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Treating eating disorders is often challenging, but radically open dialectical behavior therapy (RO DBT) may offer new options for people in need.
By incorporating principles of standard dialectical behavior therapy (DBT), RO DBT is adapted for people who tend to be overly controlling, and may be a helpful treatment option for numerous conditions, like eating disorders.
Radically open DBT is a therapy style that spun off from standard dialectical behavior therapy.
Developed to help treat borderline personality disorder, DBT has been found to be very helpful for people who struggle with issues related to high impulsivity and low self-control, including people who struggle with obsessive compulsive personality disorder and some autism spectrum disorders.
Radically open DBT aims to help people at the other end of the self-control continuum: those with too much self-control. A significant portion of RO DBT will focus on radical openness skills that include:1
Like standard dialectical behavior therapy, RO DBT sessions focus on mindfulness, emotion regulation, and interpersonal skills, though less emphasis is generally given to distress tolerance, as people who are well-suited for RO DBT tend to perform better with that skillset.
RO DBT is a specific and consistent treatment approach that can be used across a wide range of clinical settings, but it is most commonly used as a form of outpatient treatment.
The pre-planned process is generally broken down into four sections:2
Through this schedule of help and skill building, a patient will work to address and resolve their tendencies to overcontrol.
Patients are generally referred to RO DBT therapists when they exhibit issues around the need to exert too much control over themselves or their environment.
Often called “overcontrol,” this pattern of coping can lead to severe cognitive rigidity, making someone resistant to new experiences and more prone to social isolation.
In a productivity-driven culture, excessive self-control may be difficult to identify, but this pattern of behavior can nonetheless result in various mental health concerns, such as:1,3
By directly addressing overcontrol, RO DBT effectively treats these mental health conditions. Clients using this treatment protocol can expect symptom improvement in 30 weeks or less.1 People with low self-control may not be good candidates for RO DBT, so they should pursue other treatment options.
In all, these traits are thought to bring on a negative feedback loop, reinforcing controlling behavior and causing further social isolation.
In treating these unhelpful patterns, RO DBT attempts to reset someone's social signaling, allowing them to not only overcome oppressive thoughts and behaviors, but start more happily and peacefully integrating into society at large.2
Studies show that radically open DBT is effective in treating eating disorders.1,2,3 To this point, much of the research has focused on AN, since a cornerstone of this condition is excessive control of food and nutrition.
Radically open dialectical behavior therapy is still relatively new. In the future, it's possible that more studies will test whether RO DBT treatment can help with conditions like bulimia nervosa (BN) and binge-eating disorder (BED). In the meantime, RO DBT seems helpful in addressing symptoms and conditions that frequently accompany eating disorders, like anxiety, depression, and perfectionism.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
RO DBT stands for radically open dialectical behavior therapy, which is a type of therapy based on dialectical behavior therapy.
At its core, this therapeutic treatment is meant to help people relinquish some self-control, in cases where that manifests as a maladaptive coping mechanism. Instead, RO DBT implores patients to find peace in a given moment and seek out the benefits of social connections.
RO DBT focuses on radical openness skills, such as acknowledgement, self-enquiry, and flexible-responding, to help patients who struggle with overcontrol. On the other hand, DBT is recommended for patients who have low self-control and high impulsivity, focusing instead on techniques to help them better manage their emotional reactions.1
While research here is limited, the answer, so far, seems to be yes. RO DBT has proven helpful in the treatment of anorexia nervosa, and research is optimistic that it can also prove helpful for additional eating disorders.3
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