Have you ever thought, “I try so hard to do the right thing and yet, I feel different than the rest of my group?” Have you ever experienced sensations of depression or anxiety and tried to hide it, smiling on the outside and crying on the inside? Have you felt that no matter how hard you try to connect with others you still feel lonely? Do you long to belong but cannot fully connect with others in a way that makes you feel included in an authentic way?

Many of my clients open up about these struggles, and I have found that Radically-Open Dialectical Behavioral Therapy (RO DBT) is one of the best tools to help with these complex emotional difficulties. RO DBT is an evidence-based treatment targeting a spectrum of problems characterized by overcontrol (Lynch, 2018). Radical Openness is the primary principle that represents three capacities essential for emotional wellbeing: openness, flexibility, and social connectedness.  It means actively seeking areas of our lives that feel uncomfortable in order to learn (Lynch, 2018). It can help adults, young adults, and adolescents of different cultures cope with chronic depression, autism, anorexia nervosa, treatment-resistant anxiety, perfectionism, and obsessive-compulsive personality disorder.

How to overcome overcontrol

A major facet of RO DBT is moving from overcontrol to healthy self-control. Self-control is defined as the ability to suppress competing urges, impulses, behaviors, or desires and delay gratification in order to pursue distant goals.  It is often equated with success and happiness, whereas too much self-control or overcontrol has been linked to social isolation, rigidity, poor social functioning, and perfectionism(Lynch, 2018). Overcontrolled individuals have a superior capacity for self-control that is both their blessing and curse.  These individuals have an innate capacity to delay gratification, work harder than others, and are hyper-detail focused.  The detail focus attribute negatively impacts formation of close relationships and sense of well-being. They avoid uncertainty or unplanned risk and vigilantly search for potential disapproval in the environment. They may find that they feel different from other people and may feel distant in their relationships.  Individuals who are overcontrolled in how they cope tend to be serious about life, set high personal standards, behave appropriately, value honesty, fairness, doing the right thing, and frequently sacrifice personal needs in order to achieve desired goals or help others.

However, overcontrolled individuals often feel they don’t know how to join in with others or establish intimate bonds. Unfortunately, rigid and over-controlled coping results in poor interpersonal relationships and difficulties adapting to changing environmental circumstances. This can lead to loneliness, depression and other related problems. Thus, overcontrol works well when it comes to sitting quietly in school or building a rocket, but it creates problems when it comes to social relationships (Lynch, 2018). For that reason, the primary aim of RO DBT is to help overcontrolled individuals learn how to establish strong social bonds with others, increase openness to new experiences, and teach flexibility so that the individual can adapt to changing environmental conditions. Because overcontrolled individuals do not overtly signal pain to others as they mask their feelings, they must learn to share vulnerably with others to create lasting bonds.

What makes RO DBT different

RO DBT is separate from other models because it posits that social signaling, such as an eye roll, walking away, or a smile, is the primary mechanism of change. It teaches clients how to use non-verbal social signaling strategies to enhance social connectedness and express emotions in a contextually appropriate way.  Research shows that open expression of positive or negative emotion signals trustworthiness and social connectedness (Mauss, 2011).  This creates issues for overcontrolled individuals who often mask their inner feelings from their outward expression (i.e., social signaling) since they find it more difficult to feel safe in a social system. Additionally, an overcontrolled, non-expressive person can elicit anxiety in the onlooker, who may want to avoid interacting with them. Here’s an example: imagine talking to a peer who feels a longing to connect with you but keeps an expressionless, flat look on her face. This is not exactly super inviting!  

When individuals feel safe, they naturally experience a desire to flexibly communicate and be more open with others.  Therefore, in order to feel connection and belonging with others, expressing both positive and negative emotions in an authentic, contextually appropriate way is key.  For an overcontrolled individual to feel more happiness, it requires doing the hard thing of facing his fears.  If he can face trepidations, showcase flexibility when it is difficult, and offer vulnerability with others, he may see positive outcomes. The overcontrolled individual eventually lets down his inward protective walls to experience relationships more authentically. In my experience as a clinician, this leads to increased feelings of safety, reduced loneliness, and a new sense of freedom. He might see he does not have to “get it right” every time in order to be accepted. What an incredible sensation for someone who is used to shutting down and disconnecting due to overwhelming negative emotion!

Similarities between RO DBT and DBT

RO DBT and Dialectical Behavioral Therapy (DBT) are alike in the common roots they share in dialectics.  Marsha Linehan, the creator of DBT, defines dialectical as an integration of opposites (Linehan, 2015), meaning a method that involves the ability to view an issue from multiple perspectives where seemingly contradictory information can both be true at once. Here is a good example from Peterson (2012): I am doing the best I can now, and I need to do better at the same time.  DBT represents a dialectic in its focus on acceptance and change. In DBT, the focus is on emotional overactivity as a result of under-controlled emotional awareness of what your thoughts, feelings, and behaviors are by staying present in the current moment without judgement of your emotions, it utilizes mindfulness and other skills to improve your ability to calm and interpersonal skills.

RO DBT, on the other hand, focuses on overcontrol of the outward expression of emotion, high ability to delay gratification, and an overuse of focus on detail.  Self-control is necessary and leads to positive effects in life.  Too much of a good thing, however, leads to emotional loneliness and social-signaling deficits.  Radical openness requires actively questioning one’s biases and blocking automatic responses that avoid, regulate, inhibit, accept, or defend oneself (Lynch, 2018). It instead teaches that by openly expressing emotions in an authentic, contextually appropriate way, it will help a person find connection and belonging. When paired with loosening high standards, as well as becoming more adaptable and vulnerable with others, this therapy has the ability to help a client change patterns that have previously been resistant to change! 

Conclusion

Radically-Open Dialectical Behavioral Therapy is a great option for clients who find themselves stuck in unhelpful and intense ways of interacting within themselves.  This approach has been life-changing for many of my clients, and I have found myself teaching and applying these techniques in a wide variety of therapeutic conversations.  If you are desperate for change in your internal emotional world and desire to feel more connected in relationships, RO DBT may be a good fit for you!  Stay tuned for part 2 of this blog series to learn more about RO DBT.

Resources

Lynch, T. R., & Lynch, T. R. (2018). The skills training manual for Radically open dialectical behavior therapy: A clinician’s guide for treating disorders of overcontrol.

Linehan, M. M. (2015). DBT® skills training handouts and worksheets (2nd ed.). Guilford Press.

Mauss, I. B., Shallcross, A. J., Troy, A. S., John, O. P., Ferrer, E., Wilhelm, F. H., & Gross, J. J. (2011). Don’t hide your happiness! Positive emotion dissociation, social connectedness, and psychological functioning. Journal of Personality and Social Psychology, 100(4), 738–748.

Pederson, L., & Pederson, C. S. (2012). The expanded dialectical behavior therapy skills training manual: Practical DBT for self-help, and individual and group treatment settings. Eau Claire, WI: Premier Pub. & Media.