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Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that emphasizes the psychosocial aspects of treatment. Psychologist Marsha M. Linehan developed DBT in the late 1980s as a means to more effectively treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). DBT is founded on the principles of cognitive-behavioral therapy (CBT) and blends Eastern mindfulness techniques (e.g., awareness, mindfulness, and attentiveness to current situations and emotional experiences) to encourage acceptance and change. 

DBT remains the gold standard method of treatment for people diagnosed with BPD and is currently recognized as an effective form of treatment for many other mental health ailments (e.g., eating disorders, substance use disorder, bipolar disorder, depression, etc.). Building upon the work of DBT, in the early 2000s, Thomas R. Lynch developed a new therapeutic approach called Radically Open Dialectical Behavior Therapy (RO DBT). 

Adult RO DBT

RO DBT is a transdiagnostic approach that was specifically developed to better treat individuals that struggle with extremely difficult-to-treat overcontrol disorders, such as obsessive-compulsive disorder (OCD), anorexia, chronic depression, autism spectrum disorder, and more. The RO DBT approach can help people that suffer from any combination of the following symptoms

  • Rigid, rule-governed behavior and excessive self-control
  • Difficulty adapting to changing environmental circumstances
  • Trouble making and/ or deepening current friendships
  • Perfectionism, disciplined behavior, and a hyper-focus on achievement
  • Excessive delay of gratification
  • Issues with connectedness and/ or intimacy
  • Hiding or avoiding experiencing and expressing emotions
  • Over-tolerance of negative emotions
  • Depression and/ or anxiety, especially when these issues remain unresolved after participating in therapies such as CBT
  • Loneliness
  • Social isolation
  • Envy and/ or bitterness

Every individual is different and will respond distinctly to the variety of therapeutic treatment options available. That said RO DBT is an excellent comprehensive treatment option for individuals struggling with emotional over-control. 

The Format

RO DBT was originally developed as an outpatient treatment program but has since been used in some inpatient treatment settings. RO DBT focuses on and addresses the following five unhealthy themes

  • Inhibited and disingenuous emotional expression 
  • Hyper-detailed focused and overly cautious behavior 
  • Rigid and rule-governed behavior
  • Aloof and distant style of relating
  • High social comparison and envy/ bitterness

The entire program takes at least thirty weeks to complete. Like DBT, RO DBT is comprised of different therapeutic settings including weekly one-hour-long individual psychotherapy sessions, weekly two-and-a-half-hour-long group skills sessions, and as-needed phone coaching between sessions. 

RO DBT Skills Training: Weekly Breakdown

The core philosophical principle and fundamental skill in RO DBT is radical openness. Through the group skills training sessions, individuals learn helpful coping mechanisms, useful tools, and emotional strategies to shed unhealthy emotional over-controlling habits, patterns, and behaviors. The Behavior Therapist published a reader identifying an overview of the 30 weekly skills class lessons and different applications of RO DBT to include the following:

  1. Radical openness
  2. Understanding emotions
  3. Activating social safety 
  4. Enhancing openness and social connectedness via loving-kindness
  5. Engaging in novel behavior
  6. How do emotions help us?
  7. Understanding over controlled coping
  8. Tribe matters: understanding rejection and self-conscious emotions
  9. Social signaling matters
  10.  Using social signaling to live by your values
  11.  Mindfulness training part 1: over controlled states of mind
  12.  Mindfulness training part 2: the “what” skills
  13.  Mindfulness training part 3: the core mindfulness “how” skill with self-enquiry
  14.  Mindfulness training part 4: the “how” skills
  15.  Interpersonal integrity part 1: saying what we really mean
  16.  Interpersonal integrity part 2: flexible mind REVEALs
  17.  Interpersonal effectiveness: kindness first and foremost
  18.  Being assertive with an open mind
  19.  Using validation to signal social inclusion
  20.  Enhancing social connectedness, part 1
  21.  Enhancing social connectedness, part 2
  22.  Learning from corrective feedback
  23.  Mindfulness training part 1: lesson 11 repeat
  24.  Mindfulness training part 2: lesson 12 repeat
  25.  Mindfulness training part 3: lesson 13 repeat
  26.  Mindfulness training part 4: lesson 14 repeat
  27.  Envy and resentment
  28.  Cynicism, bitterness, and resignation
  29.  Learning to forgive
  30.  RO integration week

There are many highly qualified mental health clinicians in Southern California specializing in adult RO DBT. The goal of RO DBT is to help people develop optimal control over their emotions that is neither over-controlled nor under-controlled. 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.