When you’re looking for the right fit for therapy for a teen or young adult, it’s important to understand both what they’re going through and how a particular type of therapy can best help them.
When considering DBT treatment selection, it helps to look at whether you’re hoping to address emotional or behavioral overcontrol or undercontrol. This can help you choose between conventional dialectical behavior therapy (DBT) and radically open DBT (RO-DBT).
Unsure what to choose? We’ve developed this guide to help people in NY to understand undercontrol vs. overcontrol and learn who would benefit most from RO-DBT vs. DBT. Whatever you or your teen is going through, Suffolk DBT is ready to help, with expert therapists who can show you how the structure and support of the right kind of therapy can make all the difference in building a life worth living!
Overcontrol vs. Undercontrol
Dysregulation often falls into two broad categories: overcontrol and undercontrol.
What does overcontrol look like?
Overcontrol looks like trying to rigidly control experiences, thoughts, and feelings instead of responding to life spontaneously.
Overcontrol can negatively impact relationships (with others and the self) by limiting honest, open expression and by increasing criticism, negativity, and expecting the worst. It can close someone off to fully experiencing life, increasing suffering through a lack of flexibility and acceptance.
Overcontrol in teens and young adults can look like:
- Perfectionism in school, sports, relationships, or appearance
- Difficulty openly expressing feelings and thoughts, both verbally and through body language
- Muted emotional responses
- Hypervigilance
- Struggling with any feedback
- Planning, rehearsing, and avoiding uncertainty
- Rigidity around rules/right way of doing things
- Harsh self-criticism, an inability to celebrate successes
- Struggling when plans change, surprises happen, or expectations aren’t met
- Self-isolating from friends and family
- Not having any close friendships
- Trying to control outcomes
What does undercontrol look like?
Undercontrol looks like out-of-proportion emotional responses that aren’t fully grounded in present experiences. Instead of responding to life’s challenges with a balanced approach that includes processing emotions and choosing behaviors, undercontrol tends to look like strong reactions that are aligned with emotional overwhelm.
Undercontrol in teens and young adults can look like:
Undercontrol in teens and young adults can look like:- Emotional outbursts or mood swings
- Emotionally shutting down
- Feeling empty or having an unstable sense of self
- Ignoring the needs or feelings of others
- Ignoring your own needs or feelings
- Long-lasting emotional reactions
- Overspending, overeating
- Deep fear of abandonment
- Impulsive behaviors, reckless behaviors
- Substance abuse
- Disordered eating behaviors
- Regularly starting arguments or fights
- Avoiding friends, family
- Abruptly ending relationships
- Unstable or unfulfilling relationships
- Urges of self-harm or suicidal ideation
Can someone experience both overcontrol and undercontrol?
Definitely! We are all complex people, and we can experience emotional and behavioral dysregulation in many ways.
For example, imagine a Suffolk county teen who really struggles with friendships. They may pick fights with friends over little slights like a delayed text or because they fear they’re being excluded, making and breaking friendships over and over. That same teen may be a perfectionist about their grades or appearance, rigidly trying to control how they do in school or how they look.
Sounds like a fairly realistic Long Island teenager, right? It also sounds like a teenager who would benefit from DBT for some of their challenges, and RO-DBT for others. Let’s take a look at how the different styles of DBT can help.
RO-DBT vs. DBT
Dialectical behavior therapy (DBT) was created by Dr. Marsha Linehan in the 1980s, and research has shown it’s a highly effective treatment to help people who are struggling with the impacts of behavioral and emotional undercontrol. It emphasizes mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation to help people to better manage undercontrol.
In the early 2000s, after extensive research, Dr. Thomas Lynch created Radically Open DBT, or RO-DBT. RO-DBT was developed, using DBT principles and structure as a basis, with the goal of helping people who are struggling more with the negative impacts and life limitations that come from overcontrol. It emphasizes flexibility, openness, and social connectedness.
How does RO-DBT help with overcontrol?
RO-DBT encourages people to open themselves up to a more flexible, spontaneous mindset. It incorporates dialectical thought through the deconstruction of the possibility of certainty or absolutes; we all do our best, and we don’t know what we don’t know.
Through practice with a therapist and with DBT skills group therapy, RO-DBT gives people a chance to try alternatives to overcontrol in spaces that feel safer, so they are more confident in letting go of overcontrol in everyday life.
RO-DBT emphasizes:
- Flexibility: Approaching change, uncertainty, and challenges with flexibility is a cornerstone of RO-DBT. Life doesn’t always go as planned, and RO-DBT equips you to respond to changes and surprises instead of trying to control them.
- Openness: RO-DBT asks people to open up to the possibility that we don’t have to know everything before we have an experience. We can be incorrect, uncertain, or make mistakes, and still have things turn out all right; in fact, those moments are important to experience, as part of learning and living.
- Social connectedness: RO-DBT also encourages people to observe their social signals and behave in ways that more authentically, accurately, and openly express what they’re feeling. This requires both understanding of one’s thoughts and feelings, and a willingness to express them so others understand you better.
Overall, RO-DBT helps teens and young adults to let go of a desire to create certainty, so they can more mindfully engage with what’s really going on around them. It decreases loneliness through more authentic connections, decreases suffering through acceptance of change and uncertainty, and decreases dissatisfaction through letting go of the need to control all outcomes.
RO-DBT can help most with:
- Obsessive-Compulsive Personality Disorder (OCPD)
- Anorexia Nervosa (once stabilized)
- Autism Spectrum Disorder (particularly for higher-functioning individuals)
- Depression/Treatment-resistant depression
- Social Anxiety Disorder
- Avoidant Personality Disorder
How does conventional DBT help with undercontrol?
DBT provides structure to help people recognize when they’re undercontrolled, and how to handle it. It also creates connections that have an emotionally stabilizing effect through therapist and group-therapy experiences, giving people a chance to feel connected and supported as they try to deal with emotional overwhelm.
DBT emphasizes:
- Mindfulness: Staying present in the moment, without judgment, de-escalates emotional overwhelm and reduces shame, making it easier to have a calmer, controlled response to thoughts and feelings.
- Distress tolerance: Sometimes, life is just tough. Being able to tolerate distress without resorting to uncontrolled emotional outbursts or shutting down can help people prevent undercontrol from making a difficult situation worse.
- Emotional regulation: Understanding and managing emotions is key to moving from undercontrol to a balanced level of self-mastery. The goal isn’t to have no emotions; it’s not letting emotions make all your choices for you.
- Interpersonal effectiveness: Undercontrol can lead to relationship instability. Aiming for effective interpersonal interactions can help stabilize relationships even when one is emotionally overwhelmed.
DBT can help most with:
- Borderline Personality Disorder (BPD)
- Bipolar Disorder
- Depression
- ADHD
- Histrionic Personality Disorder
- Conduct Disorders
- Binge-Purge Eating Disorders
- Substance Use Disorders
- Impulsive or Emotionally Intense Behaviors
- Suicidal Ideation and Self-Harm Behaviors
Can you do both DBT and RO-DBT?
Yes! Typically, we recommend that people complete DBT therapy first, helping teens and young adults to manage any areas of undercontrol that are negatively impacting their lives. Next, RO-DBT can build on the self-mastery and willingness to change that come with DBT by providing opportunities to embrace flexibility and openness and to increase authentic social signaling to build closer relationships.
DBT and RO-DBT can build on each other, creating a robust skill set to help any young adult face life. Mindfulness and emotional regulation can be expanded through openness; distress tolerance and mindfulness can be expanded through flexibility; and interpersonal effectiveness can be expanded through social connectedness.
How do you choose what kind of DBT will help the most?
Suffolk DBT can help with DBT treatment selection
At Suffolk DBT, our expert therapists provide both conventional DBT and RO-DBT, and our intake team can help you determine which type of DBT therapy will best serve you or your NY teen.
You’re not stuck, and you’re not alone in this. Whether overcontrol is holding you back from living a fulfilling life, undercontrol is destabilizing parts of your life, or you’re dealing with overcontrol and undercontrol in different parts of your life, our therapists can help you.
Connect with our intake team today to schedule a free consultation and get started on building a life worth living!