therapy

Believe it or not, there exists a paradox in the realm of self-control, particularly concerning nutrition and eating behaviors.  While mindfulness regarding food choices is essential for maintaining a healthy lifestyle, excessive control over one’s diet can yield negative mental and physical consequences.  This phenomenon often manifests as disordered eating patterns or an unhealthy relationship with food, leading individuals to experience anxiety, guilt, and social isolation.   Radically Open Dialectical Behavioral Therapy (RO-DBT) is an innovative therapy geared towards individuals who exhibit excessive emotional restraint and perfectionism1.  Developed by Dr. Thomas Lynch and his team, RO-DBT aims to assist those struggling with mental health conditions such as anorexia nervosa, obsessive-compulsive disorder (OCD), and depression1.  This modality recognizes that while self-control can be beneficial in certain contexts, it can become detrimental when taken to extremes1.     RO-DBT targets five main themes pertinent to individuals exhibiting overcontrol behaviors1.  The first theme addresses “inhibited and insincere emotional expression”1, which often leads individuals to suppress their feelings rather than communicate them authentically.  The second theme focuses on “hyper-detailed focused and overly cautious behavior”1, where excessive attention to detail can hinder spontaneity and joy in daily activities.  Thirdly, “rigid and rule-governed behavior”1 signifies a strict adherence to personal rules that may stifle flexibility in decision-making processes.  The fourth theme highlights an “aloof and distant style of relating”1, which often results in isolation from social connections, further exacerbating feelings of loneliness or despair.  Lastly, the fifth theme delves into “high social comparison and envy/bitterness”1, where constant comparisons with others can lead to dissatisfaction with one’s life circumstances.    How Do We Use RO-DBT in Nutrition? Anorexia nervosa is a serious mental health disorder that often involves an intense fear of gaining weight and a distorted body image2.  People with this eating disorder restrict their food intake and may engage in other unhealthy behaviors, such as excessive exercise or purging2.  This can have profound physical and psychological consequences, including malnutrition, organ damage, and depression2, 3.    When working with clients who have anorexia, registered dietitians may find that traditional approaches to treatment, such as strict meal plans or nutritional counseling, are not always effective to provide lasting remission and that despite these interventions, their clients continue to get stuck in old patterns.  This is where RO-DBT skills can be particularly helpful.  These skills focus on increasing emotional openness, flexibility, and social connectedness1,  which can help clients develop a healthier relationship with food and their bodies.   One of the fundamental components of RO-DBT is the concept of self-enquiry, in which individuals can explore their “edge” or personal unknown4.  This mindfulness process begins by prompting clients to ask themselves critical questions such as, “What is it I may need to learn?” to challenge deeply rooted beliefs and emotions that drive unhealthy behaviors4.  Thus, self-enquiry is a powerful tool for personal growth and self-awareness.  By understanding and addressing underlying issues, individuals can take responsibility for their decisions, perceptions, and thoughts4 and develop healthier coping strategies that align with their personal goals and values. Moreover, RO-DBT places a significant emphasis on social connection and belonging, recognizing that overcontrolled individuals often struggle in this area1.  Individuals with anorexia often isolate themselves from social interactions and relationships, as their fixation on controlling their bodies deepens.  For instance, they may avoid settings where food is present, such as dining out with friends or attending gatherings, in an attempt to exert even more control over their eating habits.  This isolation can lead to misunderstandings among friends and family members, who may struggle to understand the complexity of their loved one’s behavior.  RO-DBT helps individuals with anorexia learn how to communicate their emotions and needs effectively, enabling them to form closer connections with others1.    Finally, flexibility and openness to change are central tenets of RO-DBT1.  Individuals suffering from anorexia often exhibit a “Fixed Mind”5, characterized by rigid food rules, strict meal timings, and specific behaviors surrounding food intake, such as weighing and measuring.  These maladaptive cognitive states serve to reinforce their disordered eating behaviors, making it challenging for them to acclimate to new situations or alter their perspectives on food and self-image.  In contrast, some clients may lean towards “Fatalistic Mind”5, where they become overwhelmed by feelings of hopelessness and despair.  This mental state can lead to emotional shutdowns that inhibit progress towards recovery.  By helping clients identify when they are operating from a “Fixed” or “Fatalistic” mindset, dietitians can facilitate a shift toward a more “Flexible” mindset that encourages adaptability5.   If you or someone you know is in need of support with overcontrol issues, consider scheduling an appointment with one of our experienced and compassionate dietitians at Laura Cipullo Whole Nutrition Services.  With their expertise in RO-DBT, eating disorders, and nutrition, they can provide the comprehensive care and guidance needed to help individuals on their journey towards healing and recovery. References What Is RO DBT and Who Is It for? Radically Open. Accessed August 14, 2024. https://www.radicallyopen.net/what-is-ro-dbt-and-who-is-it-for.html National Eating Disorders Association. Anorexia Nervosa. Nationaleatingdisorders.org. Published 2023. Accessed August 14, 2024. https://www.nationaleatingdisorders.org/anorexia-nervosa/ Mayo Clinic. Anorexia Nervosa. Mayo Clinic. Published 2018. Accessed August 14, 2024. https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591 Luoma J. What Is Self-Enquiry? The Practice of Mindfulness Questioning from Radically Open Dialectical Behavior Therapy. www.radicallyopen.net. Published November 8, 2017. Accessed August 14, 2024. https://www.radicallyopen.net/blog/what-is-self-enquiry-the-practice-of-mindfulness-questioning-from-radically-open-dialectical-behavior-therapy/ Bendel K. A Mindfulness Exercise to Reduce Perfectionism | Eating Recovery Center. Eating Recovery Center. Published November 18, 2022. Accessed August 14, 2024. https://www.eatingrecoverycenter.com/resources/mindfulness-exercise-reduce-perfectionism