Podcast Transcript

Episode 45: An Introduction to Radically Open –Dialectical Behavior Therapy

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley. And you’re listening to All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Ashley: Thank you for joining us on another episode of All Bodies. All Foods. Today we’re going to learn about Radically Open Dialectical Behavior Therapy or RO-DBT. A transdiagnostic therapy, which has been found to be effective with certain eating disorder behaviors. The Association for Behavioral and Cognitive Therapies defines RO-DBT as a type of cognitive behavioral therapy developed by Dr. Thomas R. Lynch for disorders of over control. Excessive self-control or over-control is a type of personality or coping style that can be identified in early childhood and can be associated with social isolation, poor interpersonal functioning, and mental health issues such as anorexia nervosa, autism spectrum disorders, chronic depression, and obsessive-compulsive personality disorder. In 2020, The Journal for Eating Disorders published a study involving adolescents with eating disorders, which suggests that RO-DBT led to improvements in body image, depressive symptoms, social connectedness, and emotional expression. Another study published in the Journal of Psychology found that RO-DBT may help with perfectionistic tendencies. This study highlighted that the experience of patients who found significant relief from dysfunctional levels of perfectionism symptoms associated with eating disorders. Our guest today is Shayla Patron, a licensed marriage and family therapist, program director at the DBT Center of Long Beach and founder of their RO-DBT program. Her clinical experience includes working with children, adolescents and adults struggling with anxiety, depression, eating disorders, disordered eating behaviors, body image issues, trauma, and borderline personality disorder at the residential, partial hospitalization, and intensive outpatient levels of care. Along with specialized training in dialectical behavior therapy, she has also trained in radically open dialectical behavior therapy, or the RO-DBT, for disorders of overcontrol and has assisted in developing the RO-DBT program at the DBT Center of Long Beach. Shayla, thank you so much for being here.

Shayla: Thank you.

Ashley: So, we would love to just meet you initially and learn how you got into this field. How did you become a therapist and specifically, you know, what spoke to you about DBT and RO-DBT?

Shayla: Okay. Well, thank you for that introduction, first of all. I know that saying radically open dialectical behavior therapy can be a mouthful. So, we tend to just say RO. And we’ve found that when we’re saying RO though, because when you try to say the word hour and then RO, it’s just a jumbled mess. So, we’re just going to do our best today to enunciate.

Sam: That must get confusing. It’s like, I’m ready for your hour of RO.

Shayla: Yes, it is. I fumble over it all the time. When I was a kid, I always knew that I wanted to work somewhere in the helping field. I just wasn’t really sure which direction. I was the kid in elementary school, in high school that everyone would just go to talk to. And I really enjoyed it. I really valued the relationships that developed from being able to do that. Along with, along with that, so I kind of had an idea that I wanted to be a therapist. I just didn’t really, again, know how. Also at that time my aunt was battling an eating disorder. So I grew up in a household where our food was more of a topic of high conflict and a lot of anxiety. And little did I know that I actually would go on to battle my own eating disorder for, I think it was about an 18-year battle just with, of course, not having awareness of it, denial, and all before we got to some acceptance of it. So, really after it was in treatment, it was in my own treatment where I had first been exposed to dialectical behavioral therapy and radically open DBT. It was a comprehensive DBT program and they had started sprinkling in some radically open DBT groups. Again, this treatment is very new, so there hadn’t been a lot of research conducted and the treatment center I was at was a very research-based program. And so it actually, I truly do believe that the combination of DBT and RO is really why I was able to reach a space of full recovery. And I didn’t actually know what that had looked like. I just had accepted that my life was what it was and that these thoughts and behaviors were just going to always exist. And… DBT and RO really showed me that was not what my life was meant to be. So I do feel very grateful for my recovery. So after treatment, I went on to grad school and post-grad school, started working in the field of eating disorders at all different levels of care. And something that had been important to me was I also wanted to share DBT with with everyone else, like with the rest of the world because of how impactful it was in my own life. So I started looking at opportunities and I just… Because why not? And that was actually right around when COVID started. I had found a job posting for the DBT Center of Long Beach, which didn’t exist at the time. And our founder, so it’s Tiana in Long Beach and I knew that was something that I needed to be a part of. So we opened right at the beginning of COVID in 2020. Started offering DBT to the community really in a virtual world because COVID happened in March and we opened up our doors in June/July and so all we knew was really a virtual world. Now of course post pandemic as I’ll talk about a little bit later too, this specific type of therapy is clinically indicated to be done in person. So thankfully, we’re out of just that virtual world. But so kind of as I was working at the center, we were solely focusing on DBT. And I started working with, I was generally working with our eating disorder population and I had been working with a handful of division one athletes who I started to observe were really needing something different from what standard DBT was offering. And knowing my knowledge before, and I had been level one trained in radically open DBT, I started implementing some of that into my work with this population. And that was kind of when our journey with radically open DBT began. Um, we’re now level three trained in RO and we offer full RO programming in Long Beach, Orange County, and then virtual services all over California. So yeah, so we have virtual groups going right now. We have in-person groups. And now we’re expanding down to Orange County as well to really just start to impact the community because there also was nowhere else that was conducting full RO programming between Southern California, like way south in like San Diego area and then more up north towards NorCal. And so we kind of were able to meet this need where the community was lacking.

Sam: Wow, that’s great. You know, so your first introduction to RO was actually as a client.

Shayla: It was.

Sam: And you seem so passionate about it now, obviously, you know, you’re, you know, you want to pass it on to the rest of the world. And I think it’s so awesome that you’re doing that. Do you remember you first started RO and did you love it right away or initially like what was your reaction to it?

Shayla: Oh I love this question. I’ve never gotten this question. This is wonderful. Oh my goodness when I first started RO it was a once a week group that we were going to. There was a couple of us and we were all… Let me just kind of paint a picture of what over control looks like. So perfectionists, overthinkers, people pleasers. Uh, let’s see, very rigid, difficult time being flexible. Like me as a person, I always wanted to let everybody else kind of take the reins. Like you guys say what you have to say. I will just sit here. If there’s a lull in group, I will then chime in. If not, I’m cool just cruising. And this RO skills class that I was in was so challenging because it asked us to do the very things that we were so uncomfortable with. I can remember one of the things… So one of the things we were challenged with was to do something that was uncomfortable, that was our homework assignment. And I had to wear my hair in a ponytail. Something as simple as that. For me, presentation was important. It was important for me to feel like I was someone who was getting up, maintaining like my rigid routine of I get up, I have my coffee, I get ready, just very structured. And when I was asked to do things outside of that structure, it felt really uncomfortable. And for me, at that point in my life, it caused more disruption. I knew how to maintain, I knew how to keep my thoughts calm, my anxiety suppressed in a sense by maintaining my routine. So when my routine was then disrupted, it left so much room for uncertainty. It made me feel very challenged. And so one of the things was, okay, you’re not going to get ready in the morning, you’re going to just like roll out of bed. You can toss on some makeup if you need to. If not, like just toss your hand a ponytail and let’s go. And it felt so challenging to me. And I remember that my therapist at this treatment center, she also was very similar to me. And so she never really wore her hair up. And so she offered to do the challenge with me. And so it really kind of increased that sense of camaraderie, connection, community, which are all things that RO really aims to improve or increase. And so we both showed up the next day, hair is in a ponytail. And I just remember that whole day getting feedback from people. And so that in itself was also the additional challenge because people who are over controlled don’t generally enjoy feedback, positive feedback, negative feedback, all the things that really puts us on the spot. Obviously now I’ve grown a lot but being asked to reflect on that. That’s kind of what pops up for me is I remember how much I was challenged every single time I was in that class and it even reminds me, like even now leading those classes, my clients do feel so challenged and it’s a huge part of the work and what we’re talking about.

Sam: It really requires you, it sounds like it really requires you to step completely out of your comfort zone. Even if it’s in one small way at first, but I imagine then you build on that and keep challenging yourself and make it a little harder next time. And… next thing you know, you have this newfound confidence and inner strength.

Shayla: Yeah, exactly. Exactly what you’re speaking about. It’s really looking at those small incremental changes and seeing that what I feared was going to happen, didn’t happen. And so it was really debunking a lot of those internal beliefs.

Sam: So when we talk about DBT and RO. A lot of people are familiar with DBT. I mean, that’s been around for a while, but RO, you said it’s new. Can we hear a little of the history of it? When did it come about? And how is it different from DBT as we know it?

Shayla: Yeah, so RO was developed to treat disorders of over control. And when I say over control, we’re really looking at this idea of high self-control. We live in a society that highly values self-control. Yet, radically open DBT looks at how too much self-control can also be problematic. It can lead to social isolation, a poor interpersonal functioning, perfectionism, rigidity, and really that lack of emotional expression. So, I look back on how my comfortable emotions to express years ago when I was in eating disorder were joy, happiness, and frustration. That was my vocabulary. That is no longer my vocabulary. That is not the vocabulary in DBT, right? We look at a variety of emotions that we all need and we all do experience. Yet those who are more over controlled tend to suppress. So this treatment was developed to treat exactly that. So we’re looking at over control as a coping style that is learned as a result of our biological predisposition. So our genetics, something that we’re not in control of, as well as our environmental influences. So our families, our schooling, our education system, just all of those environmental influences that we may or may not have control over. With eating disorders specifically, right, we see this over control in the form of like self-discipline. And with restriction, we’re able to see clients kind of suppress that biological sensation of hunger or like I was talking about earlier, really pushing myself to maintain such a rigid routine because it was safe for me versus going outside of that. There was this perceived threat. So it wasn’t that there was an actual threat to my life. It was, there was this perceived threat to like my wellbeing. So we see like this detailed focus on body image, caloric intake, right? These individuals are extremely threat sensitive. So there’s this immense fear of making a mistake. Different from DBT. So DBT we kind of look at as, you know, the treatment of emotions. And these are clients that would present with more emotions. They’re the ones that wear their heart on the sleeve on their sleeves. When they’re feeling something, everybody’s going to know what they’re feeling, whether it’s they’re yelling at their partner, yelling at a family member, engaging in more egregious behaviors. And so those are the types of individuals where we might recommend dialectical behavioral therapy or standard DBT. It’s when their main goal is the emotion regulation. So they’re wanting to learn ways to regulate emotions, tolerate those really intense, distressing moments. So that’s like, are their emotions the problem? Or are their relationships the issue? Because over control clients tend to lack a lot of those interpersonal relationships. And even if they have support systems and a community, they still tend to feel isolated or like they’re on the outside of those friends groups. So when we have clients present, I like to ask too, you know, do you feel like your emotions are getting in the way? Are those the problem? Or is it that or is it this emotional loneliness? Which one are we looking at? And so that really helps us determine whether a client would benefit more from DBT or from radically open DBT.

Ashley: That makes a lot of sense in preparing for this. I was, you know, trying to do my research and dig in and, and because I’m not trained in either of these therapies, you know, and so trying to pick out that distinction, but that is so helpful. The emotional piece versus perhaps the social emotional piece or the social connection, which then, so my next question is the three pillars of RO then are going to be that openness, flexible control or a flexible response and the social connectedness piece. And so I was just curious if you could speak to those about how those are kind of like the foundation of what you do in RO.

Shayla: Absolutely. So when we’re looking at openness, so really with these three core concepts, these are really the foundation of how we’re treating. And so we’re wanting to increase openness, increase that flexible control or flexible responding and then ultimately improve our social connectedness. So with openness, we’re looking at being more open to new experiences. Kind of like I was talking about a little bit earlier, also from my own perspective, it was I was not open to doing things that felt new. I love avoiding, love, love avoiding. Avoidance was my go-to if it was having to go to an event where I have friends there. I still had a lot of fear in just showing up. And I knew once I got there, I was going to be fine. So there was a lot of self-talk of having to get myself in the car just to drive to get there where I knew I was going to be fine. Just that I was very threat sensitive, which over control individuals are. So we’re really looking at that low openness to novel or new experiences. Generally also to unexpected feedback. Avoidance of uncertainty. These clients tend to not be our risk takers, right? They like to play it safe. They enjoy what’s safe. It feels comfortable. And then with openness, we’re also wanting to look at tendencies to dismiss or discount critical feedback. So we might see that in the form of trying to have these over controlled individuals feeling like they have to justify themselves, justify their behaviors, rationalize. or even defend in some ways. And so kind of creating more openness to receiving feedback, taking risks, looking at it from a more whole perspective versus from our own state of mind. And then with flexible control and responding, this is where we’re looking at an individual’s compulsive need for structure or maybe order or routine. There’s this like high social obligation. So we see that with our, with individuals who tend to relate with people pleasing. Their obligation is to their friends or it’s their responsibility to be the peacemaker. We see this with compulsive rehearsal. I can remember in college having to give a presentation and I overprepared because of the perceived threat. Like if I made a mistake, what were all my peers and my professors going to see. So much so actually, this is a funny story. One time in college, I had to give a presentation and I had so much anxiety about giving my presentation that I asked my professor, I was not willing to be flexible at this point in my life, asked my professor, I made up some like medical excuse, which wasn’t a fool. Lie, white lie. Made up this excuse though, and had my doctor sign off on it to where instead of having to give the presentation in person, in class, I was able to create a PowerPoint and present with just my voice.

Sam/Ashley: Oh wow.

Shayla: So my anxiety was so intense at that point because of I wanted to have a script that I could read. I wanted to… that was going to make me feel more comfortable.

Ashley: And you just couldn’t see any other way.

Shayla: Couldn’t see any other way.

Sam: Wow. I mean, it’s just so telling how that anxiety and that fear orchard you to the point where the lengths that you went to, to avoid the presentation. I mean, to me, I’m just thinking how awful it must’ve felt. How much anxiety and terror you must have felt in those moments.

Shayla: Absolutely. Yeah, I look back on it and I think where was this therapy when I was in high school or in college? I mean I’m so grateful that I found it when I did and because I do think it helps me recognize those patterns and in me being able to see that in myself it really does help relate to my clients a lot more. And it really helps me to bring to life the material that we teach because I do have these lived experiences. Most of our clients are adults and I so badly wish they had this when they were younger. It creates this whole new level of understanding and empathy. I can look back on that now and have so much empathy for that younger version of me who was living life so much in a box.

Sam: Yeah, and there’s so many people with eating disorders. I mean, just from my experience, we’re over control is part of the territory. And they may not even have a word for it. It’s sort of like, oh, well, I’m anxious, or, or maybe I just, I just don’t like doing this. You know, I’m just, I’m a people pleaser, but really, it’s all under this umbrella of over control that can be treated with RO.

Shayla: Yep. And if you think about it, those are the behaviors that oftentimes go unrecognized because they’re not outwardly impacting other people. The sufferer is the person that’s experiencing it.

Sam: Well, yeah. And I imagine, you know, when you experience over control in your life, you may even get so much positive reinforcement because you are cooperative. And you know, I feel like it’s the type of student where teachers say that they’re a joy to have in class or, you know, they’re so studious and conscientious. And, you know, and really this child is, is suffering so much and it can’t really be seen on the outside.

Shayla: I love that you bring that up too, because when we’re looking at our environment, I oftentimes will tell families this because when we talk about the environmental influences, sometimes I’ll have family members say like, I didn’t recognize that what I was doing was wrong. And I so quickly want to remind them that it wasn’t that they did anything wrong. They were doing the best that they could with what they knew. And now we just know more, we know better. Because I think about my family and my parents. My parents had me when they were much younger. And so they were raising me while they were they were still growing up while they were raising me. And they are to this day, my biggest supporters, they are my best friends. Like I would hang out with my mother any day. And even though we had a lot of difficulties when I was going through treatment, being able to lean RO and teach her how things were interpreted in my brain helped us to get to this space, but it wasn’t that they did anything wrong. It was just the way that I was tended to. Even if it was as little as, I can remember my first day of first grade, I went to a private school. My mom’s dropping me off. It was my first time at a new school. And they like paired me with this buddy, this buddy who to this day is my friend, is one of my best friends to this day.

Ashley: Wow.

Shayla: Yeah. 27 years later. And I was sobbing my eyes out. My teacher dismissed it like, oh, well, here’s your buddy. And then my mom’s like, all right, you’re going to be great. Why are you crying? You’re fine. See you at the end of the day. So she was being kind. She was really helping me to just be able to immerse myself into school. And at the same time, what that was communicating to me that I didn’t know because I was young, now as a therapist, what it was communicating to me was that what I was thinking, feeling, or doing was wrong, inaccurate, or inappropriate for the situation. So we look at those repeated instances. I mean, in DBT, we call that traumatic invalidation. It’s these repeated instances of invalidation, not always in a big way, sometimes in those smaller ways by the people closest to us. And so throughout life, I kind of learned, well, can’t show emotions because that’s going to get, it’s not going to get you the response you want or need because your job to really just hold on to all of that.

Ashley: I’m just sitting here listening to that story and thinking how many people for the first time feel heard or seen, even with that phrasing traumatic invalidation. I’ve not necessarily heard it said that way and I can pinpoint many a time, you know, like it makes so much sense.

Shayla: Yeah. I love that word to use traumatic invalidation because it really does I think validate the things that people would roll right on over of, oh, well, no, that wasn’t significant in my past, or, oh, they just said something that irked me. When we break it down, you know, what were the wounds of that? And I think that’s what’s such a beautiful thing about DBT and radically open DBT is that we’re looking at those pieces to provide that validation while also being very change-oriented.

Ashley: I have a quick question just backing up to some of the stuff we were talking about a few minutes ago. You mentioned, so this is very helpful and it’s very helpful to look at environmental factors when working on this. And I’m curious, is this helpful for folks that might be exhibiting over control because of kind of like a big traumatic event that occurred when they were children or younger, you know, and so the idea of like, you know, controlling their safety, controlling their space and kind of like that is where they are now. Would that be helpful for folks who have experienced trauma?

Shayla: Oh, absolutely. I mean, of course, right now, you know, there’s still so much research being done and being conducted because this is a newer type of therapy. So really speaking from my own experience and what I’ve seen is we have we have clients come in with all varieties of trauma and really being able to look at what they’ve learned from that experience or even what coping they’ve developed. And sometimes we see clients who exhibit both over control and under control. And so a part of the work is unraveling what did you learn and when. And so how do we then incorporate DBT for this and then RO for this? With trauma specifically with more of that big T trauma, it’s really dependent on the trauma itself. And again, what the negative core beliefs are that are being triggered and how they’re coping. Because if they’re engaging in more reckless behavior or if we’re seeing suicidal ideation or self-harm behaviors, we’re going to want to treat it differently than if we’re looking at someone who is suppressing their emotions and then only having these outbursts with their parents or only exhibiting these bigger emotions with their partner. Generally, we see that there is a safe person that they will be more expressive with. Yet with the over control when they’re in public, it presents differently versus someone who is more over control in public there what they’re feeling you’re going to know.

Sam: So it’s really an individualized very individualized approach. Yeah, which is so important no matter what modality. you’re using.

Shayla: Absolutely. And I’m even thinking about specific eating disorder cases that I’ve worked with. Usually over control would be we would see more anorexia, we’d see ARFID in there, and then more under controlled emotions, we’re working with the binge eating disorder and bulimia nervosa. And at the same time, that’s not only that’s not saying, nope, this is only for you. And this is only for you because of your diagnosis. Like we want to do look at the learned behaviors that they’re utilizing.

Sam: Exactly.

Ashley: Could you just quickly give like maybe a brief definition of under control? Like what do you mean when you say that.

Shayla: Yes, so under control would be like a lack of emotion regulation. So we’re looking at difficulty managing emotions. Essentially just difficulty managing difficulty regulating maybe difficulty even experiencing bigger emotions like bigger emotions just feel so overwhelming. Someone who might be more under control, yeah, under controlled, constantly feel like they’re putting out these little fires in their life. They get a bad grade on their test. They get home, they get in trouble. So they’re just reacting right there, like yelling at their family member, yelling at their partner. They can’t quite seem to get things in order or under control.

Ashley: Okay. That’s helpful. Thank you.

Shayla: Yeah, like the, yeah, just difficulty. It’s very emotional. A lot of having a lot of emotions. I mean, people who are over controlled have a lot of emotions, they’re just internal. So it’s more of the external expression of the dysregulating emotions.

Ashley: Okay, that makes sense.

Sam: I’m seeing a lot shared on social media about RO, whether it’s a clinician sharing skills or a client who wants to share what they learned in therapy. And, you know, sometimes videos on social media are accurate. Sometimes they’re not so accurate. So I thought maybe we could defer to you the expert and we can go over some of these terms and maybe you can let us know what they really mean. So one of the terms that I saw, it’s sort of a three-pronged concept here, fixed mind, flexible mind and fatalistic mind. What is all that?

Shayla: Yeah. Oh, this one’s my favorite. Okay, so fixed and fatalistic mind. How do I describe this? If we’re looking at like a Venn diagram, if we’re looking at a Venn diagram…

Sam: Yes, Shayla’s holding up a Venn diagram that’s on her screen. (laughter)

Shayla: We’re looking at these two opposite ends of a spectrum with a little component in the center. So both of those separate entities are fixed and fatalistic mind, and in the middle we’re imagining as flexible mind. So, generally fixed and fatalistic mind, these are closed-minded ways of thinking. So question that I could probably ask is like, is it more important to you that you are right about something or like? And generally, so fixed mind, fixed mind says that change is unnecessary because I already know the answer. I’m right, my way is the right way, so your way inevitably is wrong. So that’s fixed mind. Fatalistic mind, on the other hand, says change is unnecessary because there is no answer. So fatalistic mind, it says, you know what, there’s not an answer, so I might as well just toss my hands up and give up. I’m going to go down with the ship. Like there’s no answer.

Sam: Kind of like this learned helplessness or, I mean, it sounds like such a hopeless place to be.

Shayla: Yeah. And that’s exactly what it is. That’s a hundred percent what it is. And we look at both of those states of mind as problematic because they keep us from new learning and essentially keep us from learning anything new. And part of radically open DBT is looking at what is it that I can learn from this. So I can highlight this in here actually, this is important. With RO, we’re not looking at changing all of our problematic behaviors because we do recognize that again, in our society, these are traits and characteristics that are highly valued and sought after. And so we always want to be looking at the context. Context matters so much. Is this behavior helpful now? Is this going to be helpful in my relationship? And if it’s not, maybe that’s where I need to change this behavior versus with a stranger on the streets. So we really are looking at context. So flexible mind is saying exactly that. It’s saying I can be fixed or fatalistic, that’s okay in some ways. It’s serving me. And in other ways, how can I flexibly respond? How can I be in a more middle pathway in order to see how this can also be helpful in my life?

Sam: This is reminding me so much of wise mind.

Shayla: Yep.

Sam: With fixed mind and fatalistic mind, these are really the stories that keep us stuck.

Shayla: Yeah. Yeah, so fatalistic mind is, generally we tend to see behavior as kind of like avoidance or with fatalistic mind, the action urge would really be to like run away, escape the environment, feel threatening. Fixed mind, it’s more of urges to… like go towards, so more approach coping versus avoidance coping. And when we’re looking at, at this, um, we also want to highlight that we don’t see things as they are in the world. We see things as we are. So generally, when we’re looking at something, we call this perceptual bias. We’re looking at something from one perspective, whether it’s with our fixed mind or a fatalistic mind. And so the flexible mind asks us to look at things as they are instead of as we are.

Sam: Mm hmm. That’s powerful. Okay. Now I really want to learn about more here. Let me look at this list here. Um, the social safety activation toolkit. What is that? I love a good toolbox. What is that?

Shayla: Okay. Yeah. So social safety. Um, we have our fight, flight, or freeze response and over controlled individuals, mostly are in a freeze state. So, a freeze state, this is a threatened state of mind. We can also look at fixed or fatalistic mind as a threatened state of mind. So, when we have individuals or when we ourselves are responding from fixed or fatalistic mind, generally we feel threatened. There is some perceived threat. Now, over controlled individuals tend to, if we’re looking at like a little pyramid and the pyramid has like these three different levels, we’re going to look at that bottom layer as social safety. So, this is where we feel cool, calm, and collective. We’re able to be engaged with our social safety system. So, we’re able to be engaged with our relationships. Our relationships feel safe to us. The middle layer is where we might be contemplating, is this fight or is this flight? Like, what am I doing? There’s something that could be threatening, maybe not, I’m confused, I don’t know. Now, when we hit the top of that pyramid, we’re in our threat system. We’re in a free state where our body becomes immobilized. So, when we look at how over controlled individuals tend to be very threat sensitive, they tend to be that way with a lot of different circumstances in life. So, like I was sharing with that presentation I had to give, it threw me so much into my threat system that my body’s natural reaction was done, like I can’t even problem solve this. Like I’m in such a state of anxiety about this perceived threat. My body is preparing for action. It’s like when you break a bone and all the endorphins go into that area, so you actually can’t feel pain momentarily so that you could get out of some potential danger. That’s what I like to think of that top pyramid as. It’s that threat system where endorphins are going to my body. I have to figure out and deduce a threat to my life or if I’m okay. So, we see a lot of freeze happening in that area where there’s a lot of just learned helplessness, feelings of hopelessness. That’s where shame and guilt are at. So part of the social safety activation toolkit is learning ways to get a client more activated with their social safety system. So we’re wanting to be in a space of openness because in our other states, we can’t move, we can’t react. And so we have a set of skills to help turn off and on our threat system and our safety system because when our threat system is on, social safety system is off. So we want to turn on the social safety system to turn off that threat system. And we can also look at it with our parasympathetic and sympathetic nervous system. So we’re looking at things like what we call the big three plus one. Big three plus one is where you do a little eyebrow wag. Because what that does is it, it’s moving these muscles in our brain that are signaling safety. And so even just moving our eyebrows, it’s like, okay, I’m safe. So I like to joke around with my clients and I’m like, okay, just, let’s just move up and down our eyebrows real quick. There you go.

Sam: You’re sending the message… your body is sending the message to your brain that I must be safe because I’m doing a little eyebrow up and down thing.

Shayla: Yeah. Try to be mad and do that.

Sam: It’s very hard. It’s very hard. It reminds me there was a study where subjects put like a pen in their mouth, so they were like forced to smile. You know, they like held a pen like in their teeth. And they perceived things as funnier because they were they were smiling. So the brain was thinking, well, there’s a smile, I must be enjoying myself.

Ashley: That’s like the Amy Cuddy, the power poses too. If you like stand in a power pose, you’re able to better walk into a room, you know, more comfortable and with more confidence. Crazy.

Shayla: I love that. That’s actually the second piece of the big three plus one. We have the eyebrow lines with like a little half smile here. So you’re like forcing your face to do these things to signal to your brain. So it’s kind of like that research that you were talking about, Sam.

Sam: Wow, that’s amazing. So that’s an amazing tool for the toolbox.

Shayla: And leaning back too. I just got to lean back and that’s your confidence. So Ashley, you were even talking about that. You both were just identifying the big three plus one and you didn’t even know.

Sam: We didn’t even know.

Ashley: And so what’s the plus one?

Shayla: The plus one is the lean back in your chair. Oh, okay. Because if you’re standing, you really can’t lean back in your chair. You know?

Sam: This is fascinating. I think we might have time for one more here. Urge surfing, which I’ve definitely heard of before with DBT. And we often talk about, you know, writing out an urge, sitting with an urge, that sort of thing. So urge surfing, we see this a lot on social media. Could you say more about it?

Shayla: Yeah, I would love to. We have this one in DBT also. So I’ll kind of speak to it on my RO lens. Um, but urge surfing is essentially the idea that we don’t have to respond to every urge that we have. So for our over controlled individuals, they are already masterful at inhibiting control. So they’re really good at suppressing. So we oftentimes want them to learn ways to urge, serve the urges that lead to behaviors that are not aligned with their goals. So urge surfing urges to restrict. Or urge surfing the urge is to binge or purge or the urge is to correct somebody when they misuse a word, right? Because then that’s actually not inviting us into our social connection. It might be creating more disconnect. So urge surfing, wanting to problem solve for someone instead of validate. Urge surfing, the tendency to cancel plans. Instead of actually engaging in the canceling of the flight. So really looking at, okay, so how can I just allow that urge to be there, to come and go like a wave without acting on it?

Sam: Right, right. You really have to identify, you have to really be clear about the behaviors that are interfering with the relationships that you want. And then being able to be aware when those urges pop up. So I imagine there’s a lot of mindfulness that has to sort of come before this too.

Shayla: Yeah, and urges surfing actually is one of our mindfulness skills. It’s allowing us to increase our awareness of what’s happening in the here and the now. And then another skill that we use for mindfulness, what we call the awareness continuum. And it’s where we practice acknowledging our, and giving space for our thoughts, our emotions, the sensations that we experience, what we see. So, our own perspective of things, but owning it. So instead of saying, oh, I don’t like that, or that was weird, I could say, I am aware of a feeling that was uncomfortable for me, or I’m aware of imagining that you’re upset with me, versus me saying, you said this, therefore you’re upset with me. It’s me owning it and having this awareness of what I’m experiencing. So being able to go into my interpersonal relationships saying, hey, you know, when you didn’t text me back, I was aware of imagining that you no longer wanted to be my friend. What a helpful skill in relationships.

Sam: What a helpful skill in relationships. I love the phrase, I’m telling myself the story that you’re angry with me. So, it’s like a way of acknowledging what you’re feeling, but also signaling to the other person that you might be wrong about this. And it opens up that space to talk about it, hopefully without the other person becoming defensive. And it comes from a place of, like you said, humility. It’s like, I’m telling myself the story, but I know this might not actually be true.

Ashley: Sam, say that phrase one more time.

Sam: Yeah, I’m telling myself the story that you’re angry with me.

Ashley: Ooh, that’s so good.  

Sam: Yeah, yeah, I use that with my partner all the time. It works. I wish I knew this when I was in my 20s. It would have made conversations a lot easier.

Shayla: So much so. These skills are life skills.

Sam: They are. Oh my gosh.

Shayla: In RO, we believe in this concept of kindness, kindness first and foremost. So it’s kind for me to tell you and share with you what I’m imagining so that we can improve the relationship. instead of me pulling away because I’m making up this whole story in my head. Yeah, exactly.

Ashley: I just think that has to be so it’s going to build so much connection when you can really like validate and share your own experience. Because I feel like so many times we just push our thoughts away, you know… I love mindfulness and I feel like when people think of that, they think of, you know, sitting cross legged on the floor and not thinking of anything. But the truth is, we can’t turn off that thought process. And so, allowing it to come up and then kind of exist in that vulnerable or humble place just sounds so freeing to me. So Shayla, quick question. What ages… Sam and I kind of work with all sorts of ages, but when we’re thinking of eating disorders, really, or anything, what age does RO best serve?

Shayla: Yeah. Right now, they are adapting or creating an adolescent manual. So right now, what’s out is the adult manual, really geared towards like eighteen and up. I was running a, we did have an adolescent program that we were running for a little bit of time and the material in there definitely needed to be adapted in many ways to fit what the different generations experience, even for our adults. A lot of the language in there is pastimes and it’s just very different. So I was having to really prep additionally for our adolescents, but they are in the process of creating a manual specifically for younger than 18. When I was running it in the past, I think I was running it for ages 14 to 17. And it was effective. It was really, really cool, really, really awesome to see them resonating with it. And with that age, they were bringing in experiences from high school, which is when we all want to be learning about how to be in our relationships and how to discover more of ourselves and our authentic ways of responding. And so, it fully 100% can be helpful for a younger population. And what’s out right now is for adults.

Sam: Shayla, as we wrap up the episode, if there’s one thing you hope our listeners take away from this, what do you hope they understand about RO?

Shayla: One thing.

Sam: One, two or three. Let’s be flexible.

Shayla: Well, I think exactly that component of like being open to new experiences. We want to be radically open, emphasizes so much of wanting to be present in our lives. So much so rather than just kind of going through the motions of our lives and looking back and seeing what we’ve missed. And from my own experience, with my own journey, there’s so many things I would have loved, there’s so many things we all wish we could have done differently. as we know more now, and we were all doing the best that we could. So much of it is like, I really want to work outside of things being a full thing. And just looking at how we can improve our quality of life because we are all deserving of so much more. And, you know, radically open DBT really allows you to start to attend to what’s happening in the here and now in your relationships.

Sam: I love it. Shayla, how can our audience learn more about RO and connect with you moving forward.

Shayla: Yeah, so we have our website, we have the DBT Center of Long Beach website, so dbtclb.com. We also have an Instagram, which I think he mentioned will be linked below. And then you can also find me on TikTok at @shaylaphatrone_therapy. A lot of fun over control content and a lot of like mom related content on there for my fellow over controlled mamas.

Ashley: Yes. Love it. Thank you so much.

Sam: Thank you, Shayla. I learned so much from you. And I’m just so grateful that you came on our show.

Shayla: Thank you, guys, so much. It’s really been a pleasure.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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