We spend our lives trying to create an enjoyable and shareable life. Sure, we experience ups and downs, but we can flounder when the difficulties outweigh the joys. The good news is that therapy — specifically targeted therapy designed just for your struggles — can make all the difference in the world. Two such therapies are Dialectical Behavioral Therapy (DBT) and Radically Open Dialectical Behavior Therapy (RO-DBT).
“Dialectical therapies teach patients skills that have both traditional CBT (cognitive behavioral therapy) and change-oriented strategies, but also balance this with acceptance-oriented strategies or more mindfulness-based strategies. They have to do with being in the present moment and accepting and tolerating distress,” says Dr. Laurie Little, staff psychologist.
“Think of CBT as the big umbrella of treatments,” says Dr. Brett Dowdy, chief patient experience officer & chief of psychological services. “DBT and RO-DBT would still be under that umbrella.”
Despite their overlapping theoretical principles, DBT and RO-DBT differ in their treatment targets, skills and goals. DBT focuses on helping emotionally dysregulated individuals manage their difficult emotions and decrease harmful behaviors. RO-DBT focuses on helping emotionally inhibited individuals be more open, flexible and vulnerable in order to increase connection.
The Lindner Center of HOPE is a premier provider of both DBT and RO-DBT for adults and adolescents. Both therapies are integrated into all levels of care, including numerous outpatient skill classes open to the community. “Offering these effective evidence-based therapies sets us apart from other treatment providers in the area,” says Dr. Allison Mecca, staff psychologist and co-director of the RO-DBT treatment team. “Especially one as new and innovative as RO-DBT.”
When deciding the best treatment fit, the first thing therapists do at Lindner Center of HOPE is complete a biosocial assessment of their patient’s functioning and temperaments. They want to know biologically how the patient’s brain is wired to respond, and how their social experiences have shaped them to navigate and cope with the world. One of the important aspects of temperament they consider is their coping style, which is on a spectrum between overcontrolled and undercontrolled coping.
“Our goal is to help people get to that middle, to live in a stable and flexible state,” Dr. Mecca says. “For someone presenting with high distress and impulsive behaviors (undercontrolled), we teach them to downregulate and tolerate distress through DBT. For someone who is rigid and suppresses their emotion (overcontrolled), we teach them how to put more of themselves out into the world and take life less seriously through RO-DBT.”
Dialectical Behavioral Therapy was developed first by psychologist Dr. Marsha Linehan. Initially, DBT was developed to treat individuals with borderline personality disorder. Through extensive research and clinical practice, DBT has become a multi-diagnostic treatment, meaning it is effective in treating many disorders, including addictions, eating disorders, trauma, depression, anxiety and impulse disorders.
In general, DBT is a good fit for those with an undercontrolled temperament or symptom presentation. “Those who do great with DBT are people who become intensely dysregulated with unwanted or uncomfortable emotions, whether that’s anger, depression or anxiety that are quickly intensified with their feelings,” says Dr. Jennifer Farley, associate chief of psychology. “They may have a typical trigger, but they are much more sensitive, and their reaction is much more intense. The duration of their intensity lasts longer than anticipated for healthy people who might have an experience with a stressor.” This emotional dysregulation leads people to respond in ways that create more suffering such as self-harm, self-medication or self-sabotage.
Dialectical Behavior Therapy helps individuals build a life worth living despite their pain by focusing on four major skills: mindful awareness, distress tolerance, emotional regulation and interpersonal relationship skills.
Further, DBT can be a first-line treatment for people who present with trauma. Therapists might recommend they participate in DBT class and therapy first to manage the everyday
triggers of their experiences. “When they become skillful at doing that, that’s when we recommend that they delve further into trauma,” Dr. Farley says. “But without the skills they would learn from DBT, they can become quickly dysregulated, and their functioning can be even more negatively impacted if they are not adequately skillful with managing those feelings.”
Whereas DBT targets emotional dysregulation, RO-DBT targets emotional loneliness. RO-DBT was developed by Dr. Thomas R. Lynch for disorders of emotional overcontrol. Though self-control is often highly prized and rewarded by our society, too much self-control can create a host of difficulties, including social isolation and poor interpersonal relationships.
In general, RO-DBT is a good fit for those with an overcontrolled temperament or symptom presentation. People who can benefit from RO-DBT are those who appear to “have it all together” on the surface, but who are emotionally disconnected, overly inhibited and experience loneliness. Although they may be great problem-solvers, they struggle to form vulnerable, long-lasting connections with others. Those with an
overcontrolled temperament often experience chronic depression, anxiety, OCD and anorexia because of that human disconnect.
RO-DBT is designed to help individuals build a life worth sharing with others and focuses on helping them build authentic connection. The primary treatment targets and skills focus on improving social signaling, enhancing receptivity and openness, and increasing interpersonal connection.
The Right Support
As one of the only providers of RO-DBT in the area, Lindner Center staff have enjoyed witnessing the transformation in patients who have received treatment. Many have tried other forms of DBT and CBT without much success and found RO-DBT to make all the difference. “Many of my patients say the skills are life-changing for them,” Dr. Little says.
Excitingly, Lindner Center of HOPE has adapted both DBT and RO-DBT classes to a virtual model, which means that based on the provider, the classes are available to adults across 26 states. “It allows for these life-changing treatments to be more accessible and manageable,” Dr. Mecca says, especially given the treatments require weekly class attendance for six to seven months to establish effective outcomes.
It is important to note that sometimes people come into DBT or RO-DBT thinking that their overcontrol or undercontrol is a problem that needs to be fixed. Sidney Hays, an outpatient therapist, notes that an important part of the treatment is recognizing that humans develop such coping skills for a reason.
“Patients need to understand that there are some situations in which these attributes are really helpful,” Hays says. “But when we take these skills we’ve learned and globalize them to all our relationships and situations, it can create some problems. It’s not about making overcontrolled people not overcontrolled or undercontrolled people not undercontrolled but rather looking at the skills and finding the best time to use them. Also, we discuss other skills that might make them more effective in reaching their goals.”
“Despite their differences, DBT and RO-DBT are designed to meet people where they are and help them connect with their most authentic and balanced selves,” Dr. Mecca says. “In short, with DBT, the purpose is to create a life worth living. With RO-DBT, the purpose is to create a life worth sharing.”
Are you struggling to regulate your emotions or connect with others? Visit lindnercenterofhope.org or call 513-536-4673 for more information. Lindner Center of HOPE is located at 4075 Old Western Row Rd., Cincinnati, Ohio 45040.