Autistic and Struggling with Anxiety or Depression?

 

Note: This article uses identity-first language (“autistic person”) rather than person-first language (“person with autism”) in alignment with preferences expressed by most autistic self-advocates, but I recognize that different people have different preferences.  My intention is to approach autism from a neurodiversity-affirming perspective, viewing autism as a difference rather than a deficit.

If you’re autistic, you already know that your brain works differently than neurotypicals. Your way of experiencing the world has its own strengths and challenges. One therapy approach called Radically Open Dialectical Behavior Therapy(RO DBT) focuses on a specific set of experiences that some autistic people find can add emotional pain or restrictions to their lives.

RO DBT was designed for people who experience what therapists call “overcontrol.” You might see the same behaviors as having high standards, preferring clear rules, or processing emotions internally. That can all be amazing. At the same time, RO DBT is helpful for a particular pattern: when control and structure become so central that they limit your quality of life in ways you don’t want.

This therapy isn’t about “fixing.” It’s a tool that some autistic people choose to use when they want support with specific challenges. In RO the clients are always the experts on themselves. What works for you?

 

Understanding Overcontrol: Is This Your Experience?

“Overcontrol” is the clinical term, but it describes real experiences that some autistic people have. They are part of how your brain processes the world. The question is: are these patterns always working for you, or are they sometimes causing distress?

Here’s what overcontrol can look like:

• Having clear personal rules that help you navigate the world, but feeling trapped when they conflict with what you need
• Preferring predictability and structure,  but experiencing significant distress when unexpected changes happen
• Processing emotions internally because that feels safer, but feeling isolated or misunderstood as a result
• Valuing competence and self-sufficiency, but finding it difficult to ask for help even when you want it
• Having high standards for yourself that drive you to achieve, but also lead to painful self-criticism
• Protecting yourself by maintaining emotional distance, but also feeling lonely

According to research published in the Journal of Autism and Developmental Disorders, many autistic people show these patterns and many experience anxiety, depression, or social isolation connected to them when they get in the way of their goals or desires

Important note: Loving routine, having strong principles, or being private with emotions aren’t problems in themselves. The question is whether these patterns are limiting your life in ways that cause you distress or prevent you from meeting your own goals.

How RO DBT Is Different from Other Therapies

Most therapies focus on helping people control their emotions better. RO DBT does something different. It helps people open up and be more flexible. Think of it like this: if your emotions are a garden, most therapies help you build a fence around wild plants. RO DBT helps you open the gate and let some air and sunlight in.

RO DBT was created by Dr. Thomas Lynch and is based on over 20 years of research. You can learn more about the scientific foundation at the Radically Open DBT website.

 

The therapy teaches three main skills:

1. Radical Openness

Learning to be curious about your own thoughts and feelings instead of judging them. And being open to considering different ideas, solutions, and information. It is about you exploring different views and concepts and making decisions for yourself.

 

Nicole Little, Ph.D. describes Radical Openness as

being open to new information or disconfirming feedback in order to learn.

• Learning to celebrate self- discovery— it is freedom from being stuck.

• Rewarding— it often involves trying out novel ways of behaving that may help us cope more effectively.

• Courageous— it alerts us to areas of our life that may need to change.

• Capable of enhancing relationships— it models humility and readiness to learn from what the world has to offer.

• A process of purposeful self- enquiry and a willingness to acknowledge one’s fallibility— with an intention to change (if needed). It can be both painful and liberating.

• A way to challenge our perceptions of reality based on assumptions that we all have perceptual and regulatory biases and as a consequence we don’t see things as they are— we see things as we are.

• Being open to learning new things, which involves a willingness to consider that there are many ways to get to the same place.

• About taking responsibility for our personal reactions and emotions—without falling apart or automatically blaming others or the world.

• Meant to help us adapt to an ever- changing environment, rather than being stuck rigidly responding to situations in ways that don’t actually serve us.

 

2. Flexibility

Developing capacity to adapt when things don’t go as planned, not because loving routine is wrong, but because unexpected changes are inevitable in life. This skill is about building tolerance for uncertainty so that changes feel less catastrophic, not about giving up routines that genuinely help you.

 

3. Social Connection

Building genuine relationships that you want to build, by showing your true self to others, even when it feels uncomfortable.

 

Why Some Autistic People Choose RO DBT

Some therapies address problems that don’t match autistic experiences, like being “too impulsive” or “lacking self-control.” RO DBT addresses patterns that often affect some autistic people (though not exclusively).

 

Research from the National Autistic Society shows that autistic people often experience:

• High levels of anxiety (about 40-50% of autistic people have an anxiety disorder)
• Depression (rates are 2-3 times higher than in non-autistic people)
• Challenges with social relationships that cause distress
• Strong preferences for sameness that can sometimes limit opportunities

The Autism Research Institute notes that interventions addressing rigid thinking patterns and emotional regulation can improve quality of life for autistic individuals when those individuals want that change. However, every individual is different and what works for one person may not work for another.

 

It’s worth emphasizing: These changes happen when someone actively chooses them. RO DBT is about expanding your options, not erasing who you are.

 

RO DBT teaches skills to:

• Notice and work with uncomfortable feelings instead of suppressing them
• Learning the difference between harmful perfectionism and helpful perfectionism
• Approach new situations with less anxiety
• Connect with others in ways that feel authentic to you
• Hold yourself to standards that motivate rather than punish

 

What Happens in RO DBT Treatment?

RO DBT typically involves two main parts:

 

Individual Therapy Sessions

You meet one-on-one with a therapist trained in RO DBT. These sessions usually happen once a week and last about 50 minutes. Your therapist helps you identify areas where overcontrol is making life harder and teaches you specific skills to become more open and flexible.

 

 

Skills Training Classes

You meet with a small group of people (usually 6-8), usually once a week. The focus is on learning skills together, not on sharing personal stories if you’re not comfortable.

 

 

Is RO DBT Right for You? Only You Can Decide

RO DBT might be worth exploring if you:

• Have personal rules and systems that usually help you, but sometimes feel trapped by them
• Keep your emotions private in ways that increase your isolation
• Hold yourself to standards that drive achievement but also cause significant pain
• Want to connect with others but find it difficult to be emotionally vulnerable
• Experience loneliness and wish you had tools to change that
• Live with anxiety or depression that affects your quality of life
• Want more options for how you respond to life’s challenges

Final Thoughts

If you are autistic and experiencing anxiety, depression, or loneliness, consider if RO DBT might be an option for you.

For more information about autistic-affirming resources and community support, visit:

• Autistic Self Advocacy Network – Run by and for autistic people
• Neurodiversity Movement Resource
• National Institute of Mental Health
• Mental Health America

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider about your specific situation.