When it comes to therapy for OCPD, the most important difference between RODBT and ACT is that RODBT focuses on improving social signaling (e.g., nonverbal cues like facial expressions, body language, and tone of voice). Research shows that many people with OCPD are emotionally overcontrolled and that this contributes to interpersonal problems via social signaling difficulties. For some, this presents as being reserved, unexpressive, or stoic; they express very little positive or negative emotion, even when they are feeling something on the inside. For others, this presents as pervasive and inauthentic positive emotional expression; they come across as happy or upbeat all the time, even when they’re not. If your main reasons for coming to therapy relate to interpersonal problems or loneliness, and you often feel misunderstood, RODBT might be a better fit. I also run an RODBT skills class, which you can read more about here.

 

I have found ACT to be a great fit for people whose OCPD manifests with rigid routines, rule- and principle-driven behavior, excessive working, judgmental thinking, miserliness, and controlling behavior. If you identify with some of these traits and you don’t get the sense that social signaling or being emotionally overcontrolled is a big part of your OCPD, ACT might be a better fit. ACT helps individuals with OCPD break free from rigid patterns of behavior that are driven by principles, rules, and emotional avoidance. Using what really matters to you in life as your guide (referred to as values in ACT), ACT can help you show up to life’s challenges in a way you feel proud of by growing your psychological flexibility skills. 

 

There are other differences between these approaches to consider as well. RODBT is a newer and more targeted treatment approach than ACT. Whereas ACT has an established evidence base for many types of clinical problems, RODBT was specifically developed for problems of overcontrol, including OCPD. RODBT is also a manualized treatment; it is a more structured form of therapy than ACT. Part of what that means is I introduce and address certain clinical topics in RODBT according to the manual. This can help ensure that potentially important topics are explored in therapy and not overlooked. As a manualized treatment, therapy duration is also more predictable in RODBT–typically 30 weeks. In contrast, there is no single manual that outlines how to deliver ACT. Therapy duration is thus more variable. In my experience working with clients with OCPD, the average number of sessions for good outcomes is around 40. Through activities and discussion, I help clients strengthen the core components of psychological flexibility (e.g., cognitive flexibility). The focus of each session is chosen organically. While both forms of therapy are tailored to the individual, each person’s experience with ACT is likely to vary more so than each person’s experience with RODBT. 

 

Finally, it’s important to mention that there are other approaches to treating OCPD besides ACT and RODBT. Other therapists use psychoanalysis, cognitive behavioral therapy, and internal family systems to help individuals with OCPD. Regardless of therapy approach, research consistently shows the importance of the therapeutic alliance (the working relationship with your therapist) as one of the key drivers of progress in therapy. Try to find a therapist you feel comfortable opening up to and who understands you. If you’d like support choosing a therapy approach, feel free to reach out to me through my contact form below to schedule a brief intro call!