This work could not have been accomplished without a tribe. I would like to begin by thanking our patients for their willingness to share their personal struggles and insights—they have been my teachers and the raison d’être behind it all.
However, without doubt, I am most grateful for the tremendous amount of support, energy, and intellectual contributions made by my wife, best friend, and colleague Erica Smith-Lynch. Without her insight into human nature and willingness to question existing paradigms (most often those I held dearly), much of what is written would not exist. Erica helped develop and refine the core philosophical premises underlying the treatment and was seminal in the development of novel therapist training methods, as well as new RO skills. Erica is the rock of RO DBT.
I am also indebted to Roelie Hempel, who has been our research lab’s senior scientist and associate director for the past 10 years. Her basic science background in psychophysiology, her analytic brain, and her keen curiosity have been essential in our mechanisms of change research. She was the clinical trial manager for our MRC funded multi-center randomized controlled trial and primary driver behind most of our bio-behavioral and experimental research (and that’s just before breakfast). Roelie is the roll to Erica’s rock.
Importantly, this work would also not be same without the time invested and gentle challenges made by Lee Anna Clark in helping refine and strengthen the neuroregulatory model that underlies the treatment—e.g. insights regarding optimal self-regulation, the importance of accounting for bio-temperament, and the utility of undercontrol and overcontrol as multi-dimensional constructs. Finally, when it comes to core contributors, I am grateful for the wide range of intellectual and instrumental contributions made by Jennifer S. Cheavens during the early years of treatment development at Duke University—e.g., help with the development of new skills linked to openness, flexibility, and forgiveness.
In addition, I have been very fortunate to have been mentored by a number of exceptional clinical academic researchers—five of whom I consider most influential in the development of RO DBT. First, I learned most of what I know about radical behaviorism from Alan Fruzzetti—my PhD advisor at Kent State University. Alan introduced me to Marsha Linehan, who trained me in standard DBT, and I was grateful when she also began collaborating with me in research—resulting in the first multi-site RCT of standard DBT funded by NIDA (PIs: Linehan, UW; Lynch, Duke). While this was going on, I was simultaneously running several other funded studies, including an NIMH K23 career development award that afforded me the opportunity of meeting and learning from two prominent psychiatric researchers—Ranga Krishnan and Chip Reynolds. Ranga was the Chair of the Department of Psychiatry Department at Duke University Medical Center and a world-leading depression researcher. It would be impossible for me to outline all the ways Ranga encouraged, advised, and supported me during my tenure at Duke. He invited me to be part of a number of large-scale initiatives including the NIMH funded Conte Neuroscience Center as a co-investigator, which is where I met Kevin LaBar and Greg McCarthy and started to work on models of depression that integrated brain and behavioral science. It was also during this time that I met my other primary mentor for my NIMH K23 award—Charles (Chip) F. Reynolds—a world-leading clinical trial and depression researcher who was located at the University of Pittsburgh’s Western Psychiatric Institute. Chip somehow seemed to recognize something useful in me, because he spent an enormous amount of his valuable time helping me refine my grant submissions and articles, including a visit to my clinic and lab at Duke accompanied by my NIMH program officer. One of the things I admire most about Ranga and Chip was how they managed their research teams and collaborations—always with humility and openness to differing points of view.
I am also grateful to a number of key influencers who have contributed in smaller yet powerful ways to RO DBT over the years. For starters, Sophie Rushbrook was pivotal in helping me formulate the final version of the skills manual and improving our methods of training and supervision. Our dissemination work has become vastly more sophisticated under the leadership of R. Trent Codd III and Jason Luoma. Plus, I am also enormously grateful to Jackie Persons for her perspicacious read of earlier versions of this book and encouragement to “find my voice” when describing RO DBT rather than comparing it to others. Plus, the clinical observations and insights made by Christine Dunkley during the initial phases of our multi-site RCT were seminal in helping me refine a number of key concepts and treatment targets. During the early treatment development years, one of the most important influencers was Clive Robins. Clive was my primary clinical supervisor and research mentor during my clinical internship and postdoctoral training at Duke University. He was the yang to my yin—encouraging yet critical and challenging of my novel ideas. Similarly, the supportive yet oftentimes challenging feedback from Martin Bohus helped me better articulate how RO DBT differed from standard DBT. Our work with eating disorders and subsequent empirical support has largely been due to the efforts and continued enthusiastic support from Eunice Chen, Mimi Simic, Martina Wolf, and Marian Titley. A special thanks to Laura Hamilton and her team who have been instrumental in applying RO DBT in forensic settings. Plus, a note of gratitude goes out to Richard Booth and his research team who have been the driving force behind novel research testing the efficacy of RO skills alone approaches. I also wish to thank Frank Keefe, who was instrumental in the development and research of the RO loving kindness meditation protocol—whereby Frank obtained grant funding that allowed us to run a randomized controlled trial testing our LKM protocol and providing the empirical basis for adopting it in RO DBT.
Of course, those mentioned above represent only a subset of all of the people involved in this work over the years. The remaining list is too long for me to describe each person’s unique contribution—but suffice it to say the contributions were substantial, and I am grateful for each. These individuals include (and hopefully I have not left anyone out): Zach Rosenthal, Linda Craighead, Ian Russell, Ben Whalley, Alex Chapman, Heather O’Mahen, Vanessa Ford, Linda George, Sue Clarke, David Kingdon, Michaela Swales, John Beyers, Jim Carson, Leslie Bronner, David Steffens, Carl Lejuez, Dan Blazer, Steve Hollon, Mark Williams, Sarah Burford, Kate Tchanturia, and Bob Remington. In addition, I am also enormously grateful for the enthusiasm, energy, and feedback I have received from our ever-expanding tribe of senior clinician trainers, trainers-in-training, and supervisors from around the world; including Pip Thomas, Maggie Stanton, Nicole Little, Alex Fowke, Kristi Colwell, Lexi Giblin, Ann Gresham, Chris Kvidera, Michel Masler, Nate Tomcik, Jimmy Portner, Karyn Hall, Kristen Fritsinger, Kirsten McAteer, Katrina Hunt, and Amy Gaglia.
I would also like to acknowledge the wide range of instrumental and intellectual input, support, and new ideas generated from my prior students, postdocs, residents, and interns who I have mentored over the years, many of whom are now in senior positions, including; Kirsten Gilbert, Sara Beth Austin, Emily Vanderbleek, Guy Mizon, Davina Wong, Kelly Cukrowicz, Moria Smoski, Sammy Banawan, Lorie Ritschel, Steven Thorp, Megan Barnsley, Dionysis Seretis, Prue Cuper, Kristin Schneider, Ann Aspnes, Caroline Cozza, Daniel Dillon, Christine Vitt-Ferri, Beth Krause, Tamar Mendelson, and Jen Morse.
It is unlikely that our evidence base for RO DBT would be where it stands at the launch of the manual without noting the support I have been fortunate to have received over the years from a wide-range of external grant funding agencies, including NIMH, NARSAD, AFSP, MRC-EME (UK), Conte Neuroscience Centre (Duke), Centre for Aging (Duke), and the Hartford Foundation. In particular, my NIMH program officer, Enid Light, was exceptionally helpful in guiding me through the funding maze during the earlier developmental years of RO DBT. Lastly, I am grateful for the editorial expertise, practical suggestions, and wit that helped make the final product much improved—that being my senior editor, Xavier Callahan, as well as the overall support from New Harbinger—in particular that of Catherine Meyers, Erin Heath, and Matt McKay. Their flexibility, experience, and belief in this work helped me finally get it off the typewriter and out the door. I hope you enjoy reading the text and that you find the material beneficial.