Radically Open Dialectical Behavioral Therapy (RO-DBT)

Radically Open Dialectical Behavior Therapy (RO DBT) is a type of cognitive behavioral therapy developed by Dr. Thomas R. Lynch for disorders of emotional overcontrol. RO DBT is 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.

 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 patients 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 15-minute break)
  • Telephone consultation (optional)
  • 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. Still, 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. 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 standard DBT include:





Target population

Emotionally overcontrolled patient populations,    such  as anorexia nervosa, chronic depression, and obsessive  compulsive personality disorder

Emotionally undercontrolled patient populations, such as borderline personality disorder, substance misuse, or bipolar disorder

Primary treatment targets

Social signaling deficits, low openness, and interpersonal aloofness

Emotional dysregulation and poor impulse control

Role of bio-temperament

Emphasizes how bio-temperament influences perceptual and regulatory biases that clients            bring into social situations and addresses these directly

Bio-temperament not directly addressed or focused on in standard DBT

Mindfulness practices

Informed by Malamati Sufism

Informed by Zen Buddhism

Therapeutic stance

Less directive, encourages independence of action  and thought

Uses external contingencies, including mild aversives, and takes a direct stance in order to stop dangerous, impulsive behavior

Radical Acceptance vs Radical openness

Radical Openness is actively seeking the things one wants to avoid in order to learn—challenging our perceptions of reality, modelling humility, and a willingness to learn.

Radical Acceptance is “letting go of fighting reality.”

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, is comprehensive and lists the most up-to-date research. As of summer, 2017  most research support is for the treatment of chronic depression and anorexia nervosa.

 Finding a RO DBT therapist

Patients interested in pursuing RO DBT should take measures to identify a licensed clinician adequately trained in RO DBT. A useful minimal benchmark of adequate training is the successful completion of a 10-day intensive training program in RO DBT delivered by a Radically Open Ltd. sanctioned trainer. In addition, the completion of individual supervision through an approved RO supervisor is desirable. Ensuring a potential therapist has satisfied these guidelines increases the likelihood of receiving the treatment with fidelity and competence. The most reliable location for identifying such a provider is the therapist directory maintained by Radically Open Ltd.

 Additional resources

To learn more about RO DBT, please visit http://www.radicallyopen.net/.


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