Radically open dialectical behavioR theRapy

Radically Open Dialectical Behavior Therapy (RO DBT) is a type of What Is Cognitive Behavior Therapy?
cognitive behavioral therapy developed by Dr. Thomas R. Lynch for behavior therapy and cognitive behavior therapy
disorders of overcontrol. Excessive self-control or overcontrol is a type are types of treatment that are based firmly on re-
of personality or coping style that can be identified in early childhood search findings. these approaches aid people in
and can lead to social isolation, poor interpersonal functioning, and achieving specific changes or goals.
severe and difficult-to-treat mental health problems, such as anorexia changes or goals might involve:
nervosa, autism spectrum disorders, chronic depression, and obses- • a way of acting, like confronting our feared
sive-compulsive personality disorder (not OCD, but more related to thoughts
perfectionism, orderliness, and control). Individuals characterized by • a way of feeling, like helping a person be less
overcontrolled coping tend to be serious about life, set high personal scared, less depressed, or less anxious
standards, work hard, behave appropriately, and frequently will sacri- • a way of thinking, like evaluating the probabil-
fice personal needs in order to achieve desired goals or help others; yet ity of an event occuring
inwardly they often feel "clueless" about how to join in with others or • a way of dealing with physical or medical prob-
establish intimate bonds. Thus, overcontrol works well when it comes lems, like lessening back pain or helping a per-
to sitting quietly in school or building a rocket; but it creates problems son stick to a doctor’s suggestions.
behavior therapists and cognitive behavior thera-
when it comes to social relationships.
pists usually focus more on the current situation
What Is RO DBT? and its solution, rather than the past. they concen-
Radically Open Dialectical Behavior Therapy (RO DBT) is an evidence- trate on a person’s views and beliefs about their
based treatment developed specifically for problems of overcontrol. life, not on personality traits. behavior therapists
Radical openness is the core philosophical principle and core skill in and cognitive behavior therapists treat individuals,
RO DBT. The term “radical openness” means there are three important parents, children, couples, and families. Replacing
aspects of emotional well-being: openness, flexibility, and social con- ways of living that do not work well with ways of
nectedness. living that work, and giving people more control
over their lives, are common goals of behavior and
cognitive behavior therapy.
RO DBT holds that “facts” and “truth” can often be misleading be-
cause we “don’t know what we don’t know,” life is constantly in flux,
and there is much that influences us that we aren’t aware of. Radical HoW To geT Help: if you are looking for help, ei-
ther for yourself or someone else, you may be
tempted to call someone who advertises in a local
openness involves a willingness to doubt or question ourselves and our

publication or who comes up from a search of the

convictions without falling apart. It helps relationships because it mod-

internet. you may, or may not, find a competent

els humility and willingness to learn from what the world has to offer.
therapist in this manner. it is wise to check on the
RO DBT differs from other treatments by focusing on helping with
credentials of a psychotherapist. it is expected that
deficits in social-signaling that reduce social connectedness. But what
is a social signal? A social signal is any behavior a person exhibits in the competent therapists hold advanced academic de-
presence of another person; regardless of its intention (sometimes a grees and training. they should be listed as mem-
yawn is just a yawn) or conscious awareness (for example, an involun- bers of professional organizations, such as the
tary sigh). We are constantly socially signaling when around others (for association for behavioral and cognitive therapies
example, via body movements, and voice tone), even when we are de- or the american psychological association. of
liberately trying not to (silence can be just as powerful as nonstop talk- course, they should be licensed to practice in your
ing). state. you can find competent specialists who are
affiliated with local universities or mental health fa-
cilities or who are listed on the websites of profes-
The reason for this is because negative results of overcontrol are

sional organizations. you may, of course, visit our

usually related to social relationships. Overcontrolled individuals see

website (www.abct.org) and click on “Find a cbt

new or unfamiliar (especially social) situations as dangerous, rather
therapist.”
than rewarding, due to biological-temperamental differences and so-

The Association for Behavioral and Cognitive Therapies

cial/historical learning experiences. Their tendencies to hide expres-

(ABCT) is an interdisciplinary organization committed

sions of emotion make it harder for others to know their true
to the advancement of a scientific approach to the un-
intentions, something that is needed to form close social bonds. Conse-
derstanding and amelioration of problems of the human
quently, RO DBT targets indirect, hidden, and constrained social sig-
naling as the main source of emotional loneliness, isolation, and misery condition. These aims are achieved through the investi-
over problematic internal experiences (e.g., negative emotions, harsh gation and application of behavioral, cognitive, and
self-judgment, distorted thinking) and treatment strategies are other evidence-based principles to assessment, preven-
tion, and treatment.
designed to enhance social connectedness; including new skills to ac-
tivate areas of the brain associated with the social-safety system and
signal cooperation by deliberately changing body postures and facial
expressions (e.g. raising eyebrows when stressed), encourage genuine
self-disclosure, and break down overlearned expressive inhibitory
barriers (via skills designed to encourage playful behavior and candid
expression).
Thus, when it comes to long-term health, what a person feels or
thinks inside is considered less important in RO DBT, whereas how a
person communicates or socially signals their private experience to
others and its impact on social connectedness is given priority. When
you are lonely it’s hard to feel happy, no matter how much you try to
accept or change your circumstances, think more positively, keep
busy, exercise, practice yoga, or distract yourself. Revealing inten-
tions and emotions to other members of our species was essential to
creating the types of strong social bonds that are the cornerstone of
human tribes. In the long run, we are tribal beings, and we want to
share our lives with other members of our species. Essentially, when
we feel part of a tribe, we naturally feel safe and worry less. RO DBT
is designed to help emotionally lonely overcontrolled clients learn
how to make this a reality.

What Are the Components of Outpatient RO DBT?

Although RO DBT has been researched and applied clinically in a
wide range of settings (inpatient, day hospital, skills training only),
the approaches outlined in the published treatment manuals (Lynch,
2018a; Lynch, 2018b) are derived primarily from an outpatient
model of treatment delivery. Outpatient RO DBT has four compo-
nents delivered over an average of 30 weeks. The first three compo-
nents are specific to patients and the final component is specific to
the RO DBT therapist. Specifically, the components are:
1. Weekly individual therapy (one hour in duration)
2. Weekly skills-training class (2.5 hours in duration with
15-minute break)
3. Telephone consultation (optional)
4. Therapist participation in RO DBT consultation meetings
(optional)

How Is RO DBT Different From Standard DBT?

As a new treatment, RO DBT is both similar and dissimilar to its ear-
lier versions of DBT. The decision to retain the terms dialectical and
behavior therapy (BT) in the name of this new treatment reflects the
desire to acknowledge two of its fundamental roots. Dialectical prin-
ciples are used in RO DBT to encourage cognitively rigid overcon-
trolled clients to think and behave more flexibly. An example of
dialectical thinking can be seen in the RO DBT mindfulness skill of
self-enquiry. Self-enquiry requires willingness to question one’s be-
liefs, perceptions, action urges, and behaviors without falling apart or
simply giving in. The dialectical tension involves balancing trusting
versus distrusting oneself. The synthesis in RO DBT involves being
able to listen openly to criticism or feedback, without immediate de-
nial (or agreement), and a willingness to experience new things with
an open heart, without losing track of one’s values. Whereas, behav-
ior therapy principles are used to explain how certain maladaptive
overcontrolled social signaling deficits are intermittently reinforced
over time (for example, pouting is reinforced when it functions to
block unwanted feedback) and to therapeutically reinforce and shape
adaptive responses linked to establishing and maintaining close so-
 cial bonds (such as vulnerable self-disclosure and candid expression
of emotion).
Although RO DBT and standard DBT share this common ancestry,
they differ in several important 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 treat-
ment. Some of the key differences between RO DBT and standard
DBT include:
Ro DBT Standard DBT
Target developed for overcontrolled developed for undercontrolled
population clients, such as patients with clients, such as patients with bor-
anorexia nervosa, chronic depres- derline personality disorder, sub-
sion, and obsessive compulsive stance misuse, or bipolar disorder;
personality disorder; these would these would be people whose
be people whose emotions are emotions often are directed out-
often directed inward or don't ward and appear disruptive to oth-
emerge at all. ers.

primary external (interpersonal)— social internal (intrapersonal)— emotion

therapeutic signaling and social connectedness regulation, impulse control, and
focus skills. distress tolerance skills.

Role of bio- emphasizes how biology influences bio-temperament not directly ad-
temperament how we perceive others and how dressed or focused on in standard
that perception affects our actions. dbt.

Mindfulness informed by Malamati Sufism.1 informed by Zen buddhism

practices emphasis on self-inquiry, "outing- emphasis on nonjudgmental
oneself," participating without awareness of “what is” and intu-
planning, and the cultivation of itive knowing. encourages cultiva-
healthy self-doubt. tion of Wise-Mind responses that
encourages Flexible-Mind re- focus on reducing mood-depen-
sponses that promote relaxation of dent impulsive responding and in-
rigid, rule-governed control efforts creasing abilities to delay
and an increase in context-appro- immediate gratification in order to
priate emotional expression. pursue distal goals.

Therapeutic stance less directive, encourages inde- Uses external contingencies, in-
pendence of action and thought. cluding mild aversives, and takes a
direct stance in order to stop dan-
gerous, impulsive behavior.

Radical Acceptance prioritizes Radical openness—that prioritizes Radical acceptance—

vs Radical open- is, actively seeking the things one that is, letting go of fighting reality
ness wants to avoid in order to learn – and turning suffering that cannot
challenging our perceptions of real- be tolerated into pain that can be
ity, modeling humility and a willing- tolerated.
ness to learn.
1
the Malamatis are not so much interested in the acceptance of reality or seeing “what is”
without illusion (central Zen principles), but rather they look to find fault within themselves
and question their self-centered desires for power, recognition or self-aggrandizement

Several other differences between RO DBT and standard DBT exist

and are well-articulated here:
https://www.newharbinger.com/blog/how-ro-dbt-different-dbt

Is RO DBT Effective?
The evidence base for RO DBT is robust and growing. It has been
shown to be highly effective in treating chronic forms of depression
with rates of full recovery from depression reported as high as 71% in
some studies. Research has also demonstrated the potential utility of
RO DBT in the treatment of severely underweight adults with
anorexia nervosa with studies reporting significant increases in body
mass index (BMI; weight gain), low rates of treatment dropout, and
significant improvements in eating disorder related psychopathology.
In summary, as of summer 2017 (see http://www.radicallyopen.net/
research-on-ro-dbt/ for more up-to-date information) most research
support is for the treatment of chronic depression, anorexia, and mal-
adaptive personality dysfunction in adults—with additional ongoing
research examining RO DBT with violent offenders in forensic set-
tings, among young children, and with adolescent eating disorders.

Finding an 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 Rad-
ically Open Ltd. sanctioned trainer. In addition, the completion of in-
dividual supervision through an approved RO supervisor is desirable.
Ensuring that a potential therapist has satisfied these guidelines in-
creases the likelihood of receiving the treatment with fidelity and
competence.
Please feel free to photocopy or reproduce this fact sheet,
The most reliable location for identifying such a provider is the
therapist directory maintained by Radically Open Ltd.: noting that this fact sheet was written and produced by
http://www.radicallyopen.net/find-a-therapist/. ABCT. You may also link directly to our site and/or to the
page from which you took this fact sheet.

Additional Resources
To learn more about RO DBT, please visit http://www.radicallyopen.net/. For more information or to find a therapist:

References ASSoCIATIon for BeHAvIoRAl

Lynch, R.T. (2018). Radically Open Dialectical Behavior Therapy: and CognITIve THeRApIeS
Theory and Practice for Treating Disorders of Overcontrol. Reno, NV: 305 Seventh Avenue
Context Press, an imprint of New Harbinger Publications.
New York, NY 10001
212.647.1890
Lynch, R.T. (2018). The Skills Training Manual for Radically Open
www.abct.org
Dialectical Behavior Therapy: A Clinician’s Guide for Treating
Disorders of Overcontrol. Revo, NV: Context Press, an imprint of New
Harbinger Publications.