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Radically Open Dialectical Behavior Therapy: Social Signaling, Transdiagnostic Utility and Current Evidence

Authors Gilbert K, Hall K, Codd RT

Received 30 August 2019

Accepted for publication 24 December 2019

Published 8 January 2020 Volume 2020:13 Pages 19—28


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Igor Elman

Kirsten Gilbert,1 Karyn Hall,2 R Trent Codd3

1Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA; 2Dialectical Behavior Therapies Center, Houston, TX, USA; 3Cognitive-Behavioral Therapy Center of Western North Carolina, Asheville, NC, USA

Correspondence: Kirsten Gilbert
Department of Psychiatry, Washington University in St. Louis, 4444 Forest Park, Suite 2100, St. Louis, MO 63108, USA
Tel +1 314-747-0001
Fax +1 314-286-2732

Abstract: At the core of an overcontrolled personality and coping style is a tendency to have too much self-control, exhibiting as behavioral and cognitive inflexibility, high inhibition of emotion, high detail-focused processing and perfectionism, and a lack of social connectedness. Overcontrol underlies a wide variety of psychiatric illnesses and as such, an innovative transdiagnostic therapy called Radically Open Dialectical Behavior Therapy (RO DBT) has been developed to treat disorders characterized by overcontrol. RO DBT targets maladaptive social signaling in order to help individuals “rejoin the tribe,” hypothesizing that increasing social connectedness by means of targeting social signaling is the central mechanism of change in treatment. Because RO DBT is used for individuals with an overcontrolled personality style, rather than individual disordered symptoms, it can be used transdiagnostically across a range of comorbid disorders, including treatment-resistant depression and anxiety, anorexia nervosa, and personality disorders such as obsessive-compulsive personality disorder. The current article introduces this novel treatment approach and discusses its emphasis on social signaling and its transdiagnostic nature. We then provide the first review of existing literature testing the efficacy of RO DBT across clinical populations, discuss issues related to assessment of overcontrol, and speculate on future directions for this novel therapy.

Keywords: radically open dialectical behavior therapy, overcontrol, transdiagnostic, psychological inflexibility

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