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Dialectical behavior therapy (DBT) is an evidence-based psychotherapy approach that is based on cognitive behavioral therapy (CBT). Aaron Beck developed CBT in the 1960s. According to Psychology Today, CBT focuses on “modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs.” Not long after, in the late 1980s, Marsha M. Linehan developed dialectical behavior therapy. DBT is founded on the principals of CBT, but places greater emphasis on the psychosocial aspect of treatment. It was developed as a means to better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Currently, DBT is not only considered the gold standard method of treatment for people diagnosed with BPD, but evidence has shown it to be a successful therapeutic method in treating individuals with other mental health illnesses (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). 

Who Is RO-DBT For?

RO-DBT is a trans diagnostic approach that was specifically developed to better treat individuals that struggle with extremely difficult-to-treat over control disorders, such as obsessive-compulsive disorder (OCD), anorexia, chronic depression, autism spectrum disorder, and more. The RO-DBT approach can help people that struggle with any combination of the following, as provided by the Child Mind Institute

  • 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 applied in some inpatient treatment settings. The entire program takes at least thirty weeks to complete. Similar to 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 phone coaching between sessions, if needed. RO-DBT focus 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, and high social comparison and envy/bitterness. 

RO-DBT Skills Training: Weekly Breakdown

The primary underlying principal of 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

The goal of RO-DBT is to help people develop optimal control over their emotions that is neither over-controlled nor under-controlled. 

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