills. In practice, RO is taught in class and reinforced through individual RO DBT therapy, so the consult class will teach and support clinicians in the acquisition and application of RO Skills.

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Ro dbt descRiptions

RO DBT is a type of psychotherapy that teaches specific, highly efficacious skills to help people create a life worth sharing and live more fully. In RO DBT, you learn and utilize skills and strategies that are needed to change behavior and thought patterns that interfere with a satisfying life and relationships and emotional health.

What type of RO DBT do I need?

There are three types of RO DBT; RO DBT skills training classes, individual RO DBT, and RO DBT skills coaching. Usually a combination of RO DBT skills training class and individual RO DBT or RO DBT skills coaching are suggested for the best outcomes. The actual RO DBT skills that are the foundation of the RO DBT practice are taught in a class setting. RO DBT is based on using the skills, so RO DBT group is an essential part of your RO DBT Treatment.

What is an RO DBT Skills Training Class?

The class is a 30- week cycle that teaches all the DBT skills; mindfulness, radical openness, emotion regulation, and interpersonal effectiveness. Each class lasts 1- 1.5 hours/ once a week and is structured beginning with Mindfulness (meditation), then Homework review is conducted to show how you are using your RO DBT skills to assess what is working and what isn’t working. Then, we teach the next skill, and Homework assigned for what to practice for the week.

What is individual RO DBT?

Individual RO DBT is used in conjunction with RO DBT skills training class to increase the level of care for clients with behavioral problems that significantly interfere with their quality of life and relationships. Individual RO DBT Therapy is highly structured and utilizes self- enquiry and a diary card to efficiently target the most important behaviors to address in therapy. Clients discuss life threatening behaviors (When applicable); therapeutic alliance ruptures, social signaling problems all using a structured format of behavior chain analysis. This is a very highly effective behavior change therapy.

What is RO DBT Skills Coaching?

RO DBT skills coaching is used when clients need individualized intentional focus in applying and understanding the RO DBT skills that are being taught in the class. Clients may find that RO DBT class alone does not provide the level of support that they need to really change the behaviors they are identifying as problems. RO DBT skills coaching helps clients get highly individualized support in understanding RO DBT skills, how to apply them in their lives, and gives one-on-one outside of class support for skills integration. Skills coaching with the RO DBT skills training class is a highly effective and efficient way to change and create a life worth sharing.

What is RO DBT?

Radically Open (RO) DBT is a treatment for people who have tendencies to overly control their lives. In order to feel safe and avoid vulnerability, overly controlled (OC) people hard work, self- sacrifice, avoid risk, follow rules and delay gratification. OC People tend be have very high expectations of themselves and others, tend to have a strong sense of wrong and right, and tend to have a high need for order and structure in a way that interferes with happiness, spontaneity, relaxation and relationships. OC people may feel like they are doing all the right things in their lives, and yet they are frustrated and confused that they still feel emotionally lonely, and they long for deeper connection in relationship.

RO DBT teaches us to be more flexible in our responses to life, question our actions and reactions through self- enquiry and enhance emotional vulnerability to create more intimate bonds with others. Following RO tenants helps to create “a life worth sharing” by enhancing intimacy and vulnerability. We learn the importance of social signaling, being vulnerable with others, increasing flexible responses and sharing needs to connect authentically with others. Most common RO DBT tools and building blocks for the treatment are self-enquiry, diary cards, behavior chains, and learning the RO Skills.

What are the main tenets of RO DBT?

There are seen to be three main components of emotional health in RO DBT:

• Being receptive and open to disconfirming feedback in order to learn (receptivity and openness).

• Flexible control-Flexibility to adapt to changing environmental conditions (flexible responding).

• Intimacy with at least one other person (social connectedness).

What is Radical Openness (RO)? (Lynch, 2018)

• RO is developing a passion for going opposite to where you are.

• RO is actively seeking the things that make you uncomfortable in order to learn. Challenges our perceptions of reality- “We don’t’ see things as they are, we see things as we are”.

• RO involves purposeful self -enquiry to cultivate a willingness to be wrong- with an intention to change if necessary.

Who benefits from RO DBT?

People with:

• Anorexia Nervosa

• ASD

• Treatment resistant depression

• Treatment resistant anxiety

• OCPD (Perfectionism, orderliness, and control)

• Cluster B diagnoses

• “People who tend to be serious about life, set personally high standards, work hard, behave appropriately, and frequently sacrifice personal needs in order to achieve goals or help others; yet they often feel clueless about how to join with others and establish intimate bonds”. (abct.org)

Am I Over Controlled?

Well, you may ask yourself, “Am I overcontrolled?”

So, here is a test, list of diagnoses for OC, and a checklist to see if the term fits.

Over -Control (OC) Assessment Questions (Lynch, 2018)

Do you believe it is important to do things properly or in the right way?
Are you a perfectionist–meticulous, driven to achieve, always striving to do your best at anything you try, and pushing others to do the same?
Are you cautious and careful about how you do things?
Do you prefer order and structure? Are you organized?
Do you like to plan ahead? Do you think before acting?
Are you able to delay pleasure or satisfying a desire that you have? Are you able to not act upon a strong and unreflective urge or desire?
Do you consider yourself conscientious? Are you dutiful?
Is it hard to impress you?
Does it take time to get to know you?
Are you likely to not reveal your opinion immediately but wait until you get to know someone better?

Why do I have OC tendencies? (Lynch, 2018)

Here are some Underlying Problems that lead to OC.

❏ Sensitivity to Threat

❏ Low Novelty and Risk Taking

❏ High Inhibitory control

Ok, layman’s terms- what does sensitivity to threat mean?

• Overcontrolled people are hard-wired to have a higher sensitivity to threat - we see threat faster and more frequently than most- milliseconds.

• More than even the average bear, They are constantly scanning the environment for threat and feel threat if not obvious safety.

• Being this sensitive to threat makes relationships and interactions with people feel even more risky and out of control because we focus on social comparisons and performance as well as fear of rejection.

What do you mean by low novelty seeking or risk taking?

• Most OC people avoid novelty and risk taking, especially when they are not planned- harder to be perfect.

• Being spontaneous can be very challenging for OC people as they prefer structure and predictability.

• Do you enjoy taking unplanned risk or do you prefer a predictable schedule, doing things you know well?

What is Inhibitory Control?

• Self -control that’s out of control.

• OC people have been praised for their ability to control their expression of thoughts, emotions, and behaviors.

Inhibitory control means you can voluntarily inhibit yourself.

• Do you hide your emotions and not show them to others? Do you carefully consider what you say, can you resist acting on urges, do others think that you are always in control?

What about high detail processing?

• People with OC coping styles see details that others do not.

• They can have very strong urges to correct things in the environment or other people, regardless of the impact on the relationship.

• Noticing details can be a great characteristic for work life, but being overly focused on the trees versus the forest can make it hard to relate to others.

Treatment Themes and Target Behaviors in RO DBT Treatment

❏ Emotion Inhibition

❏ Inhibiting or masking expression

❏ Smiling when distressed

❏ Needing to feel or appear like I have control

❏ Never letting people see me distressed

❏ Behavioral Avoidance

❏ Avoiding new things

❏ Avoiding ambiguous things

❏ Avoiding self-reflection

❏ Avoiding taking risks

❏ Being overly guarded or cautious

❏ Rigid Behavior

❏ Needing to be correct

❏ Needing structure

❏ Rigidity in rules

❏ Perfectionism

❏ Obsessive Planning

❏ Aloof and Distant Relationships

❏ Quickly abandoning relationships

❏ Deficits in self-disclosure and validation of others

❏ Taking secret pride in self-control

❏ Taking secret pride in not being like others

❏ Believing no one can understand me

❏ Envy and Bitterness

❏ Holding onto grudges

❏ Making frequent social comparisons

❏ Feeling underappreciated

❏ Feeling resentful, cynical, resigned, or pessimistic

❏ Feeling like a martyr

❏ Having desires for revenge

References for Further Reading

Hall, K., Astrachan-Fletcher, E., & Simic, M. The RO DBT Workbook for Eating Disorders: From Overcontrol and Loneliness to Recovery and Connection. New Harbinger: Oakland.

Lynch, T. (2018). The Skills Training manual for Radically Open Dialectical Behavior Therapy: A Clinicians Guide for Treating Disorders of Overcontrol. Context Press.

Lynch, T. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Context Press.

Lynch, T. (2015). Radically Open DBT. Episode 39 www.cbtradio.org

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