Date of Award

Spring 5-2023

Author's School

Graduate School of Arts and Sciences

Author's Department


Degree Name

Master of Arts (AM/MA)

Degree Type



Background: Overcontrol is a phenotype characterized by inflexibility, perfectionism, and a need for control or structure, which increases risk for disorders such as anorexia nervosa, social anxiety, and obsessive-compulsive disorder. Given high comorbidity and limited efficacy of current treatments for these disorders, Radically Open Dialectical Behavior Therapy for adolescents (RO DBT-A) attempts to improve outcomes by targeting overcontrol as a transdiagnostic mechanism. This study aimed to test preliminary efficacy of telehealth-delivered RO DBT-A in targeting overcontrol as a mechanism of psychopathology in a heterogeneous clinical sample.

Method: Participants were female adolescents (ages 13-21; 83% white; 80% non-Hispanic/Latino) who presented with elevated overcontrol. RO DBT-A was provided as the sole psychological treatment for those who wanted it (n = 13) over 16 weeks via skills group and individual sessions. Therapy was delivered via online platform due to the study being during the 2020 COVID pandemic. Non-treatment seeking participants served as controls (n = 7). Outcomes measured at baseline and post-treatment included psychiatric symptoms and overcontrol self-report, and neural responses to reward (wins/losses) and errors via electroencephalogram (EEG).

Results: There were significant improvements in depression (t(10.3) = -1.78, p = 0.01) and quality of life (W = 75, p = 0.02) in the RO DBT group compared to the control group. Testing change within the RO DBT group from baseline to post treatment demonstrated significant improvements in overcontrol (t(12) = 2.76, p = 0.04), anxiety (t(12) = 2.91, p = 0.04), depression (V = 82.5, p = 0.04) and quality of life (t(12) = -3.01, p = 0.04), even after FDR correction. No change in EEG based neural markers was found, although the study was underpowered to detect neural changes.

Discussion: This study provides preliminary evidence for efficacy of telehealth-delivered RO DBT-A in targeting behavioral overcontrol, decreasing symptomology, and importantly, improving quality of life, in a heterogenous clinical sample of teens. Future studies should employ randomized design and examine neural markers in larger sample sizes.


English (en)

Chair and Committee

Deanna Barch, Kirsten Gilbert

Committee Members

Tom Rodebaugh