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Radically Open DBT: A Therapy to Ease a Life of Control

By Ellen Astrachan-Fletcher, PhD, FAED, CEDS-S

Have you heard of the theory of the suffering of the "overcontrolled" individual? Overcontrolled individuals tend to be perfectionists who live most of their life in a state of high threat (rapid heart rate, high blood pressure and quick breathing rate). Radically Open DBT addresses three different areas that can help overcontrolled individuals achieve a richer and more rewarding emotional life.

Radically Open DBT

Have you heard of the theory of the suffering of the “overcontrolled” individual? Overcontrolled individuals tend to be perfectionists who live most of their life in a state of high threat (rapid heart rate, high blood pressure and quick breathing rate). They also tend to have some of these characteristics:

  • Being highly detail-oriented
  • Having trouble letting go of mistakes
  • Avoiding risks
  • Not liking new things or experiences
  • Having a high sensitivity to feeling threatened
  • Not easily impressed by rewards or compliments
  • Planning everything

 Do these traits seem familiar to you personally — or do you know someone who has these characteristics? If so, a new manual for mental health therapists on Radically Open Dialectical Behavior Therapy (RO DBT) may be of interest. 

Overcontrol and RO DBT

Individuals who live a life of “overcontrol” are prone to certain mental health issues, including depression, anxiety, dissociation, self-harm and eating disorders (self-starvation). Taken to its extreme, a high degree of overcontrol can be damaging and is associated with:

  • Being extremely isolated
  • Having trouble relating to others
  • Experiencing higher rates of anxiety, anorexia nervosa and chronic depression*

In our society, individuals who strive for total control may be lauded for their perceived abilities to “hold it all together.” Their ability to maintain this high amount of self-control — in a world where uncontrolled behavior is often censured — is seen as a plus. Indeed, as children, these individuals may have been told either directly or indirectly to “be perfect.” Growing up, they pursue perfection and may, in fact, achieve a great deal of success. But, inside, they can struggle.

Treatment for overcontrol

Radically Open DBT (RO DBT) addresses three different areas that can help overcontrolled individuals achieve a richer and more rewarding emotional life. One area in particular is to help overcontrolled individuals reduce loneliness and connect to others by addressing the following areas of deficit.

Receptivity and Openness — RO DBT helps individuals become more receptive to feedback; feedback and constructive criticism can be difficult for perfectionists to acknowledge; those with a high sense of control find feedback to be quite threatening. Yet, we cannot learn and grow unless we are open to feedback. Also, most people do not like those they perceive as close minded or as “know it all’s.”

Flexibility — RO DBT helps those with overcontrol develop a sense of flexibility — a key to living a full life: life itself requires adaptability because our behavior in one situation might not be appropriate in another situation; we certainly can’t control everything — and trying to do so will inevitably lead to internal strife.

Intimacy and Connectedness — RO DBT teaches emotional recognition and emotional expression — these are important skills often lacking in people who are overcontrolled; these skills help us facilitate healthy and rewarding relationships.

“Overcontrol” or “undercontrol”?

Like many traits, controlled coping is on a spectrum. A combination of genetic, environmental and learned factors contributes to whether an individual leans one way or the other.

Just as there are those who are overcontrolled, there are those who live a life with an “under-control” style of coping. These people may struggle to control emotions, inhibitions and impulses while enjoying risks, rewards and new experiences. Interestingly, those who live an “under-controlled” life may be more likely to get help, because they themselves — and those around them — are more aware of their demonstrative suffering.

The vast majority of people are what we call “flexibly controlled,” leaning to the overcontrol or undercontrol side — yet having flexibility in their coping and responses. Neither side of the spectrum (over- or under-controlled) is considered better or worse. But, being at an extreme on this spectrum could lead to one’s suffering. RO DBT can help.

Overcontrol and emotions 

You may read this post and think, “yes, these traits describe me.” Or you may read this post and think, “this somewhat describes me, but I am not emotionally overcontrolled; just last night, I exploded in anger at my husband because he was late picking up our daughter from dance class.”

Many people who live a life of overcontrol, as outlined above, also exhibit an emotional state coined “emotional leakage.” They tend to hold their emotions in so tightly, and for so long, that eventually the dam must burst. Yelling, insults and other intense displays of emotions can occur. Typically, though, emotional leakage only happens in the privacy of one’s own home.

The good news is that emotional leakage is a behavior that can be addressed and managed with the skills taught in Radically Open DBT.

Anorexia and overcontrol

Most people who have anorexia nervosa are known to have the bio temperament of the overly-controlled.** An extreme restriction of food may serve to numb overcontrolled individuals from discomfort or other experiences of suffering.

Those who are overcontrolled live in a state of feeling constantly threatened. Restrictive eating (a symptom of anorexia) actually helps those who feel constantly threatened numb some of their unpleasant feelings, so they feel less pain. Thus, restrictive eating becomes negatively reinforced because the person gets some relief of their experiences. However, the price they pay for this is they can end up living life like a zombie, not able to connect to others, not able to live their valued goals, just pursuing numbness.


Info about RO DBT

If you are interested in learning more about this therapy, Eating Recovery Center is currently offering Radically Open DBT at select locations in the country. If you are interested in learning more, please call us at 877-711-1878 to schedule a free, confidential consultation with an Eating Recovery Center Masters-level clinician.

The RO DBT manual has been in development for 20 years and is intended to help clinicians better understand and work with patients who are overcontrolled through a variety of methods: skills classes, group, homework and behavioral interventions.

Dr. Ellen Astrachan-Fletcher is Regional Managing Clinical Director at Eating Recovery Center and Insight Behavioral Health Centers and is a senior RO DBT clinician, training directly under Tom Lynch and she is a nationally recognized expert in the field of DBT, is functionally trained in the FBT (Family-Based Treatment) model and is a frequent presenter at national eating disorders conferences. She co-authored The Dialectical Behavior Therapy Skills Workbook for Bulimia: Using DBT to Break the Cycle and Regain Control of Your Life (2009), which is used at eating disorders treatment facilities throughout the country. 

“Our focus is on helping create change from the inside out – and not simply from the outside in.” -Dr. Astrachan-Fletcher

* Lynch & Cheavens, 2008; Riso et al., 2003; Zucker et al., 2007
** Lynch, T.R., Gray, K.L., Hempel, R.J., Titley, M., Chen, E.Y., & O’Mahen, H.A. (2013).
Radically open dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry, 13, 293.
Related Reading:
Lynch, T.R. (2018). Radically open dialectical behavior therapy. Oakland, CA: New Harbinger Publications

dr ellen astrachan fletcher
radically open dialectical behavior therapy
Written by

Ellen Astrachan-Fletcher, PhD, FAED, CEDS-S

Ellen Astrachan-Fletcher, PhD, FAED, CEDS-S, is the Regional Clinical Director, Midwest for Eating Recovery Center and Pathlight Mood and Anxiety Center. She has a wealth and breadth of experience…

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