Radically Open Dialectical Behaviour Therapy (RO-DBT)

Radically Open Dialectical Behaviour Therapy (RO-DBT) is a specialised form of therapy designed to help people who struggle with being too controlled or rigid in their emotions and behaviours. While regular DBT helps people who have trouble controlling their emotions, RO-DBT is for people who have the opposite problem - they control their emotions and behaviours so much that it causes problems in their relationships and daily life. This therapy was developed by Dr. Thomas Lynch and focuses on helping people become more open, flexible, and connected with others.

Table of Contents | Jump Ahead

• How It Works
• What to Expect
• Who Can Benefit
• Important Considerations
• Finding Help
• References

How It Works

RO-DBT is based on the idea that some people have "overcontrol" - they try so hard to manage their emotions and follow rules that they become isolated and unhappy. The therapy teaches three main skills:

• Openness - Learning to be curious about new experiences and feedback from others, even when it's uncomfortable or challenging.
• Flexibility - Developing the ability to adapt when things don't go as planned, rather than rigidly sticking to rules or routines.
• Social Connectedness - Building genuine, close relationships by learning to express emotions authentically and connect with others.

The therapy focuses heavily on "social signalling" - how you communicate your emotions to others through your facial expressions, body language, and tone of voice. Many people with overcontrol problems send mixed signals (like smiling when they're upset), which makes it hard for others to trust them or feel close to them.

What to Expect

RO-DBT typically includes:

• Individual therapy sessions - One-on-one work with a trained therapist
• Skills training classes - Group sessions where you learn and practice specific techniques
• Homework assignments - Real-world practice of new skills between sessions

During treatment, you'll work on:

• Recognising when you're being too rigid or controlled
• Learning to express emotions more genuinely
• Practising flexibility in daily situations
• Building closer, more authentic relationships
• Developing curiosity about yourself and others

Sessions typically last:

• Individual sessions: 50-60 minutes weekly
• Skills groups: 90-120 minutes weekly
• Treatment duration: Usually 6-12 months, depending on your needs

Who Can Benefit

RO-DBT was specifically designed for people who struggle with:

Mental health conditions:

• Chronic depression that hasn't responded to other treatments
• Anorexia nervosa and other eating disorders
• Obsessive-compulsive personality disorder
• Social anxiety and isolation
• Perfectionism that interferes with daily life

Personality traits and behaviours:

• Being overly cautious or risk-averse
• Having trouble expressing emotions genuinely
• Feeling different from or superior to others
• Struggling with envy or bitterness
• Having few close relationships despite wanting them
• Being overly focused on rules and "doing things right"

You might benefit from RO-DBT if you:

• Often feel lonely despite being around people
• Have been told you seem "fake" or hard to read
• Struggle to relax or be spontaneous
• Find it hard to accept compliments or criticism
• Feel like you have to be perfect all the time
• Have trouble trusting others or letting them get close

Important Considerations

• Effectiveness: Research shows RO-DBT can be very helpful for people with overcontrol problems. Studies have found significant improvements in depression, eating disorders, and relationship quality.
• Different from regular DBT: While both therapies use similar names, RO-DBT is quite different from standard DBT. Make sure your therapist is specifically trained in RO-DBT if this approach seems right for you.
• Not for everyone: RO-DBT is specifically designed for overcontrol problems. If you struggle more with impulsivity or emotional outbursts, regular DBT or other therapies might be more helpful.
• Requires commitment: Like all effective therapies, RO-DBT requires regular attendance and practice of skills outside of sessions.

Finding Help

• Look for therapists specifically trained in RO-DBT (not just regular DBT)
• Check the official Radically Open website for certified providers
• Ask potential therapists about their specific RO-DBT training and experience
• Consider that this is a newer therapy, so fewer therapists may be trained in it compared to other approaches

Remember that recognising you might have overcontrol problems and seeking help shows courage and self-awareness. Many people with these challenges are high-functioning and successful in some areas of life, but struggle with loneliness and authentic connections.

References

Radically Open Institute. (2024). What is RO DBT and who is it for? https://www.radicallyopen.net/what-is-ro-dbt-and-who-is-it-for.html

Gilbert, K., Hall, K., & Codd, R. T. (2020). Radically Open Dialectical Behavior Therapy: Social Signaling, Transdiagnostic Utility and Current Evidence. Psychology Research and Behaviour Management, 13, 19-28. https://pubmed.ncbi.nlm.nih.gov/32021506/

Lynch, T. R., Gray, K. L., Hempel, R. J., Titley, M., Chen, E. Y., & O'Mahen, H. A. (2013). Radically open-dialectical behaviour therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry, 13, 293. https://pubmed.ncbi.nlm.nih.gov/24199611/

Hatoum, A. H., & Burton, A. L. (2024). Applications and efficacy of radically open dialectical behaviour therapy (RO DBT): A systematic review of the literature. Journal of Clinical Psychology, 80(11), 2283-2302. https://pubmed.ncbi.nlm.nih.gov/39056514/