What is RO DBT?

Radically Open Dialectical Behavior Therapy (RO DBT) is a specialised form of cognitive-behavioral therapy (CBT) developed by Dr. Thomas Lynch. RO DBT is designed to address a particular subset of individuals who exhibit overcontrol tendencies, which means they have a strong inclination to control their emotions, thoughts, and behaviors to a degree that it becomes maladaptive and hinders their overall well-being.

Key features of Radically Open DBT include:

  1. Target Population: RO DBT is primarily intended for individuals who experience chronic difficulties related to overcontrol, such as those with conditions like treatment-resistant depression, autism spectrum disorders, anorexia nervosa, and obsessive-compulsive personality disorder.
  2. Emotion Regulation: The therapy places a strong emphasis on emotional regulation, aiming to help individuals become more aware of their emotions, express them effectively, and find a healthier balance between emotional control and emotional expression.
  3. Social Signaling: RO DBT recognizes the importance of social connection and teaches individuals how to improve their social signaling skills, which involve non-verbal cues, expressions, and body language, to foster better interpersonal relationships.
  4. Mindfulness: Mindfulness practices are integrated into RO DBT to enhance self-awareness, emotional regulation, and present-moment awareness, helping individuals stay grounded and more in touch with their emotions.
  5. Validation and Acceptance: Like other dialectical behavior therapies, RO DBT incorporates validation and acceptance strategies to create a non-judgmental and empathetic therapeutic environment where clients feel understood and supported.
  6. Behavioral Experiments: Clients are encouraged to engage in behavioral experiments to test their overcontrol tendencies, challenge rigid patterns of behavior, and learn to tolerate uncertainty and discomfort.
  7. Individual Therapy and Skills Classes: RO DBT typically includes both individual therapy sessions, where clients work one-on-one with a trained therapist, and skills training classes, where clients learn and practice specific skills alongside others experiencing similar challenges.
  8. Manualised Treatment: RO DBT is a structured and manualized treatment, meaning that it follows a specific curriculum and set of therapeutic techniques tailored to address overcontrol tendencies.

RO DBT’s ultimate goal is to help individuals with overcontrol issues develop greater emotional openness, flexibility, and social connectedness. By addressing these core challenges, RO DBT aims to improve individuals’ overall quality of life and psychological well-being.

What are the components of outpatient RO DBT?

Outpatient RO DBT is comprised of four components delivered over an average of 30 weeks. The first three components are specific to individuals in treatment with the final component specific to the RO DBT therapist.

Specifically, the components are:

  • Weekly individual therapy (one hour in duration)
  • Weekly skills training class (2.5 hours in duration with a 15-minute break)
  • Telephone consultation (optional)
  • Therapist participation in program-based RO DBT consultation meetings (optional)

How is RO DBT different from other psychotherapies?

RO DBT differs from other psychotherapies in several ways, and the most fundamental distinctions between RO DBT and all other treatments is that RO DBT is the first treatment to prioritise social-signaling as the primary mechanism of change. This is based on research showing that overcontrolled individuals have a heightened bio-temperamental threat sensitivity that makes it more difficult for them to enter into their neurobiologically based social-safety system. When individuals feel safe, they naturally experience a desire to explore and flexibly communicate with others. To address this difficulty, RO DBT teaches clients how to express emotions in a context-appropriate way and to use non-verbal social-signaling strategies to enhance social connectedness. It also teaches skills that activate areas of the brain associated with the social-safety system. Finally, radical openness involves skills for actively seeking one’s “personal unknown” in order to learn from a constantly changing environment.

How is RO DBT different from standard DBT?

Radically Open Dialectical Behavior Therapy (RO DBT) and standard Dialectical Behavior Therapy (DBT) share a similar name because they both emphasize their common roots in dialectics and behavior therapy. Although they share this common ancestry, they differ in several substantive ways. Understanding their differences is important because the similarities in their names can lead to the misperception that they are substantially alike or even the same treatment.

Some of the key differences between RO DBT and DBT are:

  • In DBT the focus is on increasing an individual’s capacity to regulate emotions, tolerate distress, and reduce impulsivity.
  • In RO-DBT the focus is on increasing an individual’s awareness of social signaling, connecting with their ‘tribe’, and increasing a capacity for openness.

Is RO DBT effective?

The evidence base for RO DBT is robust and growing. The Radically Open Ltd website is comprehensive and lists the most up-to-date research available in RO-DBT with the most research support for the treatment of chronic depression and anorexia nervosa. Research on RO DBT is available on the Radically Open Ltd website.

What is overcontrol and why treat it?

The term “overcontrol” refers to an excessive or maladaptive form of self-control that can contribute to chronic mental health issues.

Self-control is the ability to restrain competing urges, impulses, behaviors, or desires and delay gratification in pursuit of future goals. It is often associated with personal success and happiness. Failures in self-control are evident in many personal and societal challenges in contemporary society, including substance abuse, criminal behavior, domestic violence, financial problems, teen pregnancy, smoking, and obesity (Baumeister, Heatherton, & Tice, 1994; Moffitt et al., 2011).

However, excessive self-control, known as “overcontrol,” can also pose significant problems. Overcontrol is linked to social isolation, loneliness, difficulties in interpersonal relationships, and severe mental health conditions that are challenging to treat, such as anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder (e.g., Lynch & Cheavens, 2008; Zucker et al., 2007). Individuals with overcontrol-related disorders often experience silent suffering, which may not be readily apparent.

Regrettably, due to the high societal value placed on the ability to delay gratification and suppress overt displays of potentially harmful emotions and impulses, issues related to excessive inhibitory control or “overcontrol” have received limited attention and may have been misunderstood. Consequently, clinicians may struggle to identify and address these problems.

Maladaptive overcontrol can be characterized by four primary deficits:

  1. Low Receptivity and Openness: This is marked by limited openness to new, unexpected, or disconfirming feedback, avoidance of uncertainty or unplanned risks, suspicion, hyper-vigilance toward potential threats, and a tendency to dismiss or discount critical feedback.
  2. Low Flexible-Control: Individuals with low flexible-control exhibit compulsive needs for structure and order, hyper-perfectionism, a strong sense of social obligation and dutifulness, compulsive planning and premeditation, rigid rule-following, and a belief in the existence of only one correct way of doing things.
  3. Pervasive Inhibited Emotional Expression and Low Emotional Awareness: This involves inhibiting emotional expression in inappropriate contexts (e.g., maintaining a neutral expression when receiving a compliment), insincere or incongruent emotional displays (e.g., smiling while distressed), consistent under-reporting of distress, and limited awareness of bodily sensations.
  4. Low Social Connectedness and Intimacy with Others: Individuals with low social connectedness and intimacy often have distant and aloof relationships, perceive themselves as different from others, frequently engage in social comparisons, experience high levels of envy and bitterness, and demonstrate reduced empathy.

The evidence-based approach Radically Open Dialectical Behavior Therapy (RO DBT) was developed by Dr. Thomas Lynch to address excessive or maladaptive forms of self-control that can contribute to chronic mental health issues.