Dr Peter King, PhD, Executive Director at the Australian DBT Institute
Radically open dialectical behaviour therapy (RO DBT) is an evidence-based, transdiagnostic treatment targeting a spectrum of disorders characterised by excessive self-control, or ‘overcontrol’. Overcontrol is associated with social isolation, poor interpersonal functioning, perfectionism, rigidity, and lack of emotional expression, characteristics shared by a number of severe and difficult-to-treat mental health problems, such as chronic depression, anorexia nervosa, and personality disorders (PDs), most notably avoidant PD and obsessive compulsive PD (e.g., Lynch et al., 2020).
RO DBT differs significantly 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 signalling, openness and flexible responding. The treatment is fully manualized (Lynch, 2018a; 2018b) and involves individual treatment sessions as well as skills training classes. The evidence base for RO DBT extends across the age range (adolescent, adult, and older persons) and across diagnoses (e.g., depression, anorexia nervosa, autism, personality disorders).
Dr Peter King will introduce the concept of overcontrol, the associated PD’s and the importance of the bio social model and temperament in PD diagnosis.
Rebecca Ciatto, Co-Director at The Centre for RO DBT and DBT
Radically Open Dialectical Behaviour Therapy (RO DBT, Lynch, 2018) treats overcontrolled (OC) personality traits using a fully manualized transdiagnostic treatment approach. It’s particularly effective in treating cluster C personality disorders by targeting social signalling deficits to reduce loneliness, increase flexibility and openness, and increase emotional expression. In contrast, standard Dialectical Behaviour Therapy (DBT) is effective in treatment of cluster B personality traits and clients that present with undercontrolled (UC) traits.
Current services see referrals for OC clients into standard DBT programs, and this is particularly true for clients referred due to non-suicidal injury and suicidal ideation. While standard DBT provides effective tools to treat emotional dysregulation in UC clients, this may reinforce behaviours of overcontrol.
This presentation will discuss a case of an adolescent that presents with cluster C personality traits and was referred for standard DBT after a suicide attempt. The presenter will summarize the assessment tools used to determine if the client was OC or UC, discuss the implications standard DBT would have had on the client, provide examples of how the biosocial theory translates to the case, outline social signalling deficit targets and interventions used, and discuss treatment plan, obstacles and outcomes.
Tanya Gilmartin, the Victorian centre of excellence in eating disorders (CEED) and Monash University department of neuroscience.
When it comes to psychological treatment, one size does not fit all. Large-scale studies examining comorbidity have revealed two superordinate styles of maladaptive coping: undercontrolled (UC) and overcontrolled (OC) coping, which precede the development of mental health problems, including personality disorders, chronic depression and anxiety. Despite OC and UC constructs having been around for some time in various literatures (e.g., Block & Block, 1980), assessing for overcontrol is generally not part of regular clinical assessments, which can lead to misdiagnosis and being offered a treatment that does not address issues associated with overcontrol.
This presentation will introduce empirical data from two separate samples that explored the Personality Inventory for DSM-5 Short Form (PID-5-SF) as a measure to identify OC and UC maladaptive coping styles. In study 1, a k-means cluster analysis revealed clusters within the data that appeared consistent with conceptualisations of maladaptive OC and UC. In study 2, participants were classified as OC or UC following a clinical interview, and their PID-5 SF profiles explored to find patterns in the data. A more widespread understanding of how to define and assess maladaptive coping styles is expected to improve the formulation and treatment allocation of individuals presenting to treatment.