Radically Open Dialectical Behavior Therapy (RO DBT)

Radically Open DBT is an evidence-based type of cognitive behavioral therapy developed by Dr. Thomas R. Lynch for disorders of emotional overcontrol (OC) or excessive sef-control.  While ‘self-control’ is usually seen as a good thing, too much self-control can cause difficulties with our ability to effectively and flexibly navigate a variety of interpersonal challenges, leading to significant emotional suffering for OC individuals and their families. A growing body of research shows that excessive self-control is associated with problematic relationships, hyper-perfectionism, chronic and/or treatment resistant depression, social anxiety, eating disorders, obsessive compulsive traits. Based on this body of research,  RO DBT was developed as a transdiagnostic treatment indicated for patients with diagnoses of chronic depression, treatment-resistant anxiety disorders, anorexia nervosa, autism spectrum disorders, and avoidant, paranoid and obsessive-compulsive personality disorders.  The therapy directly targets over-controlled coping, inflexible behavioral response patterns, and emotional inhibition.

What are the components of outpatient RO DBT?

Outpatient RO DBT consists of four components delivered over an average of 30-35 weeks. Specifically, the components are:

1)    Weekly individual therapy

2)    Weekly skills training class

3)    Telephone consultation indicated

4)    Therapist participation in RO DBT consultation meetings (optional)

How is RO DBT different from other psychotherapies?

RO DBT differs from other psychotherapies in several ways, but the most fundamental distinction between RO DBT and all other treatments is that RO DBT is the first treatment to prioritize 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 and standard Dialectical Behavior Therapy 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. Some of the key differences between RO-DBT and standard DBT include target population and primary treatment targets.  RO-DBT is used to treat clients that experience problems of overcontrol, including those with diagnoses of anorexia nervosa, chronic depression, and obsessive compulsive personality disorder.   The primary treatment targets in RO-DBT are social signaling deficits, low openness, interpersonal aloofness, and ultimately, loneliness.    Several other differences between RO DBT and standard DBT exist and are well-articulated here.

Is RO DBT effective?

The evidence base for RO DBT is robust and growing. The RO DBT Research website which can be found here, is comprehensive and lists the most up-to-date research.

Lynch, T. (2018). Radically Open DBT: Theory and Practice for Treating Disorders of Overcontrol. New Harbinger Publications

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