Radically Open Dialectical Behaviour Therapy (RO-DBT) at The Wave

The Wave programs utilise RO-DBT to help treat disorders related to over-control, in both our group and individual treatment plans.

We are currently the only adolescent treatment program offering RO-DBT in practice, and are always keen to include the most current and engaging treatment modalities to help our young people and their families.

The Wave programs were designed to be ‘just a little bit different’, and our core philosophy perfectly aligns with the values that Dr Lynch describes in the RO-DBT therapeutic stance. Rather than focusing on ‘what’s wrong’, our programs allow young people to experience and focus on what is healthy. This allows us to create a therapeutic alliance that is open and flexible, able to accept feedback and receptive to challenges.

What is RO-DBT?

Radically Open Dialectical Behaviour Therapy (RO-DBT) is an exciting, innovative treatment that targets a range of disorders characterised by excessive self-control – often referred to as overcontrol (OC).

It combines the foundations of neuroscience, together with the evidence-based principles of Dialectical Behaviour Therapy (DBT), mindfulness, personality and developmental theory.

RO-DBT typically centres around five overcontrol themes:

  • Inhibited and disingenuous emotional expression
  • Hyper-detailed, focused and overly cautious behaviour
  • Rigid and rule-governed behaviour
  • Aloof and distant styles of relating
  • High social comparison and envy/bitterness.
    The approach is particularly useful in areas of treatment resistance, where standard CBT/DBT has been ineffective, or in young people who find connection with treatment difficult to sustain. The treatment models flexibility, an area that can be challenging for young people with internal and external ideas of perfectionism and a strong critical self.

RO-DBT is built on communication and rapport, which are two of the keys areas of effective treatment intervention, and teaches strategies to build core skills such as:

  • Receptivity and openness
  • Flexibility and adaptability to change
  • Social connectedness and intimacy.

RO-DBT is an evidence-based and effective treatment supported by over 20 years of clinical research.

What is Over-Control ?

Self-control is a concept that is much revered in most cultures. It includes the ability to inhibit competing urges, impulses and behaviours and delay gratification in order to pursue future goals. It is often equated to happiness, success, honesty, friendships and trustworthiness.

Lack of self-control is often deemed to lead to social disorder. Society does not, on the whole, lack self-control – this would be seen as a negative character trait.

Too much self-control, however, can lead to overcontrol, which can prove to be problematic. Those who suffer from emotional and behavioural overcontrol tend to be extremely serious about life and exhibit:

  • inflexibility
  • lack of social connection or
  • isolation
  • clinical perfectionism (or hyper-perfectionism)
  • rigid rule-book life choices
  • restriction (food, love,
  • relationships, connection, finance, self-care)
  • lack of emotional expression
  • lack of emotional awareness.

Overcontrol is indicated in (and can lead to) the diagnosis of severe mental illness.

What is Maladaptive Over-Control?

Overcontrol becomes problematic when individuals become excessively rigid and critical in their thinking and behaviours. They exhibit low levels of flexibility, and change can be challenging for them to manage. This can lead to unpleasant situational and emotional overwhelm.

Young people with issues of overcontrol can:

  • be seen as hyper-vigilant
  • find it hard to accept any feedback or critical appraisal
  • find it overwhelming to endure changes to their structure or routines
  • become entrenched in rigid and rule-governed behaviours.

This way of being can leave them running on empty, as there is minimal downtime to relax, be playful and simply enjoy life.

Those with issues of overcontrol may also:

  • find making intimate or close friendships challenging, as they place themselves on the outside
  • find joining in and having ‘fun’ difficult
  • seem aloof and disconnected at times
  • describe feeling different from others
  • make frequent social comparisons to others (often related to others’ food or eating styles in those with a history of anorexia nervosa).

Young people who experience overcontrol may often say, ‘I’m fine’, denying both their emotions and their needs. They may appear incongruent, with facial expressions, feelings and behaviours that seem misaligned. They may also have a high tolerance of pain (psychological and physical), under-report the stress they feel at any given time, and find it difficult to place or recognise sensations in their bodies.

What Do Those with Issues of Over-Control Need to Learn?

Through RO-DBT, those with overcontrol issues are encouraged and supported to develop a range of skills that allow them to become more open, more flexible, and more connected to other people.

RO-DBT at The Wave specifically focuses on:

  • receptivity
  • flexibility
  • social connectedness
  • celebrating obstacles as opportunities for self-discovery
  • recognising experiences lead to self-enquiry
  • using the past as an opportunity for personal growth, not punishment.

What is RO-DBT Used for in Clinical Treatment?

RO-DBT is used for a spectrum of disorders that share a common theme of overcontrol (OC), including, for example, teenagers and young adults who present with symptoms of:

  • eating disorders, including anorexia nervosa
  • chronic depression
  • maladaptive perfectionism
  • obsessive-compulsive personality disorder
  • treatment-resistant anxiety
  • autism spectrum disorders.

RO-DBT is the first treatment that targets social signalling and non-verbal aspects of communication.

Grow, heal, and lay the groundwork for a successful, happy life

About The Wave

At The Wave, we help teenagers and young adults, between the ages of 15 and 30, overcome eating disorders, behavioural problems, addiction, and other mental health problems. We use a combination of physical activities and therapy sessions to help our young people to grow, heal, and lay the groundwork for a successful, happy life.

Mahisha Naidu leads our Creative Arts Therapy activities, having trained in Dance and Movement Psychotherapy at Goldsmiths, London. Mahisha has led The Wave Clinical Team for two years. She is passionate about her treatment of eating disorders and leads our food and body groups three times a week. Her role has seen her develop a specialist interest in working with adolescent girls, particularly focused on borderline personality disorder, self-harm and developing emotional regulation.

Mahisha is currently studying Internal Family Structures (IFS), which is an innovative therapy, particularly suited to our work at The Wave, where it has been used effectively with our young people and their families. Mahisha is a member of APPCH.

To learn more about Art Therapy at The Wave, please contact us.

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