Radically Open Dialectical Behaviour Therapy

Radically Open Dialectical Behaviour Therapy (RO DBT) is a type of cognitive behavioural therapy developed by Dr. Thomas R. Lynch for disorders of emotional over-control. RO DBT is a transdiagnostic treatment indicated for individuals with diagnoses of chronic depression, treatment-resistant anxiety disorders, anorexia nervosa, autism spectrum disorders, and avoidant, paranoid, and obsessive-compulsive personality disorders.

The RO-DBT approach is supported by 20 years of clinical experience and translational research that parallels established guidelines for treatment development (e.g., UK Medical Council, 2008; Rounsville & Carroll, 2001; 2006).


Australian treatment programs in RO-DBT are rare. The DBT Clinics team has sought training and supervision from approved RO-DBT trainers and supervisors with Radically Open Ltd in the UK to ensure the Australian community receives the most effective treatment approach.

The approach is characterised by Therapeutic Silliness (hence the Mr. Bean image to the left). The RO DBT approach takes silliness very seriously! Therapeutic Silliness is one of many approaches used by RO-DBT clinicians to help over-controlled individuals achieve their valued goals and viscerally experience what it feels like to be part of a tribe.



Below is a brief explanation of Radically Open Dialectical Behaviour Therapy by treatment developer Professor Thomas Lynch from Radically Open Ltd.


Most frequent questions and answers

Yes, the RO-DBT approach is supported by 20 years of clinical experience and translational research that parallels established guidelines for treatment development (e.g., UK Medical Council, 2008; Rounsville & Carroll, 2001; 2006).


Research has found RO-DBT to be effective in the treatment of:

– Chronic Depression

– Anorexia Nervosa

– Obsessive Compulsive Personality Disorder

– Autism Spectrum Disorders

– Maladaptive Perfectionism

– Treatment Resistant Anxiety

Outpatient RO DBT is comprised of four components delivered over an average of 30 weeks. The first three components are specific to individuals in treatment 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 program-based RO DBT consultation meetings (optional)

RO DBT differs from other psychotherapies in several ways, and the most fundamental distinctions between RO DBT and all other treatments is that RO DBT is the first treatment to prioritise 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.

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 the differences between Radically Open Dialectical Behavior Therapy and standard Dialectical Behavior Therapy 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 in each approach include:

– DBT’s focus is on increasing an individual’s capacity to regulate emotions, tolerate distress, and reduce impulsivity.

– RO-DBT’s focus is on increasing an individual’s awareness of social signaling, connecting with their ‘tribe’, and increasing a capacity for openness.



By ‘overcontrol’ we mean excessive or maladaptive self-control, to such an extent that it can lead to chronic mental health problems.


Self-control is the ability to inhibit competing urges, impulses, behaviors, or desires and delay gratification in order to pursue future goals and is often equated with success and happiness. Indeed, failures in self-control characterize many of the personal and social problems afflicting modern civilization, including substance abuse, criminal activities, domestic violence, financial difficulties, teen pregnancy, smoking, and obesity (Baumeister, Heatherton, & Tice, 1994; Moffitt et al., 2011).


However, too much self-control, or overcontrol, can be equally problematic. Overcontrol is associated with social isolation, loneliness, poor interpersonal functioning, and severe and difficult-to-treat mental health problems, such as anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder (e.g., Lynch & Cheavens, 2008; Zucker et al., 2007). Individuals with disorders of overcontrol are often quietly suffering, even though their suffering may not be apparent.


Unfortunately, due to the high value most societies place on capacities to delay gratification and inhibit overt or public displays of potentially destructive emotions and impulses, problems linked with excessive inhibitory control or ‘overcontrol’ have received little attention, or been misunderstood, and it has been difficult for clinicians to recognize such problems.


Maladaptive overcontrol is characterized by four core deficits:

  1. Low receptivity and openness: manifested by low openness to novel, unexpected, or disconfirming feedback, avoidance of uncertainty or unplanned risks, suspiciousness, hyper-vigilance for potential threat, and marked tendencies to discount or dismiss critical feedback.
  2. Low flexible-control: manifested by compulsive needs for structure and order, hyper-perfectionism, high social obligation and dutifulness, compulsive rehearsal, premeditation, and planning, compulsive fixing and approach coping, rigid rule-governed behavior, and high moral certitude (e.g., there is only one right way of doing something).
  3. Pervasive inhibited emotional expression and low emotional awareness: manifested by context inappropriate inhibition of emotional expression (e.g., exhibiting a flat-face when complimented) and/or insincere or incongruent expressions of emotion (e.g., smiling when distressed, showing concern when not feeling it), consistent under-reporting of distress, and low awareness of body sensations.
  4. Low social connectedness and intimacy with others: manifested by aloof and distant relationships, feeling different from other people, frequent social comparisons, high envy and bitterness, and reduced empathy.


Source: https://www.radicallyopen.net/what-is-ro-dbt-and-who-is-it-for.html

Access to RO-DBT Programs through DBT Clinics

DBT Clinics program clinicians receive mentoring and supervision from Radically Open Ltd in the UK and have completed Level 3 training in RO-DBT. Our team was part of Australia’s first Level 3 Training in RO-DBT in March 2023 in partnership with Radically Open Ltd.


In 2024, we are running RO-DBT programs at Melbourne DBT, Sydney DBT and Gold Coast DBT from the Essentia Health Clinics and online through DBT Assist.


2024 is the 20-year anniversary that DBT and DBT-informed programs have been led by the Australian DBT Institute’s Executive Director Dr. Peter King. The DBT Institute provides a model of best practice that has been replicated around Australia. Dr. King and his team support the development of DBT programs, educate staff, and evaluate DBT Clinic programs.


Dr. King leads our DBT & RO DBT programs nationally and our intake team is available to answer any questions you may have related to DBT or RO-DBT and our DBT programs.


About our RO-DBT Programs


Individuals who enter our range of DBT and RO-DBT programs are in the Stabilisation Phase of treatment and may have presentations related to being over-control or under-control. Our RO-DBT programs run for 20- weeks in 10-week blocks with 2 weeks break in between each 10-week block and are suitable for individuals with excessive over-control including maladaptive perfectionism, chronic depression, anorexia nervosa, OCD, Autism Spectrum Disorders and treatment-resistive Anxiety. To get the most from our programs, we also recommend that participants enter the program once they have completed at least an assessment followed by a 2-week Foundation Phase. 


The foundation phase is similar to the commitment phase which Thomas Lynch and Marsha Linehan discuss in their text. Sessions focus on orientating individuals to the structure, treatment targets, and goals of each client’s specific RO-DBT program. We also provide an overview of the RO-DBT program and orientation to technology such as Zoom and DBT Assist used during each participant’s DBT program.


All participants agree to the following expectations of our program:

– Attend foundation session(s) with our intake team (initial 10 to 20-minute session over the phone is free of charge)

– Attend RO-DBT Skills Classes and individual therapy sessions (continue with your existing clinician or connect with one of ours)

– 2-3 weeks of leave in between each 10-week term

– Complete weekly homework/practice tasks

– Complete a diary card on a weekly basis

– Complete self-reporting tools to assist our team measure the effectiveness of treatment

– Abide by the guidelines of the program including not entering relationships with other participants, not attending intoxicated or hung over, and being on time

– Payment of weekly fees for individual therapy and for group


We like to improve our programs and other programs throughout Australia and overseas and ask participants to contribute to the improvement of our programs by providing feedback about the effectiveness of our programs. If you would like to participate in our research programs we also have opportunities to participate in non-identifiable research through the Australian DBT Institute. The Australian DBT Institute, which reviews and accredits our programs, is Australia’s oldest (Established in 2004) National DBT & DBT informed service.  


Intake, Referrals & Inquiries


Our DBT Clinics intake team on the Gold Coast provides intake and referral support to our DBT programs. Our intake team is led by Dr. Peter King (Clinics Director). Our intake team is available Monday to Friday from 10am until 3pm for inquiries and referrals.


We have five options for individuals seeking to be referred to our DBT programs.

– Call our team on 07 5646 3811 or 03 7065 0789

– Complete the form below

– Send an email to email: intake@dbtclinics.com

– Have your GP or Psychiatrist fax a referral to 07 5676 6771

– Ask your GP to send a referral via Medical-Objects to Dr. Peter King (5949971K)


Once we receive your referral our team will be in contact to discuss the best program for you.


RO-DBT Program Referral Form

If you currently have a Psychologist, Social Worker or Counsellor please provide their details. If you do not have a therapist please type "No current therapist"
Choose your preferred days and times for appointments above.
Click or drag files to this area to upload. You can upload up to 5 files.
If you have any referral information it is always useful to provide this information to support our intake processes.