Radically Open Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) has been found to be particularly helpful for people whose coping style leans towards undercontrol (impulsivity), including people experiencing:

• Cluster B personality disorders such as Borderline Personality Disorder
• Emotion lability (intense and fluctuating emotions)
• Complex PTSD
• Impulsive behaviours
• Self-harm and suicide attempts
• Binge Eating Disorder and Bulimia Nervosa

In 2018, Thomas Lynch published a modified version of DBT called Radically Open Dialectical Behaviour Therapy (RO-DBT) that was developed and tested to support people whose coping style leans towards overcontrol (excessive self-control), including people experiencing:

• Anorexia Nervosa
• Treatment resistant depression
• Treatment resistant anxiety
• Cluster A personality disorders such as Paranoid Personality Disorder
• Cluster C personality disorders such as Avoidant Personality Disorder

Key Differences Between DBT and RO-DBT

DBT is skills based therapy that covers four key topics: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness (communication skills). In contrast, RO-DBT focuses on Interpersonal Effectiveness as a means to wellness, and as such is primarily a social therapy. RO-DBT emphasises gradually opening oneself up to experiencing emotions, communicating these emotions to others, and exploring playfulness and silliness in social settings, all as a way to connect to others to feel part of a tribe.

Why work on overcontrol? Isn’t self-control good?

Self-control in itself isn’t a problem, but some people rely on self-control as a coping strategy so heavily that it starts to feel compulsive. This rigid, overcontrolled way of coping often reflects ongoing anxiety and a deep fear of losing control.

People with an overcontrolled coping style often:

• Are achievement oriented
• Have very high standards for themselves (and sometimes others)
• Avoid confrontation
• Tend to be very serious about life
• Tend to put others’ needs before their own

While a lot of self-control can be useful when it comes to work or study, in relationships it can really get in the way. People who cope in an overcontrolled way often feel at a loss as to how to build close relationships or become part of a group, and overcontrol can contribute to:

• Loneliness
• Depression
• Ongoing feelings of emptiness
• Low emotional awareness
• Difficulty connecting with others in a meaningful way
• Difficulty communicating with others
• Difficulty coping with change
• An intense fear of making mistakes
• Avoiding expressing emotions
• Intense self-criticism
• Finding it hard to think flexibly
• A strong need for structure
• Finding it hard to take in feedback
• Unintentionally coming across to others as unapproachable or lacking warmth
• Frequent social comparison and, in some cases, competitiveness, envy, bitterness, and even schadenfreude (delight in the downfall of others)

Here is a brilliant article on the problems that arise when good things (such as self-control) are taken to excess.

RO-DBT Principles

RO-DBT posits that there are three core components to psychological wellness:

1. Receptivity and Openness - This involves being receptive and open to new experiences as well as being receptive and open to disconfirming feedback in order to learn and grow as a person
2. Flexible Control  - Rather than rigid control, flexible control allows us to adapt to changing environments and conditions
3. Intimacy and Social Connectedness - This involves opening ourselves up to at least one other person based on the idea that species survival involves the ability to form long-lasting bonds and cooperate with others in a group setting

RO-DBT Skills

Key ideas in RO-DBT include:

1. Dialectics -  This involves finding a healthy balance between the extremes of ‘compassionate gravity’ (being serious) and playfulness & connection
2. Radical Openness - Developing a curiosity towards one’s internal state, curiosity towards the internal state of others, and learning that there is no one right way to feel. It also involves being radically open to connecting to others
3. Self Enquiry - Moving away from the extremes of self-judgement or overconfident perfectionism towards healthy self-doubt in order to come to acceptance of imperfection

Is RO-DBT meant to be a group therapy?

Yes. Like DBT, RO-DBT was designed to be delivered in a weekly 2.5-hour group skills training session as well as a weekly 1 hour individual session. We do not offer group therapy at Exhale Psychology Centre, but can deliver RO-DBT in individual sessions. You and your therapist can work together to discuss whether group therapy might be helpful.