Radically Open Dialectical Behaviour Therapy (RO-DBT)

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