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Radically Open DBT in Anorexia
Radically open Dialectical Behavior Therapy may provide targeted treatment for those struggling with anorexia nervosa and overcontrol.
Dialectical Behavior Therapy (DBT) has proven to be effective in supporting the treatment of eating disorders such as anorexia nervosa.
As researchers learn more about the effectiveness of this treatment modality, new variations of DBT are also being explored.
One of these variations is referred to as Radically Open DBT (RO DBT), which is intended to treat “disorders related to excessive overcontrol [1].”
DBT vs. RO DBT
Both DBT and RO DBT use behavioral principles and the dialectical philosophy, but they differ in many ways.
DBT was developed to support individuals that are under control, meaning they struggle to regulate and control their emotional responses and behaviors [2]. RO DBT targets individuals that experience the opposite in that they are over-controlled; therefore, inhibiting and controlling impulses and emotions has become customary to them [2].
Individuals that would benefit from DBT experience an anxious-avoidant style in feeling fear related to rejection, wherein those that would benefit from RO DBT have an avoidant attachment style due to the extreme control they maintain over their emotional output [2].
The problem being addressed in DBT involves emotion dysregulation and poor impulse control, and RO DBT addresses social deficits and lack of openness. The primary therapeutic focus of DBT is to focus on internal emotion regulation, gaining behavioral control, and distress tolerance [2].
RO DBT therapy focuses on the external aspects of social signaling, openness, and social connectedness [2].
RO DBT and Anorexia Nervosa
Individuals with anorexia nervosa display symptoms similar to those that struggle with overcontrol.
Some of these include “propensities for aloofness/social withdrawal, cognitive rigidity and insistence on sameness, low novelty seeking/insensitivity to reward, strong personal needs for structure and symmetry, heightened threat sensitivity, clinical perfectionism, and invalidating or critical childhood environments [3].”
Emotionally, those with anorexia nervosa often display “impaired recognition of emotion in others and reduced emotional expression, particularly the expression of negative emotions [3].”
Few studies have examined the effectiveness of RO DBT in treating anorexia nervosa. However, the Journal of Eating Disorders did recently publish a study indicating that “the combination of different treatment components, as well as the broader focus beyond ED symptoms, were highlighted as helpful [1].”
A good number of participants did drop out, reporting “social comparison and not feeling safe in skills class” and the demanding material as some of the reasons.
This leads researchers to consider that brains in starvation may not respond as well to RO DBT as those further along in their refeeding process [1].
Overall, participants reported that they found the increased social connectedness to be beneficial to their treatment.
Resources
[1] Isaksson, M., et al (2021). Sharing and connecting with others – patient experiences of radically open dialectical behavior therapy for anorexia nervosa and overcontrol: a qualitative study. Journal of Eating Disorders, 9:29. [2] Lynch, T. (2017). How is RO-DBT different from DBT? New Harbinger Publications. Retrieved https://www.newharbinger.com/blog/professional/how-is-ro-dbt-different-from-dbt/?platform=hootsuite [3] Lynch, T. R., et al. (2013). Radically open dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry, 13:239.About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published April 26, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 26, 2021, by Jacquelyn Ekern MS, LPC
The EatingDisorderHope.com editorial team comprises experienced writers, editors, and medical reviewers specializing in eating disorders, treatment, and mental and behavioral health.
