Helping Kids Who Are Too Controlled

Learning to manage difficult emotions is a big part of growing up. When children can’t handle painful feelings without throwing a tantrum or, when they’re older, lashing out or doing something self-destructive, experts call them “undercontrolled.” They haven’t developed enough self-control to channel their emotions in a healthy way.

But there are also kids who develop too much self-control, who are called “overcontrolled.” That means that they are suppressing their feelings so severely that it’s undermining their mental health.

Kids who are overcontrolled lack the flexibility to adapt effectively to changing situations. “They tend to be rule-governed and rigid,” explains Alexandra Hamlet, PsyD, a clinical psychologist. They’re often not open to new ideas, information or experiences. They try to avoid stepping outside their comfort zone. “It ends up starting to limit them, and their connection to the world.”

Since we value self-control — and self-control contributes to success — we may not recognize that these overcontrollers are struggling. By the time they’re teenagers they may be highly focused on perfection and achievement, but their lack of flexibility and expressiveness cuts them off from other people, leaving them isolated.

Some of these children or teenagers have recognized diagnoses, which include depression, anxiety, anorexia and autism. Overcontrol is what therapists call a “trans-diagnostic” symptom — it shows up in conjunction with a range of diagnoses.

People who are overcontrolled are thought to have a biological temperament set to perceive threats more readily than others. They feel the need to be constantly on alert, and they use excessive self-control as a way of coping. The temperament can be identified in early childhood, and may be exacerbated by an environment that encourages perfectionism and achievement.

“They’re often fearful that if they make one little change, that the whole house of cards falls,” explains Dr. Hamlet. “You see this pattern with people who have anorexia. They think, ‘If I have one cookie, I won’t be able to stop myself.’ ”

Adds Joanna Stern, PsyD, a clinical psychologist at the Child Mind Institute:  “Someone with an eating disorder thinks, ‘If I can control what I eat, that’s good. If I can control what I eat to the nth degree, where I’m taking in only 70 calories a day, that’s really good.’ ”

In addition, when these overcontrolled people rigidly mask their feelings, or present expressions that seem fake, they are often perceived by others as untrustworthy or inauthentic. That in turn increases their distress and loneliness.

But there’s now a form of therapy, developed by Thomas R. Lynch, PhD, professor emeritus at Southampton University, that’s designed specifically for people who are overcontrollers — whatever diagnosis they might have. It’s an offshoot of DBT (dialectical behavior therapy), which is a therapy for people who are undercontrolled. And, like DBT, it’s been adapted specifically for teenagers and young adults.

DBT teaches skills to help people be more aware of and get healthier control over their emotions. The therapy for overcontrollers, called RO DBT (radically open DBT) has the opposite goal: RO DBT teaches skills for becoming more open, more flexible, and more connected to other people.

Like all forms of DBT, RO DBT is based in part on mindfulness, the practice of being aware of our emotions without judging them. Before teenagers and young adults who are overcontrolled can learn to be more flexible, they need to become mindfully aware that they are thinking and acting in a way that is unusually closed and rigid, and that they are sending signals to others that they are unapproachable.

RO DBT can only work, Dr. Stern explains, if the person is motivated to make a change. “If a parent is bringing a teen for treatment and the teen is like, “I don’t have a problem with over control, I’m fine,” that’s really where we have to start. The first step is to get them to buy into the idea that there are some areas of their life that aren’t working so great for them.”

Identifying the areas of their lives that are problematic, and being willing to work on them, form the basis for these overly “type A” teenagers and young adults to develop and use skills to respond flexibly to life.

RO DBT treatment involves both individual treatment sessions and skills training classes, which are  focused on three traits that are key to emotional health functioning: openness to new experiences, flexibility and connectedness.

Skills training classes center on these goals related to overcontrol:

• Increasing self-awareness and expanding one’s ability to recognize and adopt alternative points of view
• Decreasing inhibited and disingenuous emotional expression
• Reducing hyper-detailed-focused and overly cautious behavior
• Loosening rigid and rule-governed behavior
• Decreasing aloof and distant style of relating
• Decreasing social comparison and envy/bitterness.

Some of the techniques taught in RO DBT involve using changes in your body – your posture, your facial expression and your breathing – to trick your brain into feeling safe. With a smile, raised eyebrows, and a relaxed, leaning-back posture, you are signaling to yourself that it’s okay to stand down. At the same time you signal to others around you that you’re comfortable. Dr. Lynch calls it “social safety signaling.”

Dr. Stern explains it this way: “What we do is we sort of reset ourselves through these things that we do with our face, with our body posture to say, ‘Yep, there’s actually no danger here. Everything’s fine.’ And when we signal that to ourselves, we’re signaling it to other people, so other people want to approach us, which in turn perpetuates us feeling safe.”

One group that RO DBT can be especially helpful for is people with treatment-resistant depression or anxiety. Overcontrollers may resist treatment for associated disorders because they’re not open to new information. “They tend to really think that they know the answer,” explains Dr. Hamlet, “and that there’s no point in really being open or flexible, because their answer is right.”

So flexibility skills can help them respond to treatment for other symptoms as well.

Dr. Hamlet uses the example of children she’s treating who have the form of anxiety called emetophobia – fear of vomiting. The conventional treatment for emetophobia is a form of CBT called exposure therapy, which involves gradual exposure to the thing that triggers anxiety until it loses its power. But if kids are overcontrollers it may not work. “It doesn’t really get at the underlying mechanism of overcontrol,” she points out. “Vomiting is something you really have no control over, so it’s a classic problem for an overcontroller.”

Learning flexibility and connecting to others both help overcontrollers feel less threatened by things that are new or outside their comfort zone. “New learning can only occur when you feel safe,” she adds, “And safety over time is with others. We’re evolutionarily programmed to feel safe with other humans.”

To enable overcontrollers to connect with others, they are taught skills that target openness about yourself and being honest about how you really feel.

Did you know the Child Mind Institute is offering telehealth services? Learn more about Telehealth.