Skills Training Manual for Radically Open Dialectical Behavior Therapy , livre ebook

“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 inhibitory control or overcontrol (OC). This is the first treatment that directly targets social signaling and nonverbal aspects of communication not only in clients but also in therapists.”
—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 techniques for moving them in a positive direction. Emphasizing flexibility, openness, connection, 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 of Get 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 compassionate 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 of The Appetite Awareness Workbook


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
Copyright © 2018 by Thomas P. Lynch
Context Press
An imprint of New Harbinger Publications, Inc.
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“Who Makes These Changes?” from THE ESSENTIAL RUMI by Jalal al-Din Rumi, translated by Coleman Barks. Copyright © 1997 by Coleman Barks. Used by permission.
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Library of Congress Cataloging-in-Publication Data
Names: Lynch, Thomas R. (Professor of clinical psychology), author. | Complemented by (work): Lynch, Thomas R. (Professor of clinical psychology). Radically open dialectical behavior therapy
Title: The skills training manual for Radically open dialectical behavior therapy : a clinician’s guide for treating disorders of overcontrol / Thomas R. Lynch.
Description: Oakland, CA : New Harbinger Publications, Inc., 2018. | Companion volume to Radically open dialectical behavior therapy / Thomas R. Lynch. 2018. | Includes bibliographical references and index.
Identifiers: LCCN 2017040505 (print) | LCCN 2017043166 (ebook) | ISBN 9781626259324 (pdf e-book) | ISBN 9781626259331 (ePub) | ISBN 9781626259317 (paperback)
Subjects: | MESH: Behavior Therapy--methods | Compulsive Personality Disorder--therapy | Behavior Therapy--education | Self-Control--psychology
Classification: LCC RC489.B4 (ebook) | LCC RC489.B4 (print) | NLM WM 425 | DDC 616.89/142--dc23
LC record available at https://lccn.loc.gov/2017040505
This book is dedicated to the the most important people in my life— my wife Erica and our daughter Kayleigh
If I know anything, it is that I don’t know everything and neither does anyone else.
— Michael P. Lynch, True to Life: Why Truth Matters
Chapter 1. Basic Principles, Treatment Overview, and Global Structure of Skills Training Classes
Radically open dialectical behavior therapy (RO DBT) is an evidence- based treatment targeting a spectrum of disorders characterized by excessive inhibitory control, or overcontrol (OC). It is intended for clinicians treating clients with chronic problems such as refractory depression, anorexia nervosa, and obsessive- compulsive personality disorder. Radical openness (RO) is the core philosophical principle and core skill in RO DBT. The feasibility, acceptability, and efficacy of RO DBT are evidence- based, supported by more than twenty years of clinical translational research experience as well as by five published trials and one large multicenter randomized controlled trial; for an overview, see Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol (T. R. Lynch, 2018; this core source, to which the manual you are reading is the companion, will be cited frequently throughout the manual, and so I will refer to it simply as “the RO DBT textbook”). RO DBT research, training, and clinical work have been extended to differing age groups (adolescents, older adults, young adults), differing disorders (anorexia nervosa, chronic depression, autism, OC personality disorders, treatment- resistant anxiety), differing cultures and countries (Europe, North America), differing settings (forensic, inpatient, outpatient), and a wide range of differing providers (psychologists, nurses, social workers, psychiatrists, family therapists, occupational therapists); a range of differing modalities has also been developed and applied (skills alone, multifamily training, RO couples therapy). The primary aims of this manual, in contrast to those of the RO DBT textbook, are to provide a detailed overview of underlying treatment principles and clinical guidelines for assessing, targeting, and intervening with problems of overcontrol and to provide a hands- on practical guide and the supporting materials needed to teach RO skills (referred to throughout this manual simply as “RO skills”). The manual includes step- by- step teaching instructions, class exercises, and clinical tips on how to manage maladaptive behavior in class, with a brief overview of the underlying theory and interventions that are detailed more fully in the RO DBT textbook. The client handouts and worksheets for each RO skills lesson plan, available at http://www.newharbinger.com/39317, can be printed for distribution to clients and/or modified as needed for a particular setting.
This chapter begins with a definition of overcontrolled coping, followed by a description of the RO DBT therapeutic stance used when teaching RO skills. Next, principles for gaining commitment to attend RO skills training classes are described, followed by a description of the overall structure for each RO lesson plan and an overview of RO skills.
What Is Overcontrol?
Self- control— the ability to inhibit competing urges, impulses, behaviors, or desires and delay gratification in order to pursue distal goals— is often equated with success and happiness. Indeed, inhibitory control is highly valued by most societies, and failures in self- control characterize many of the personal and social problems afflicting modern civilization. However, too much self- control can be equally problematic. Overcontrol has been linked to social isolation, poor interpersonal functioning, hyperperfectionism, rigidity, risk aversion, lack of emotional expression, and the development of severe and difficult- to- treat mental health problems, such as chronic depression, anorexia nervosa, and obsessive- compulsive personality disorder.
Maladaptive overcontrol is posited to represent a personality style that results from transactions between temperamental predispositions (nature) and family/environmental/cultural influences (nurture) that create a style of coping characterized by excessive inhibitory control and aloof relationships (OC coping) that functions to limit new learning, flexible responding, and the development of close social bonds. There are four dimensions of infant temperament relevant to the “nature” component of this model: Negative affectivity (threat sensitivity) Positive affectivity (reward sensitivity) Effortful control (self- control capacity) Detail- focused (versus global) processing of stimuli
Children at risk for overcontrolled coping and social isolation are likely to have high threat sensitivity, low reward sensitivity, high detail- focused processing, and high effortful control and are characterized by being behaviorally inhibited, shy, timid, risk- avoidant, emotionally constrained; by having hyper- detail- focused processing;