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What Puts the RO in RODBT?

By Elizabeth Weiner,  LMFT

Clients seeking eating disorder recovery have already had some experience with traditional DBT. They may report that they know all the DBT acronyms. However, I have also heard several clients emphatically state, “I’m not doing ANY more DBT!” Unfortunately, the traditional DBT model can feel like an experience of mis-attunement for clients with a tendency toward overcontrol (OC, characterized by rigidity, perfectionism, and inhibition of feelings). Contrastingly, individuals that lean toward undercontrol (UC, characterized by impulsivity and immediate expression of feelings) are more likely to feel aligned with the goals of DBT.

RODBT seeks to correct this overgeneralization by allowing our overcontrolled clients to have their clinical needs addressed more accurately. Research on RODBT in the treatment of eating disorders indicates that restricting and atypical anorexia nervosa (AN) have the highest levels of overcontrol, that Borderline Personality Disorder had the highest level of undercontrol, and that bulimia and the community sample were in-between (Isaksson,Ghaderi,and Wolf-Arehult, 2021). That being said, a treatment geared towards overcontrol is more appropriate for recovery from AN.

What puts the RO in RODBT? The RO refers to Radical Openness. Radical Openness means being open to new information or disconfirming feedback to learn new ways of experiencing ourselves and others.

4 CORE themes are targeted in RODBT…

  • RECEPTIVITY & OPENNESS TO NEW EXPERIENCE & DISCONFIRMING FEEDBACK
  • FLEXIBLE CONTROL
  • INTIMACY AND SOCIAL CONNECTEDNESS WITH AT LEAST ONE OTHER PERSON
  • EMOTIONAL EXPRESSION AND AWARENESS

You may also be familiar with the popular term “growth mindset”. Growth mindset is akin to radical openness in that both are related to trying new things and experiencing failure and setbacks along the way. Both of these concepts are geared toward individuals who “present well” and appear to be “high achieving” or “highly disciplined”. Both promote uncertainty and even incompetence as essential for learning. Are you getting a little uneasy at the sound of experiencing feelings of uncertainty and incompetence? Can you notice any signs of aversion to those words as you read them?

If so, RODBT may be just the thing for you!

In RODBT, the clinician takes on a role of actively engaging in spontaneous and playful activities with group participants. The facilitator is also less directive, encourages independence of action and opinion, and emphasizes self-enquiry and self-discovery. In RO, the therapist and the participants work together to reward candid disclosure and uninhibited expression of emotion.

DBT promises to teach emotion regulation skills, behavioral control, impulse control, and delaying of gratification. In contrast, delaying gratification and restraining impulses are just a few of the areas in which AN clients are likely too skilled. Dr. Lynch (developer of RODBT) often refers to these clients as having “too much of a good thing!” In my groups and individual sessions, I tend to reframe these skills as being useful for delaying impulses to engage in ED behaviors as part of their recovery.

Clients in RO groups have an opportunity to learn how “too much of a good thing” can negatively impact their ability to build close bonds and seek support. Self-Control is an example of a “good thing” one can have “too much of”. It is needed for tribes to be able to form and cooperate for the purpose of their common goals.  Self-control allowed for humans to adapt to safer means of resolving conflict and creating community. RODBT contends that dietary restriction may serve several functions of overcontrol for an individual with AN. One of these functions involves reducing experiences of anxious physiological arousal and inducing feelings of emotional numbness (Lynch et al., 2013)

For example, a client may report “I’m doing fine” when asked how they are coping after they have just learned about infidelity in their marriage. They may under-report their emotional pain and offer a strained smile in a well-intentioned effort to protect others (and themselves) from discomfort. RODBT teaches participants that this incongruent messaging actually leads to peers feeling LESS trusting and LESS likely to offer support.

Why does social signaling matter? Did you know that in 4 milliseconds, humans form an emotional response to facial stimuli and in 200 milliseconds, they apply a label to it in their prefrontal awareness? Humans have an exceptional ability to read non-verbal communication before they are even consciously aware they are doing so.

Did you know that non-expressive people arouse anxiety in others, and this leads to rejection? Emotional expression evolved to help humans communicate. We have the most facial muscles as a species. Free expression of emotions signals trustworthiness and increases social connectedness.

Human survival depends on our ability to work together. Tribes are founded on shared values and goals Humans are the ONLY species willing to risk self for others. Non-human primates die in days or weeks when isolated from tribe! A tribe is defined as two or more individuals committing to making self-sacrifice for the wellbeing of the group.

Having the chance to learn new ways to connect with others can ease the frustration and loneliness that is often experienced by individuals suffering with AN. Having the chance to form closer bonds can decrease dependence on the eating disorder for support and safety.

RODBT also teaches how social signaling positively and negatively impacts the “tribe”. Social signals are emphasized in treatment, not the eating disorder. For example, “If I feel connected and seen in a meaningful way, I may no longer need to rely on being thin, sexy, or on being the most “disciplined” person in the room to get these needs met.

When assessing for appropriateness for RODBT, explore how and when social signaling occurs. Is it mood dependent (UC) or non-mood dependent (OC)? Are displays of emotion private (OC) or public (UC)? However, it is possible that an over-controlled individual may move into states of being under-controlled in very specific circumstances. Perhaps…a punk rock concert where it is socially acceptable to lose control…

When in doubt, seek a professional trained in RODBT to conduct an assessment.

Elizabeth Weiner is a Licensed Marriage & Family Therapist with offices in Westlake Village and Agoura Hills, CA. She supports youth and families managing the symptoms of depression, anxiety, grief, trauma, and eating disorders using evidence-based therapies including Somatic Experiencing, Brainspotting, and Eye Movement Desensitization Reprocessing. She can be reached at (747) 888-0378 or you can visit www.canyoncreektherapists.com to learn more.

This post was shared with VFED with the author’s permission and was originally published here on the Canyon Creek Therapists blog.