Is RO DBT effective for this diagnosis?

Radically Open Dialectical Behavioral Therapy (RO DBT) is showing promise in treating treatment-resistant chronic depression (TRD). Whereas standard DBT was developed to treat impulse control disorders, RO DBT applies the opposite principles to treating disorders of overcontrol and rigidity. TRD is characterized by these traits. RO DBT helps increase flexibility and connectedness as well as addressing the behaviors associated with overcontrol. We, at the DBT Center of Marin, offer Radically Open DBT to best address your TRD. 

What is Treatment-Resistant Chronic Depression?

Treatment-resistant chronic depression is depression that does not respond to antidepressant medications or psychotherapy. How nonresponse is defined varies widely, however it’s estimated that only one-third of patients respond to their first antidepressant trial. Symptoms of depression include a persistent feeling of sadness, loss of interest or pleasure in activities and a sense of hopelessness. TRD is considered a disorder of overcontrol because sufferers struggle with emotional suppression and social withdrawal. TRD can be mild or debilitating and can negatively impact your quality of life. Despite the name, TRD is treatable. 

How does RO DBT support this diagnosis?

RO DBT can help draw those with TRD back into life with a biologically-based approach tto therapeutic skills. The therapy focuses on three core components of mental health: openness, flexibility, and social connectedness. Support for these symptoms extends beyond the therapy session through phone coaching as a crisis intervention tool in addition to individual weekly psychotherapy and skills groups. RO DBT provides clients with guidance on how to apply therapeutic skills to the unique situations in their lives. 

Which specific modules are most relevant?

Learn how to manage your TRD through the 3 components of RO DBT: Openness, Flexibility, and Social Connectedness.

Openness: Learn to take new risks and accept critical feedback.

Overcontrolled behaviors can create an unfulfilling life. You may be naturally suspicious and miss the benefits of trying novel behaviors. Biologically-based skills help you stay calm when trying new things. Similarly, RO DBT skills can help you accept unexpected feedback that would usually upset you.

Flexibility: Learn to free yourself from perfectionism and rigidity. 

Staying rigid is impractical in a world that is ever-changing. RO DBT teaches skills that help you downregulate your hyperactive safety system, allowing you to adapt more readily to a changing environment. Mindfulness skills and cultivating healthy self-doubt help you stay in a flexible mindset.

Social Connectedness: Learn to successfully connect with others.

Overcontrolled individuals often feel uncomfortable and incapable of facilitating intimacy. RO DBT uses the science of social signalling to enhance your ability to connect with others. Additionally, skills help you cope with social shame, bitterness, and envy. By cultivating and skillfully applying vulnerability to your social interactions, you can improve your connections with others.

References to research that demonstrate the efficacy of the treatment for the diagnosis

1. This study found that RO DBT treatment of individuals with TRD showed enhanced psychological flexibility and emotional coping.

Lynch, T.R., Hempel R.J., et al. Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT. Efficacy and Mechanism Evaluation 5: 7 (2018). https://doi.org/10.3310/eme05070

2. This research study found that RO DBT participants reported better psychological flexibility.

Lynch, T.R., Hempel, R.J., et al. Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms. The British Journal of Psychiatry216, 204–212(2020). https://doi.org/10.1192/bjp.2019.53