Radically Open Dialectical Behavior Therapy , livre ebook

522

pages

English

Ebooks

2018

Écrit par
R. Lynch Thomas

Publié par
New Harbinger Publications

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522

pages

English

Ebooks

2018

Lire un extrait

Obtenez un accès à la bibliothèque pour le consulter en ligne En savoir plus

Publié par

New Harbinger Publications

Date de parution

17 janvier 2018

Nombre de lectures

EAN13

9781626259294

Langue

English

Poids de l'ouvrage

28 Mo

Based on over twenty years of research, radically open dialectical behavior therapy (RO DBT) is a breakthrough, transdiagnostic approach for helping people suffering from extremely difficult-to-treat emotional overcontrol (OC) disorders, such as anorexia nervosa, obsessive-compulsive disorder (OCD), and treatment-resistant depression. Written by the founder of RO DBT, Thomas Lynch, this comprehensive volume outlines the core theories of RO DBT, and provides a framework for implementing RO DBT in individual therapy.

While traditional dialectical behavioral therapy (DBT) has shown tremendous success in treating people with emotion dysregulation, there have been few resources available for treating those with overcontrol disorders. OC has been linked to social isolation, aloof and distant relationships, cognitive rigidity, risk aversion, a strong need for structure, inhibited emotional expression, and hyper-perfectionism. And yet—perhaps due to the high value our society places on the capacity to delay gratification and inhibit public displays of destructive emotions and impulses—problems linked with OC have received little attention or been misunderstood. Indeed, people with OC are often considered highly successful by others, even as they suffer silently and alone.

RO DBT is based on the premise that psychological well-being involves the confluence of three factors: receptivity, flexibility, and social-connectedness. RO DBT addresses each of these important factors, and is the first treatment in the world to prioritize social-signaling as the primary mechanism of change based on a transdiagnostic, neuroregulatory model linking the communicative function of human emotions to the establishment of social connectedness and well-being. As such, RO DBT is an invaluable resource for treating an array of disorders that center around overcontrol and a lack of social connectedness—such as anorexia nervosa, chronic depression, postpartum depression, treatment-resistant anxiety disorders, autism spectrum disorders, as well as personality disorders such as avoidant, dependent, obsessive-compulsive, and paranoid personality disorder.

Written for mental health professionals, professors, or simply those interested in behavioral health, this seminal book—along with its companion, The Skills Training Manual for Radically Open Dialectical Behavior Therapy (available separately)—provides everything you need to understand and implement this exciting new treatment in individual therapy—including theory, history, research, ongoing studies, clinical examples, and future directions.

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Publié par

New Harbinger Publications

Date de parution

17 janvier 2018

EAN13

9781626259294

Langue

English

Poids de l'ouvrage

28 Mo

“Radically open dialectical behavior therapy (RO DBT) is a truly innovative treatment, developed through translation of neuroscience into clinical practice, integrating various influences from dialectical behavior therapy (DBT), mindfulness-based approaches, emotion, personality and developmental theory, evolutionary theory, and Malamati Sufism. RO DBT is applicable to a spectrum of disorders characterized by excessive inhib-itory control orovercontrol (OC). This is the first treatment that directly targets social signaling and nonverbal aspects of communication not only in clients but also in thera-pists.…This book on the theory and practice of RO DBT, together with the skills training manual that describes the content of skills classes, are excellent guides for clinicians who want to embark in delivering transdiagnostic treatments based on science and clinical practice.”

—Mima Simic, MD, MRCPsych, joint head of the child and adolescent eating disorder service, and consultant child and adolescent psychiatrist at the Maudsley Hospital in London, UK

“A new and comprehensive statement from one of the more creative minds in evidence-based clinical intervention today, RO DBT brings together a contemporary focus on a limited set of key transdiagnostic processes, with new assessment and intervention tech-niques for moving them in a positive direction. Emphasizing flexibility, openness, connec-tion, and attention to social signaling, RO DBT specifies the details that can matter, from how you arrange your consulting room furniture to how nonverbal cues signal social information. RO DBT seems destined to make an impact on evidence-based care in many corners of clinical work. Highly recommended.”

—Steven C. Hayes, PhD, codeveloper of acceptance and commitment therapy (ACT); Foundation Professor of psychology at the University of Nevada, Reno; and author ofGet Out of Your Mind and Into Your Life

“RO DBT offers an intriguing reconceptualization of traditional views of internalizing and externalizing disorders, and provides the clinician with valuable new tools to address a number of problems that have been particularly resistant to standard CBT approaches. I will definitely include RO DBT theory and techniques in my graduate-level intervention class. I know beginning clinicians in particular will be grateful to have a systematic way to approach these slow-to-warm-up clients who are difficult to establish rapport with. Their early termination from therapy and failure to respond to traditional approaches often leaves clinicians befuddled and critical of their own skills. RO DBT provides a com-passionate way for clinicians to view this type of resistant client, as well as to work on some areas that are likely to benefit them. A very welcome addition to any clinician’s toolbox.”

—Linda W. Craighead, PhD, professor of psychology and director of clinical training at Emory University, and author ofThe Appetite Awareness Workbook

RADICALLY OPEN DIALECTICAL BEHAVIOR THERAPY

THEORYandPRACTICEforTREATING DISORDERSofOVERCONTROL

T H O M A S R . LY N C H , PHD

ContextPress An Imprint of New Harbinger Publications, Inc.

Publisher’s Note

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological,financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.

Distributed in Canada by Raincoast Books

Figure 6.3, “Prototypical Emotional Expressions,” from Keltner, D., Young, R. C., & Buswell, B. N. (1997). “Appeasement in human emotion, social practice, and personality.”Aggressive Behavior, 23(5), 359–374. Copyright © 1988 by Wiley. Used with permission.

Images in figure 6.5, “Polite Smile vs. Genuine Smile,” © Vladimir Gjorgiev and Monkey Business Images/Shutterstock.

Figure 6.12, “Subtle, Low-Intensity Social Signals Are Powerful,” from EMOTIONS REVEALED: RECOGNIZING FACES AND FEELINGS TO IMPROVE COMMUNICATION AND EMO-TIONAL LIFE by Paul Ekman, copyright © 2003 by Paul Ekman. Used by permission of Paul Ekman.

Illustrations on pages 163, 164, and 168 by Henrietta Hellard

Cover design by Amy Shoup; Acquired by Catharine Meyers; Edited by Xavier Callahan; Indexed by James Minkin

Library of Congress Cataloging-in-Publication Data

Names: Lynch, Thomas R. (Professor of clinical psychology), author. Title: Radically open dialectical behavior therapy : theory and practice for treating disorders of overcontrol / Thomas R. Lynch. Description: Oakland, CA : New Harbinger Publications, Inc., [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017040500 (print) | LCCN 2017042252 (ebook) | ISBN 9781626259294 (pdf e-book) | ISBN 9781626259300 (ePub) | ISBN 9781626259287 (hardcover : alk. paper) Subjects: | MESH: Behavior Therapy--methods | Compulsive Personality Disorder--therapy | Self-Control--psychology Classification: LCC RC489.B4 (ebook) | LCC RC489.B4 23 (print) | NLM WM 425 | DDC 616.89/142--dc23 LC record available at https://lccn.loc.gov/2017040500

Acknowledgments

Key Terms

Contents

IntroductionOverview of Core RO DBT Tenets Overview of the Book’s Contents In RO DBT, Silliness Is No Laughing Matter

Radical Openness and Disorders of OvercontrolSelf-Control: Can You Have Too Much of a Good Thing? Basic Postulates of RO DBT Treatment Development and Efficacy Research

A Neurobiosocial Theory for Disorders of OvercontrolA Novel Neuroregulatory Model of Socioemotional Functioning A Biosocial Theory for Disorders of Overcontrol Social Signaling: A Novel Mechanism of Change

Assessment StrategiesAssessing Overcontrol: A Conceptual Framework Common Errors and Problematic Assumptions The OC Diagnostic Protocol: Diagnosing Overcontrol, Step-by-Step Future Directions

Overview of Therapy Assumptions, Structure, and TargetsRO DBT Core Assumptions Overview of Treatment Structure and Targets

Maximizing Client EngagementEnhancing Client Engagement via the Physical Environment Enhancing Client Engagement via Orientation and Commitment Commitment Problems Unique to Overcontrol Enhancing Engagement Through Sequencing

vii

1 1 2 4

7 7 11 19

33 33 46 66

69 69 70 76 83

85 86 88

97 97 100 137 140

RADICALLY OPENDialectical Behavior Therapy

SocialSignalingMatters:Micromimicry,MirrorNeurons,and Social ConnectednessSocial Bonds, Mimicry, and Mirror Neurons One Size Does Not Fit All Eye Contact The “Deer in the Headlights” Response Heat-Off Strategies Heat-On Strategies Therapeutic Use of Cooperative Social Signaling The Therapist as Tribal Ambassador Managing Maladaptive OC Social Signaling Tribe Matters

RadicalOpennessandSelf-Enquiry:PersonalPractice,Therapeutic Modeling, Supervision, and Team ConsultationOpenness Is Tribal Glue Openness, Collaboration, and Compliance Openness, Tribes, and Learning One Secret of Healthy Living Is the Cultivation of Healthy Self-Doubt What Is Radical Openness? Practicing Self-Enquiry and Outing Oneself RO DBT Team Consultation and Supervision Using a Consultation Team to Enhance Supervision and Treatment Outcomes

The Therapeutic Alliance, Alliance Ruptures, and RepairsThe RO DBT Therapeutic Stance The Therapeutic Alliance Alliance Ruptures and Repairs Prevention of Premature Treatment Dropout

Treatment Targeting and Intervention: Prioritizing Social SignalingKindness First and Foremost Radically Open Living: Developing a Life Worth Sharing Structuring Sessions with the RO DBT Treatment Target Hierarchy Targeting In-Session Social Signaling: Basic Principles Monitoring Treatment Targets with Diary Cards Valued Goals, Themes, and Targets From Targeting to Intervention: An Overview of Treatment Strategies

Dialectical and Behavioral StrategiesWhy Dialectics? Behavioral Principles and Strategies

145 146 149 149 151 153 155 156 161 170 175

177 178 180 181 184 186 190 192 198

209 209 211 213 223

229 230 232 233 240 257 267 270

297 297 327

Final Remarks, Practical Questions, and Treatment AdherenceSome Commonly Asked Questions Final Remarks

Appendix 1: Assessing Styles of Coping: Word-Pair Checklist

Appendix 2: The Clinician-Rated OC Trait Rating Scale

Appendix 3: The Overcontrolled Global Prototype Rating Scale

Appendix 4: RO DBT Semistructured Suicidality Interview

Appendix 5: Targeting Indirect Social Signals: In-Session Protocol

Appendix 6: Setting the Stage for Effective RO DBT Chain Analysis: In-Session Protocol

Appendix 7: Using RO DBT Chain and Solution Analysis: Principles and In-Session Protocol

Appendix 8: RO DBT Adherence: A Self-Assessment Checklist

Endnotes

References

Index

Contents

371 371 373

377

381

385

401

405

415

419

433

453

461

493

Acknowledgments

This work could not have been accomplished without a tribe. I would like to begin by thanking our patients for their willingness to share their personal struggles and insights—they have been my teachers and theraison d’êtrebehind it all. However, without doubt, I am most grateful for the tremendous amount of support, energy, and intellectual contributions made by my wife, best friend, and col-league Erica Smith-Lynch. Without her insight into human nature and willingness to question existing paradigms (most often those I held dearly), much of what is written would not exist. Erica helped develop and refine the core philosophical premises underlying the treatment and was seminal in the development of novel therapist training methods, as well as new RO skills. Erica isthe rockof RO DBT. I am also indebted to Roelie Hempel, who has been our research lab’s senior scientist and associate director for the past 10 years. Her basic science background in psychophysiology, her analytic brain, and her keen curiosity have been essential in our mechanisms of change research. She was the clinical trial manager for our MRC funded multi-center randomized controlled trial and primary driver behind most of our bio-behavioral and experimental research (and that’s just before breakfast). Roelie is therollto Erica’srock. Importantly, this work would also not be same without the time invested and gentle challenges made by Lee Anna Clark in helping refine and strengthen the neu-roregulatory model that underlies the treatment—e.g. insights regarding optimal self-regulation, the importance of accounting for bio-temperament, and the utility of undercontrol and overcontrol as multi-dimensional constructs. Finally, when it comes to core contributors, I am grateful for the wide range of intellectual and instrumental contributions made by Jennifer S. Cheavens during the early years of treatment devel-opment at Duke University—e.g., help with the development of new skills linked to openness, flexibility, and forgiveness. In addition, I have been very fortunate to have been mentored by a number of exceptional clinical academic researchers—five of whom I consider most influential in the development of RO DBT. First, I learned most of what I know about radical behaviorism from Alan Fruzzetti—my PhD advisor at Kent State University. Alan introduced me to Marsha Linehan, who trained me in standard DBT, and I was grateful when she also began collaborating with me in research—resulting in the first multi-site RCT of standard DBT funded by NIDA (PIs: Linehan, UW; Lynch, Duke). While this was going on, I was simultaneously running several other funded studies, including an NIMH K23 career development award that afforded me the opportunity

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