Radically Open Dialectic Behavior Therapy for ASD

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grahambaster
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11 Jun 2018, 8:44 pm

I have had lifelong depression and in the last few years was diagnosed asd-1. I recently began a RO DBT program and in part was drawn to it because autism spectrum disorder is one of the core diagnoses of treatment along with anorexia nervosa, chronic depression, obsessive-compulsive, avoidant, paranoid, and schizoid personality disorders. I haven't looked super hard but haven't seen this therapy mentioned in any autism community. So here it is.

web: radicallyopen.net / How is RO-DBT different from DBT?

RO DBT is for people who exhibit maladaptive overcontrol:

Low receptivity and openness: manifested by low openness to novel, unexpected, or disconfirming feedback, avoidance of uncertainty or unplanned risks, suspiciousness, hyper-vigilance for potential threat, and marked tendencies to discount or dismiss critical feedback.

Low flexible-control: manifested by compulsive needs for structure and order, hyper-perfectionism, high social obligation and dutifulness, compulsive rehearsal, premeditation, and planning, compulsive fixing and approach coping, rigid rule-governed behavior, and high moral certitude (e.g., there is only one right way of doing something).

Pervasive inhibited emotional expression and low emotional awareness: manifested by context inappropriate inhibition of emotional expression (e.g., exhibiting a flat-face when complimented) and/or insincere or incongruent expressions of emotion (e.g., smiling when distressed, showing concern when not feeling it), consistent under-reporting of distress, and low awareness of body sensations.

Low social connectedness and intimacy with others: manifested by aloof and distant relationships, feeling different from other people, frequent social comparisons, high envy and bitterness, and reduced empathy.


In regards to references to autism spectrum disorder, this bit is all I can find that directly references ASD:

In the transdiagnostic model underlying RO DBT, autism spectrum disorders (ASD) are also considered to represent classic problems of overcontrol, including behavioral-cognitive rigidity, lack of emotional expression, and interpersonal aloofness. Research shows that individuals with ASD seek order and predictability, use rule-based methods of coping, exhibit a constricted range of expression, and have poor social cognitive abilities (see Baron-Cohen & Wheelwright, 2003; Lawson, Baron-Cohen, & Wheelwright, 2004). High-functioning ASD individuals are not only aloof and socially withdrawn but also focused on details; they fail to integrate the context or understand the gist of a situation (see Zucker et al., 2007). Preference for detail over global configurations has been repeatedly documented in ASD (for a review, see Happé & Frith, 2006); and, although research is limited, similar information-processing biases appear to characterize AN and OCPD (Zucker et al., 2007). Thus, although research applying RO DBT to ASD has yet to be systematically conducted, the clinical appropriateness of RO DBT for ASD appears to have face validity.

some talk about overcontrol:




Any thoughts? Anyone heard of this? Anyone doing this? Is this a cult? a scam?



B19
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11 Jun 2018, 9:13 pm

This academic is the originator of the theory:
https://en.wikipedia.org/wiki/Thomas_R._Lynch

I would like to see some independent critique from qualified social scientists. The link you posted was very promotional. It isn't a cult or a scam, but many psychological theories don't work in practice and only time may establish if this is one of the successes or failures.

Lynch seems to have a bit of a scattergun approach in that he is aiming his idea at such a variety of target conditions. That may be overly hopeful of him, and the comparison with Linehan's work may not be valid as she worked only with borderline clients and was one herself, so her rapport and insider perspectives as well as her training gave her certain advantages as a therapist using DBT in the way that she did.

Without pilot studies then well designed follow up studies and independent peer review and assessment, there is no way to know whether it amounts to more than wishful thinking and career advancement for Lynch.



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11 Jun 2018, 9:36 pm

Never heard of this before, but I share B19's thoughtful skepticism. I'm not saying it's B.S., but I'm adopting a wait-and-see attitude.

OP, you might want to do the same, even while participating in the therapy. Actually I think that's a good approach with any therapy. One should question the yardstick used to measure success and then question the therapy if the yardstick shows no improvement. I hope you'll share your perspective as you gain more experience with this.


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23 Jun 2018, 12:26 pm

I would be very interested to hear about your experience Mr Baster.

There are so many different approaches to therapy these days which makes it even harder to fathom which ones are more effective.

The approach is only a percentage of the outcome. Other factors which play a part are the therapist, the client, client network support and relationships etc.

There is also plenty of research out there to show that most of the long standing approaches are about as effective as each other.

If you get a decent therapist who knows what they are doing and you as a client are committed and open then there is more chance of there being some kind of shift in situation. Add supportive loved ones and other things to help like interests etc then it seems that these outside resources also help in the therapeutic process.

I wish you luck and peace. :)



grahambaster
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23 Jun 2018, 9:17 pm

Thanks for thoughtful replies. I sang Sunny (poorly) at my community center karaoke party today. I wanted to sing that song for at least a couple years although I've never sang karaoke before. I did it without practicing or planning which is something I'm learning. Then I took a city train to a park I like near me and walked along the creak to the river and back. This is something I haven't done in years. My therapist is a LICSW who I see once per week and also once per week I go to a skills class for 2 1/2 hours. It's definitely challenging and also kind. Recently it occurred to me that openness might be something like a state of grace in contrast to rule making, planning, rehearsing, getting mad or shutting down. (10 weeks in)


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23 Jun 2018, 9:41 pm

I watched the white lady's video. What she said is good and fine but her lip smacking is unbearable. I really struggled to listen to her and I almost had a meltdown.


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31 Aug 2018, 6:43 am

Hey grahambaster,

Can you post some of the most uncomfortable activities the robdbt group or private sessions have had you do? I'm thinking about doing the 7 month program (sounds crazy) and at my pdoc's suggestion since I liked a social thinking workshop series I did (Michelle Garcia Winner). However, what little I could find on the technique isn't much.

I'm unsure of ASD being so readily lumped in with other diagnosis for group sessions (how have your mixed group sessions gone?) - it seems like someone with trauma or bi-polar vs. autism might benefit from being taught differently or would respond differently (I would guess that people can recover from some mental illness or can cycle better or worse while autism's effects holds fairly steady).

Some DBT I've done was to better control emotions I needed to - now, I have to express other emotions more! It's like the world is never satisfied with people like me. Too much, not enough. Too sensitive, too insensitive. I'd like to learn how to pass for normal better and make other people feel more comfortable, but maybe getting out from the NT spotlight I'm now under at work would be just as good an idea...

What does the rodbt help you with most? I'm worried a lot of it won't be new to me.



grahambaster
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02 Sep 2018, 3:45 pm

So I've quit this group and therapist. I left in part because during the four months I wasn't able to do the weekly assignments, just like when I was in school. Every week was new skills, class starts wherever the group happens to be so fundamentals aren't covered. I could have spent a long time with a therapist just doing fundamentals before even starting group. It's a real hard push to be social and I wasn't ready for that. Also I experienced a lot of internal resistance/fear to changing. Also again this quitting/leaving is something I tend to do a lot of.

I don't (want to) remember I shut that off. I did think it was pretty cool though, like " this is it."


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04 Sep 2018, 10:54 pm

Thanks for the info. You did something I'm not willing to do - karaoke.
I like being social a lot more than I used to, so willingness for that part might not be a problem but I still make mistakes and don't "do normal" well enough totally blend in, I can tell afterward that something I did or didn't do might have been abrasive but it all happens so quickly in a social situation that it's hard to get it right!



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04 Sep 2018, 11:53 pm

I'd be interested in hearing how this all goes for you. Different things work for different people.


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05 Sep 2018, 1:41 pm

Very interesting articles, thank you for posting. I did regular DBT when I was 16 and found it somewhat (I originally used the term "very", but then thought of the reason I was put in there and the fact that I still can't shake that dangerous habit, so it didn't work perfectly, but then again, what does?) helpful. This is the first time I have heard about RO-DBT.


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