Institute 5 - Targeting Emotional Loneliness Using Radically Open Dialectical Behavior Therapy: Theory and Assessment of Overcontrol

Emotional loneliness and social isolation are key risk factors for mental and physical health and are seen as the core problems for clients struggling with maladaptive overcontrol. Maladaptive overcontrol is a coping style characterized by excessive inhibition, compulsive planning, and aloof relationships that limit new learning and the development of close social bonds. Overcontrol is common in clients with chronic depression, restrictive eating disorders, obsessive-compulsive personality disorders, social anxiety, and autism, for example.
Radically open dialectical behavior therapy (RO DBT) aims to address clients’ emotional loneliness by teaching them skills to enhance their flexibility, openness to new learning, and above all, their social signaling. RO DBT’s key mechanism of change proposes that context-appropriate social signaling enhances trust, resulting in improved social connectedness and mental health. RO DBT is a fully manualized (Lynch, 2018) and evidence-based transdiagnostic treatment for disorders of overcontrol, supported by research demonstrating its effectiveness for adults and adolescents with anorexia nervosa, chronic depression, personality disorders and autism spectrum disorders (for a systematic review, see Hatoum & Burton, 2024).
The aim of this institute is to learn the foundations of RO DBT and assess whether RO DBT could benefit your overcontrolled clients. You will learn how to recognize and assess clients with overcontrol, as well as understand the basic treatment structure, and consider how to implement RO DBT in your own practice. Using role-plays, exercises and demonstrations, the instructors will engage the audience and provide you with the tools to assess overcontrolled clients within your practice.

Outline:
• Review of the evidence-base of RO DBT
• The differences between over- and undercontrol
• Assessing overcontrol
• Introduction to RO DBT Treatment Structure and Targeting

Recommended Reading 1: Hatoum, A. H., & Burton, A. L. (2024). Applications and efficacy of radically open dialectical behavior therapy (RO DBT): A systematic review of the literature. Journal of Clinical Psychology, Advance online publication(1097-4679 (Electronic)). https://doi.org/https://doi.org/10.1002/jclp.23735

Recommended Reading 2: Baudinet, J., Stewart, C., Bennett, E., Konstantellou, A., Parham, R., Smith, K., Hunt, K., Eisler, I., & Simic, M. (2021). Radically open dialectical behaviour therapy adapted for adolescents: a case series. BMC Psychiatry, 21(1), 462. https://doi.org/10.1186/s12888-021-03460-3

Recommended Reading 3: Lynch, T. R., Hempel, R. J., Whalley, B., Byford, S., Chamba, R., Clarke, P., Clarke, S., Kingdon, D. G., O'Mahen, H., Remington, B., Rushbrook, S. C., Shearer, J., Stanton, M., Swales, M., Watkins, A., & Russell, I. T. (2020). Refractory depression - mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms. Br J Psychiatry, 216(4), 204-212. https://doi.org/10.1192/bjp.2019.53

Recommended Reading 4: Gilbert, K., Codd, R. T., Hoyniak, C., Tillman, R., Baudinet, J., Pires, P. P., Hempel, R., Russell, I., & Lynch, T. R. (2023). Processes of change in a randomized clinical trial of radically open dialectical behavior therapy (RO DBT) for adults with treatment-refractory depression. J Consult Clin Psychol, 91(2), 71-81. https://doi.org/10.1037/ccp0000795

Recommended Reading 5: Hempel, R. J., Rushbrook, S. C., O'Mahen, H., & Lynch, T. R. (2018). How to Differentiate Overcontrol from Undercontrol: Findings from the RefraMED study and Guidelines from Clinical Practice. The Behavior Therapist, 41(3), 132-142.