Treatment: Radically Open Dialectical Behavior Therapy for Disorders of Overcontrol
2015 EST Status: Treatment pending re-evaluation
Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status: Modest Research Support
Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Strength of Research Support
- Basic premise: Radically Open Dialectical Behavior Therapy or RO DBT significantly differs from other treatment approaches, most notably by linking the communicative functions of emotional expression to the formation of close social bonds and via skills targeting social-signaling, openness and flexible responding. RO DBT is the first treatment in the world to prioritize social-signaling as the primary mechanism of change.
- Essence of therapy: RO DBT is a transdiagnostic treatment targeting a spectrum of disorders characterized by excessive inhibitory control or overcontrol (OC). Overcontrol is associated with social isolation, loneliness, poor interpersonal functioning, and severe and difficult-to-treat mental health problems, such as anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder (e.g., Lynch & Cheavens, 2008; Zucker et al., 2007). Individuals with disorders of overcontrol are often quietly suffering, even though their suffering may not be apparent. RO DBT treatment involves both individual treatment sessions and skills training classes and centers around five OC themes: inhibited and disingenuous emotional expression; hyper-detailed focused and overly cautious behavior; rigid and rule-governed behavior; aloof and distant style of relating; and high social comparison and envy/bitterness.
- Length: The recommended and researched duration for outpatient treatment is approximately 30 weeks of concurrent individual RO DBT therapy sessions and skills training classes.
Editors: R. Trent Codd, III, Ed.S.; Roelie Hempel, PhD
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals Training Resources Measures, Handouts and Worksheets Self-help Books Smartphone Apps Video Demonstrations Video Descriptions Clinical Trials Meta-Analyses and Systematic Reviews Other Treatment Resources
Treatment Manuals / Outlines
Books Available for Purchase Through External Sites
- Radically open dialectical behavior therapy: Theory and practice for treating disorders of overcontrol (Lynch, 2018)
- The skills training manual for radically open dialectical behavior therapy: A clinician’s guide for treating disorders of overcontrol (Lynch, 2018)
Training Materials and Workshops
- Radically Open is the official training company for RO DBT. They offer introductory, intensive, and comprehensive online and offline training for mental health professionals wanting to develop Radically Open DBT services for patients with severe and difficult-to-treat mental health problems.
Measures, Handouts and Worksheets
- The RO DBT Skills Handouts and Worksheets can be downloaded from the publisher’s website.
- Assessment materials for adults: The Materials for Assessing Overcontrol from the Appendices in the RO DBT Textbook can be downloaded from the publisher’s website.
- Assessment materials for adolescents: Youth Over- and Under-Control (YOU-C) Screening Measure (Lenz et al., 2021)
- Assessment materials for children aged 4-7: The Overcontrol in Youth Checklist (OCYC) (Gilbert et al., 2019)
- Grow RO app is a companion or stand-alone application for iPhones to help people with RO DBT skills, diary card tracking, social safety activation and self-enquiry.
Videos Available for Purchase Through External Sites
- On-demand video courses and demonstrations are available here: https://radicallyopen-blendedlearning.net/
- A range of podcasts and videos about RO DBT is available for free here: https://www.radicallyopen.net/videos-and-podcasts/
- Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms (Lynch et al., 2020)
- Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT (Lynch et al., 2018)
- A Radically Open DBT informed group intervention for over-control: A controlled trial with 3-month follow-up (Keogh et al., 2016)
- Adapting dialectical behavior therapy for outpatient adult anorexia nervosa—A pilot study (Chen et al., 2014)
- Radically Open-Dialectical Behavior Therapy for adult Anorexia Nervosa: Feasibility and outcomes from an inpatient program (Lynch et al., 2013)
- Treatment of older adults with co-morbid personality disorder and depression: A dialectical behavior therapy approach (Lynch et al., 2007)
- Dialectical behavior therapy for depressed older adults: A randomized pilot study (Lynch et al., 2003)
- Radically open dialectical behaviour therapy adapted for adolescents: A case series (Baudinet et al., 2021)
- Radically open dialectical behavior therapy for anorexia nervosa: A multiple baseline single-case experimental design study across 13 cases (Isaksson et al., 2021)
- Evaluation of radically open dialectical behaviour therapy in an adult community mental health team: Effectiveness in people with autism spectrum disorders (Cornwall et al., 2020)
- Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series (Baudinet et al., 2020)
- Refractory depression – Mechanisms and Evaluation of radically open Dialectical behaviour therapy (RO-DBT) [REFRAMED]: Protocol for randomised trial (Lynch et al., 2015)
Meta-analyses and Systematic Reviews
- Radically Open Dialectical Behavior Therapy: Social signaling, transdiagnostic utility and current evidence (Gilbert et al., 2020)
Other Treatment Resources
- Special Issue on RO DBT in the Behavior Therapist (Click on Volume 41, No. 3)
- Full list of research papers on RO DBT and Overcontrol
- Blogs on RO DBT written by a range of therapists and clients
- Factsheet on RO DBT on the ABCT website
- Free access to an on-demand webinar “The Missing Dialectic: How RODBT differs from DBT” by Professor Thomas Lynch, the RO DBT treatment developer, via the mailing list sign-up of Radically Open