Karyn D. Hall - The Radically Open DBT Workbook for Eating Disorders: From Overcontrol and Loneliness to Recovery and Connection

This book is such an important contribution! Ive worked with countless people with eating disorders who have told me that radically open dialectical behavior therapy (RO DBT) is the treatment that resonates best for them. This book is the first of its kind to make RO DBT accessible to anyone. I cant wait to recommend this book to my own patients!

Leslie Anderson, PhD, FAED , associate clinical professor at the UC San Diego Eating Disorders Center, and coeditor of Clinical Handbook of Complex and Atypical Eating Disorders

This workbook is an important contribution to the tools available for treating eating disorders. It offers a novel and evidence-based approach for those suffering from any eating disorder diagnosis to augment multidisciplinary treatment with RO DBT. The style is simple and clear, yet comprehensive and engaging. The skills and worksheets make this workbook dynamic and interactive. I commend the authors for this contribution and hope that many will find recovery through it.

Ovidio Bermudez, MD , physician specializing in the treatment of eating disorders

With a sharp and inquisitive mind, scientific rigor, and deep respect for our patients, Hall, Astrachan-Fletcher, and Simic took all this information developed for therapists and created a very easy-to-read and excellent research-based self-help book that targets the emotional loneliness that typically underlies many mental health conditions, emphasizing social signaling as the primary mechanism of change. This book tackles complex problems and makes solutions available to everyone.

Eva Ma. Trujillo Chi Vacuan, MD, FAED, CEDS, Fiaedp, FAAP , CEO and cofounder of Comenzar de Nuevo Eating Disorders Treatment Center; clinical professor at Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey; and past president of the Academy for Eating Disorders

I highly recommend this workbook for those struggling with eating disorders, and for all clinicians in the field. This book provides new insights into the development and treatment of eating disorders, offering what will undoubtably be a missing piece for many. The reader is invited to explore emotional overcontrol; social signaling; the role of playfulness and connection; and feelings such as envy, bitterness, and shame. This is an exceptional contribution to the field and there is simply nothing like it available to our clients. Engaging, relatable, and refreshing, this is a book you are going to want to read and share!

Anita Federici, PhD, CPsych, FAED , owner of the Centre for Psychology and Emotion Regulation; and adjunct faculty at York University in Toronto, ON, Canada

Therapy workbooks are seldom good reads, usually only coming alive once they become part of treatment. However, this is a great deal more than a workbook, weaving together a range of perspectives that together provide an informative, insightful, and thought-provoking book. I strongly recommend the book to anyone wishing to gain new insights into how emotions and the way we handle themboth individually and in social situationsget tangled up in eating disorders.

Ivan Eisler, OBE, PhD , emeritus professor at Kings College London, and joint head of the Maudsley Centre for Child and Adolescent Eating Disorders

Publishers Note

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.

NEW HARBINGER PUBLICATIONS is a registered trademark of New Harbinger Publications, Inc.

New Harbinger Publications is an employee-owned company.

Distributed in Canada by Raincoast Books

Copyright 2022 by Karyn D. Hall, Ellen Astrachan-Fletcher, and Mima Simic

New Harbinger Publications, Inc.

5674 Shattuck Avenue

Oakland, CA 94609

www.newharbinger.com

Cover design by Sara Christian

Acquired by Catharine Meyers

Edited by Jennifer Eastman

All Rights Reserved

Library of Congress Cataloging-in-Publication Data

Names: Hall, Karyn D., author. | Astrachan-Fletcher, Ellen, author. | Simic, Mima (Psychiatrist), author.

Title: The radically open DBT workbook for eating disorders : from overcontrol and loneliness to recovery and connection / Karyn D. Hall, Ellen Astrachan-Fletcher and Mima Simic.

Description: Oakland : New Harbinger Publications, 2022. | Includes bibliographical references.

Identifiers: LCCN 2021058421 | ISBN 9781684038930 (trade paperback)

Subjects: LCSH: Eating disorders--Treatment. | Dialectical behavior therapy.

Classification: LCC RC552.E18 H34 2022 | DDC 616.85/26--dc23/eng/20211207

LC record available at https://lccn.loc.gov/2021058421

Contents

Foreword

When we feel part of a tribewe feel safe.

T. R. Lynch

Humans are a hyper-cooperative speciesmore so than any other animal species. We engage in highly complex and coordinated group activities with non-kin and comply without resistance to requests from complete strangers. Research shows that rather than falling apart or running amuck when disaster strikes, most humans are calm and orderly, and work together to help others. During times of extreme crisis, we forget about our individual differences, backgrounds, and beliefs and unite for a common cause. For example, ask anyone closely involved in the 9/11 crisis in New York City the extent they were worried about whether the person they were helping was homeless or a millionaire, religious or atheist, black or white.

A core component of this evolutionary advantage involved the development of complex social-signaling capabilities that allowed for a quick and safe means to evaluate and resolve conflict and to manage potential collaborations. Our social-signaling capacities are more powerful than most individuals realize, as they viscerally impact not only the person we are interacting with but also our own physiologymost often at the preconscious level. Slow-motion film analysis has robustly revealed that we react to changes in the body movement, posture, and facial expressions of others during interactions without ever knowing it. Indeed, we are constantly social-signaling when around others (e.g., micro-expressions, body movements)even when deliberately trying not to. This means that silence can be just as powerful as nonstop talking.

For our very early ancestors living in harsh environments, the cost of not detecting a signal of disapproval was too high to ignoresince banishment from the tribe was essentially a death sentence from starvation or predation. Consequently, we are constantly scanning the social signals of others for signs of disapproval and are biologically predisposed to read them as disapprovingespecially when theyre ambiguous. This means we are essentially a socially anxious species. Blank expressions, furrowed brows, or slight frowns are often interpreted as disapprovingregardless of the actual intentions of the sender (some people frown or furrow their brow when concentrating). Moreover, being rejected hurtsresearch shows that social ostracism triggers the same areas of the brain that are triggered when we experience physical pain. Thus, we fear the pain of exclusion, and our emotional well-being is highly dependent on the extent we feel socially connected.

When I first began to develop principles for helping individuals who experience overcontrolled coping, I was unaware of just how much the final intervention would emphasize the importance of social signaling as a primary mechanism of change (see radically open dialectical behavior therapy treatment manuals; Lynch 2018a and 2018b). Overcontrolled coping is characterized by a strong desire to control ones environment, restrained emotional expression, limited social interaction, problems with close relationships, and rigid and inflexible responses to change. And it became increasingly clear over time that the main downsides of overcontrolled coping (often called maladaptive overcontrol) were primarily social in nature. These individuals tend to be serious about life, set high personal standards, work hard, behave appropriately, and frequently will sacrifice personal needs to achieve desired goals or help others; yet inwardly they often feel clueless about how to join in with others or establish intimate bonds. For example, overcontrolled individuals tend to perceive new or unfamiliar (especially social) situations as potentially dangerous, so they will tend to mask or inhibit expressions of emotion, which often damages close social bonds and leads to misunderstanding or distrust, because it is hard for others to read their true feelings or intentions. Often no one outside the immediate family is aware of an overcontrolled individuals inner psychological distress. Moreover, since self-control is highly valued by most societies, the problems associated with excessive inhibitory control have received little attention or have been misunderstood. Most treatments do not recognize maladaptive overcontrol as a problem, so most overcontrolled clients suffer in silence.