Open radical dialectic behavior therapy (RO DBT) is an empirically based, empirical, psycho-therapy-based psychotherapeutic intervention designed to treat a disorder spectrum characterized by over-control of overcontrol, or overcontrol (OC). Informed by more than 20 years of clinical and experimental research, RO DBT is based on biosocial theory that identifies factors (in particular, individual differences in temperament, environmental influences, perceptions/judgments and inhibitory/regulatory control) leading to rigid coping and exaggerated forces that underlie various kinds of psychopathology. RO DBT is aimed at doctors who deal with clients with chronic problems such as refractory depression, anorexia nervosa, and obsessive-compulsive personality disorder. The treatment is fully manual and is accompanied by separate radical disclosure training (RO) training which presents twenty RO skills, class exercises, leaflets and worksheets, and detailed notes for instructors.
While incorporating basic cognitive and dialectical principles, therapeutic strategies, core skills, and theoretical perspectives used in DBT RO differ dramatically from other treatment approaches, including standard DBT. In contrast to interventions designed to treat emotional dysregulation, DBT RO considers emotional loneliness as the core problem facing its patients. Thus, RO targets the communicative function of emotional expression associated with the establishment of a close relationship with altering neurophysiological stimuli and teaching skills that target social-signaling.
Video Radically Open Dialectical Behavior Therapy
Histori
The initial framework for RO DBT emerged from Thomas R. Lynch's research on diagnostic comorbidities, personality disorders, and emotional regulation. The development of treatment is a recurring process - ie clinical observation leading to experimental theory and research, which informs further clinical work - the final outcome into a comprehensive treatment package informed by the transdiagnostic personality model and socio-emotional function. Later Lynch work precursors that focus on uncontrollable and over controlled personality styles can be seen in initial research on two personality variables - a high need for affiliation with others (dependence/sociotrophy) and a high need for independence and achievement (autonomy ) - and his interest in this, in turn, is related to relationship conflict, communication problems, partner dissatisfaction, and depression. In addition, preliminary studies examined the role of mediation inhibition of emotional expression between temperaments (eg, affects intensity) and psychological pressure were the catalysts for the development of key change hypothesis mechanisms in DBT RO (ie, open expression = trust = social connectivity).
Attempts to understand excessive control have led to significant reforms of optimal mental health and wellbeing. Although self-regulation is often equated with the ability to achieve success and happiness in life, overly controlled patients seem to have too many "good" things. Lynch observes that although OC patients are often very successful because they are able to hamper their search for short-term rewards (often fun) to pursue distal goals, their problem is that they do not seem to be able to relax even if they want to. Following this realization, Lynch argues that mental health is less about achieving happiness or success, as this experience is temporary, but rather the ability to Maps Radically Open Dialectical Behavior Therapy
Overcontrol
The ability to inhibit emotional impulses, impulses, and behaviors to pursue long-term goals is evolutionary prosocialism; thus, in most societies, the ability to control oneself is valued and linked to success. Greater capacity for self-control has been linked to positive outcomes in child and adult populations, including better performance in school and work settings, better relationship functioning, and better overall psychological adjustment. However, too much self-control can be just as problematic. Excessive self-control is associated with social isolation, poor interpersonal function, perfectionism, stiffness, lack of emotional expression, and severe and untreatable mental health problems, such as anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder.
Related to that, the Diagnostic and Statistical Manual-Fifth Edition examination shows that PD involves pervasive problems with emotional/impulse control and interpersonal relationships - features associated with undercontrol and overcontrol, which overlap with a well-established division between internalization and externalization disturbances. The core similarities of PD that are characterized by overcontrol (ie paranoid, obsessive-compulsive, and avoidant styles) are (i) a strong desire to control one's environment; (ii) controlled emotional expression; (iii) limited social interaction/social problems with close relationships (due to distrust, indifference, distance, fear or rejection/criticism); and (iv) cognitive and behavioral rigidity.
Personality researchers have supported the usefulness of this broad approach through the identification of a strong hierarchy of personality dimensional structures with clear links to social functions and psychological disorders. While under-controlled, impulsive, dramatic, emotionally expressive children have been shown to be more likely to develop disruption of externalization, overcontrolled, emotionally limited, avoiding the risk of children more likely to develop internalized disorders and become socially isolated in adulthood.
Lynch argues that the above observations have obvious medical implications. Treatments targeting undercontrol problems should aim to improve inhibition control and reduce mood-dependent behaviors, while treatments targeting overcontrol problems require interventions designed to reduce inhibitory control and improve emotional expression, acceptance, and flexibility. However, there is a scarcity of research that checks for overcontrol disorder, despite evidence that they are highly prevalent and associated with impaired function and increased use of health care services. Indeed, obsessive-compulsive PD, prototypical overcontrol disorder, is the most common personality disorder in the community as well as a clinical sample. The following table provides a brief overview of the core differences between overcontrol and uncontrolled control in biotemperament, social introduction, and family/environmental strengthening.
Background and Overview
RO DBT shares some similarities with its predecessors, but differs in many important respects. The development of RO DBT has been informed by various philosophical, etiological, and treatment models and approaches. Mainly, it consists of dialectical philosophy and dialectical behavioral therapy, an awareness-based approach, cognitive behavioral therapy, Gestalt therapy, motivational interviews, basic emotional theories, affective neural sciences, personality and developmental theories, evolutionary theories, and MalÃÆ'§Â die Sufism.
RO DBT places the OC phenotype to be characterized by four core deficits: low acceptance and openness (eg, low disclosure of confusing feedback, avoid ambiguity or uncertainty, hypervigilance against potential threats), low flexible controls (eg the need for structure and order , perfectionism, compulsive planning, rigid and regulated behavior), stunted emotional expression (eg, negative emotional suppression, inappropriate emotional expression, lack of reporting of distress), and low social connectivity (eg, aloof and distant relationships, jealousy and bitterness, reducing empathy). Overcontrol disorder is common and also they are least likely to respond to treatment. RO DBT argues that individuals often fail to respond to interventions because most treatment approaches are based on false assumptions that the categories of disorders are homogeneous. For example, about 40-60% of unipolar depression clients also meet the criteria for comorbid personality disorder.
RO DBT rests on the biosocial overcontrol theory derived from empirical research on the neuroregulator processes involved in autonomous functions. According to the DBT RO model, the OC is considered to be a product of the genetic disposition of high inhibitory control, early environmental experiences, and avoidance and rigid coping styles that limit a person's ability to learn from past experiences and adjust behavior; these factors inhibit the formation of close relationships. More specifically, OC manifests bio-temperaments through increased threat sensitivity, reduced reward sensitivity, high inhibition control capacity, and superior attention to detail. This trend interacts with early family/cultural experiences that overstate the emotional, perfectionist, high performance, and strict adherence to strict personal rules and standards. Overcontrolled coping - characterized by inhibited expression, risk aversion, perfectionism, distress, excessive tolerance, and secret expression - arises through this "nature-nurturing" transaction. This interceptive force is intermittently reinforced negatively by a reduction in passion associated with avoidance of the dreaded situation, and is positively reinforced by performance or performance.
Core Weaving RO DBT
- Humans are a tribe naturally. The survival of our species requires capacity building to form long-term social ties, share valuable resources, and work together in tribes or groups.
- Psychological health involves meeting three factors: acceptance, flexibility, and social relationships.
- The genotypic/phenotypic differences between groups of disorders require different treatment approaches.
- Overcontrol is a multi-faceted paradigm - involving complex transactions between biology, the environment, and coping.
- Bio-temperamental deficits make the behavior response more rigid and less able to adapt flexibly to changing environmental conditions.
- It takes a willingness to "turn off" the determination!
- Social incriminating things! The deficit in pro-social signaling represents a core problem for too much disorder and is considered the source of their emotional loneliness.
- Radical disclosure assumes ' we do not see things as they are - we see things like us '.
- One of the secrets of 'healthy living' is the cultivation of 'healthy self-doubt' .
- The radical openness and self-inquiry is an experience - they are not something that can be understood only through intellectual means. The therapist needs to practice the radical openness itself to model it to the client.
Distinguishing Features
RO DBT is the first treatment to prioritize social signaling as the primary mechanism of change by linking the communicative function of human emotions to the formation of social relationships. RO DBT also differs from most other treatments in stating that the wellbeing of individuals can not be separated from the feelings and responses of larger groups or communities. Thus, what one feels or feels inside or personal is considered less important in the DBT RO than with other treatments, whereas the way a person gestures their inner experience to other members of the tribe is of the utmost importance, and the focus is on the impact of social signal on social connectivity.
Psychological health or wellbeing in RO DBT is hypothesized to involve three core transaction features: 1) Reception and openness to new experiences and confusing feedback, to learn, 2) Flexible control, Familiarity and social connectivity (with at least one other person), based on the place that survival requires the ability to form long-term bonds and work in groups or tribes. The basic idea is that OC clients are more likely to benefit from a treatment approach that emphasizes openness, honest emotional expression, flexibility, and social connectivity - rather than approaches that judge selfless awareness, self-limitation, impulse control, or delayed satisfaction.
Radical Disclosure is the core philosophical principle and core skill in RO DBT. As a state of mind, it entails a willingness to submit prejudices about how the world should be. Thus, the core principle in DBT RO is that the individual's perception and regulatory bias makes it impossible for him to achieve high self-awareness in isolation; we need others to show our blind point. Other distinguishing features include:
- RO DBT breaks down emotional regulation into three temporal elements that transact; (1) perceptual coding factors (regulation of sensory receptors) that precedes (2) internal modulation factors (cognitive central regulation) which then results in (3) external behavioral expressions and concrete actions (regulation of response selection). Separating external rules from internal rules helps to explain why one can "feel" anxiety inside but shows no sign of outside "inside" anxiety.
- RO DBT can be distinguished from other awareness-based approaches through its emphasis on the principles of radical openness and self-inquiry practice.
- RO DBT is also somewhat different from other behavioral approaches by training therapists to be wary of subtle emotional expression in sessions, changes in eye or contact direction, posture shift, change in tone or speed of speech, and length of verbal responses - and to recognize they are a possible social signal.
- RO DBT argues that the human emotional expression develops not only to communicate intentions, but to facilitate the formation of strong social ties and altruistic behavior among unrelated individuals. As a result, RO DBT teaches social non-verbal therapist-signaling strategies designed to increase client engagement and learning - for example, movements, postures, and facial expressions that universally signal openness, non-domination, and friendly intentions. This non-verbal strategy often differs considerably from how the therapist has been trained in other therapies.
- RO DBT teaches the therapist how to balance the displeasure of playing with compassionate gravity, and using therapeutic temptations as the core means to challenge maladaptive behavior.
- RO DBT does not consider medication compliance, commitment statements, or lack of conflict as a strong indicator of therapeutic relationships. Indeed, the breakup of the alliance (which is corrected) is seen as evidence of the work of a strong therapeutic relationship within the DBT RO.
- RO DBT introduces an entirely unique approach to the use of behavioral exposure with special relevance to the OC population - which involves conditioning rewards experiences beneficial for short exposures to tribal participation (Lynch, 2018a).
- DBT RO's skills take a "bottom-up" approach to transforming too early and maladaptive strategies that perpetuate OC. By activating complex ventral vagal areas associated with feelings of social security (through intentional modification of clear and secret body language, facial expressions, and emotional expression), DBT RO uses physiology as a therapeutic change mechanism.
Structure and Target Treatment
RO DBT is usually given in outpatient care settings. RO DBT outpatient has four components delivered over an average of 30 weeks, including:
- Weekly individual therapy (one hour in duration)
- Weekly skills training class (2.5 hours duration with 15 minutes break)
- Phone consultation (optional, and used by patients less than in standard DBT)
- Therapist participation in RO DBT consultation meetings (optional)
The main objective of RO DBT involves a decrease of problem overcontrol and indifference/distance, while increasing flexibility, openness, and vulnerable emotional expression. RO DBT identifies restricted social signals as a major source of emotional loneliness and isolation of internal experience (eg, negative emotions, harsh self-assessment, distorted thinking); hence, treatment strategies are designed to enhance social linkage through prosocial signaling and honest expression.
There are three ways in which RO DBT incorporates these goals into care interventions:
- Teaches clients the context of appropriate emotional expression and nonverbal signaling strategies that have been shown to improve social relationships.
- It targets OC deficits and excesses by teaching the skills of OC clients designed to activate areas of the brain associated with social security systems, and encourage clients to use these skills before engaging in social interaction. This approach allows overly controlled clients to naturally send nonverbal friendship signals, thus facilitating mutual responses from others.
- Teach the therapist how to gain activation of the social security system on their clients by educating them about the use of deliberate body movements, postures, and facial expressions that communicate relaxation, hospitality, and non-domination. This aspect of care highlights the need of therapists to practice radical disclosure skills in their personal lives, because overcontrolled clients may not believe that it is socially acceptable to play, relax, admit mistakes, or openly express emotions unless their therapist modeled such behavior first./li>
Assessment
Clinical assessment of OC is a multi-step process. Questionnaires relevant to OC are used to identify core features and integrate with data obtained from clinical interviews. The doctor then completes the OC Global Prototype Rating Scale and determines whether the client appears to be more compatible with a Highly-Resented or Overly Repressed subtype. Finally, clinical impression-assessed by the nature of OC is used to complement diagnostic impressions and guide care planning. This instrument can be found in the DBT RO treatment manual.
Research Support
RO DBT is supported by numerous studies, including two randomized controlled trials of NIMH (RCT) targeting refractory depression and comorbid personality dysfunction of OC, two trials targeting adult Anorexia Nervosa, a non-randomized trial using DBT RO skills with adults resistance to treatment with excessive control trends, and large multi-center ongoing RCTs targeting refractory depression and excessive personality disorder.
Training and consultancy
The central point of contact for training and supervision at RO DBT is Radically Open Ltd. The company offers intensive training and a detailed list of upcoming introductory lessons that can be found on their website.
References
Source of the article : Wikipedia
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