Radically Open Dialectical Behavior Therapy (RO-DBT) for Teens and Young Adults: A Treatment For Overcontrolled Copers

Radically open Dialectical Behavior Therapy (RO DBT) is an evidence-based treatment for individuals who cope with their emotions by exercising excessive self-control. While it can be adaptive to be in control, research indicates that there is a zone of optimal control, and certain individuals struggle to find a healthy balance. Ultimately, this can create impairments in functioning, and causes feelings of loneliness and isolation.

An overcontrolled (OC) coper may exhibit the following:

  • Consistently trying to find ways to feel and be in control

  • Compulsive striving

  • Excessive delay of gratification

  • A need to ‘win’- at school, work, or even in social relationships

  • Perfectionistic or ‘Type A’ tendencies

  • Emotional suppression or closedness 

  • A social life that either does not exist or that feels unsatisfying 

  • Dysregulation if things feel out of control

  • A need to compare oneself to others, causing envy and bitterness

And exercising covert and overt behaviors to emotionally regulate. Examples include:

  • Food restriction

  • Self-injurious and/or suicidal behavior

  • Creation and adherence to rigid, rule governed behavior 

  • Working harder even when exhausted

  • Rumination

OUR APPROACH

We are intensively trained in RO DBT. Dr. Hamlet spent two weeks learning from the treatment’s founder, Dr. Thomas Lynch. Other practice clinicians were intensively trained by senior RO DBT clinicians. All Hamlet Therapy clinicians partake in a weekly RO DBT consultation team meeting for peer to peer support. Additionally, we receive additional supervision from a senior RO DBT trained clinician on a regular basis.  

We currently use RO DBT to treat clients of all ages and their families who struggle with disorders of overcontrol. Disorders that fall into the category of overcontrol include anorexia nervosa, obsessive-compulsive personality, avoidant personality, dependent personality, autism spectrum disorders, and treatment resistant anxiety or depression. Treatment consists of:

  • A consultation or evaluation to determine goodness of fit for the treatment

  • Individual treatment, usually 45 minutes weekly where patients work on specific problem behaviors and apply techniques learned in the skills class to their goals 

  • Skills class, where OC copers learn healthier ways of approaching their stressors

  • Coaching, where the patient can reach out to their therapist for in the moment support outside of the therapy appointment time

  • Consultation for the therapist, which consists of a group of practitioners who are trained in RO DBT. Here, we seek support and share knowledge to best support our OC patients and their families.

  • Separate parent consultation as needed 

In individual therapy, we work with patients on attaining psychological health by targeting the following general areas:

  • Flexibility to one’s ever changing environment

  • Receptivity and openness to learning from others

  • Increased connectedness and deepening of relationships

In skills class, we teach OC copers:

  • Mindfulness, to increase awareness of thoughts, feelings, body sensations with the goal of increasing openness, learning, and adopting new ways of approaching stressors

  • The science behind emotions

  • How to approach envy, bitterness, resentment, and shame skillfully

  • How to engage in novel behavior

  • How to forgive and let go of grudges

  • How to be flexible and to participate without planning

  • How to accept feedback 

  • How to signal genuineness and vulnerability to others in an effort to increase connection socially 

Skills class ranges from 20-25 weeks for one cycle and occurs weekly for 90 minutes. Patients may choose to repeat a cycle to deepen their skills proficiency. Skills class is generally available for teens and young adults.*

Treatment is usually most effective with all components working in tandem, however the model can be flexible. It is possible for example to join a skills class and continue with a provider who is not trained in RO DBT. Additionally, it is possible to start with individual RO DBT treatment and not partake in skills class.

*Skills class for Fall 2024 is currently open for enrollment. Contact Hamlet Therapy to request more information or enroll.

For more information on RO DBT, click here.