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Radically open dialectical behavior therapy (RO DBT)

Reviewed by Brooks Baer, LCPC, CMHP

A therapist and a client, both men, sit across from each other in a therapy room talking

What is RO DBT?

Radically open dialectical behavior therapy (RO DBT) helps people deal with emotions and behaviors related to overcontrol. It’s based on cognitive behavioral therapy (CBT) and builds upon dialectical behavior therapy (DBT), teaching people how to be more “radically open.” To be “radically open” means to embrace vulnerability, learn from mistakes, and take healthy risks.

What is overcontrol?

Overcontrol is a coping style that features excessive self-control, emotional inhibition, and perfectionism.1 People with overcontrol tend to push down emotions and impulses, and fear losing control. These behaviors can lead to social isolation, as well as mental health problems such as anxiety, chronic depression, and obsessive-compulsive disorder.

Signs of overcontrol include:

  • Avoiding risks
  • Strictly following rules
  • Aloofness
  • Pushing down emotions or masking
  • Overplanning
  • High pain tolerance
  • Oversensitivity to criticism
  • Cynicism or resentment toward others
  • Being a high achiever

RO DBT vs. standard DBT

RO DBT and standard DBT are related, but each targets different populations and teaches distinct skills.

RO DBT focuses specifically on treating people with overcontrolled coping styles. These people struggle with rigid thoughts and behaviors, excessive self-control, and difficulty adapting to change. They may have avoidant attachment styles and engage in self-destructive behaviors as a form of punishment or rule-following. Through self-discovery and radical openness, RO DBT aims to help them develop more flexible behaviors, leading to improved social functioning and well-being.

On the other hand, DBT is a well-established therapy for individuals with borderline personality disorder (BPD) and those who exhibit undercontrolled coping styles. These people may experience intense emotions, impulsivity, and unstable relationships because of their anxious attachment style. They may engage in self-destructive behaviors as a way of lessening or escaping overwhelming emotions. The goal of DBT is to improve impulse control and emotional regulation, leading to reduced self-harm behaviors and better relationships.

How does RO DBT work?

RO DBT is based on two key concepts: biosocial theory and social signaling.

Biosocial theory is a way of understanding mental health in terms of how it’s influenced by a person’s genes and social experiences—including past traumas. RO DBT uses this theory to help people with certain traits or behaviors. These traits could be personality styles you’re born with, while learned behaviors might stem from growing up in a strict household or being bullied at school.

Social signaling refers to the unconscious cues we send and receive in social interactions, often without realizing it. People with overcontrolled coping styles may have trouble accurately interpreting these signals, leading to social difficulties. Instead of expressing emotions to connect with others, they focus too much on being in control, which can make them feel lonely. When this is the case, RO DBT helps people learn to express their feelings while also considering other people’s feelings over their need for control.

RO DBT techniques

In RO DBT, you’ll learn various techniques to help you overcome overcontrolled behaviors and improve your mental health. These include:

Social signaling training helps you to better express your emotions and communicate with others, leading to improved social connectedness. More specifically, it helps you understand and react appropriately to social cues in and out of the individual therapy setting.

Mindfulness and self-inquiry exercises can help you develop the ability to observe your thoughts and feelings without judgment or reacting to them impulsively. Self-inquiry encourages you to ask questions about your beliefs and assumptions, promoting openness, flexibility, and social awareness.

Skills training classes will teach you how to manage your emotions and respond to situations in a more flexible way. These sessions may cover topics such as tolerating uncertainty, coping with change, and embracing new experiences.

Behavioral exposure involves engaging in activities that challenge your overcontrolled tendencies. By facing your fears and stepping out of your comfort zone, you can develop greater emotional flexibility and openness to new experiences.

What to expect from RO DBT

The typical RO DBT therapy-treatment plan takes about 30 weeks.2 Each week, you’ll have a one-hour private session with your therapist and a two-and-a-half-hour group session to learn new skills. Participating only in group sessions, without private ones, may also be an option.

You can expect to engage in a variety of activities and exercises, such as group discussions, role-playing, and mindfulness practices. These will help you develop more flexible thinking and behavior patterns.

An important aspect of RO DBT is learning about emotional expression and how it helps communication. It will help you better understand the signals you may be unknowingly sending to others, and how these signals can be either helpful or unhelpful in your relationships.

The overall goal is to help you be less controlling and distant, rather than just managing impulsive behavior and mood changes, like in standard DBT. You can expect to be encouraged to be more open, spontaneous, and expressive of your emotions.

What RO DBT is used to treat

RO DBT can help treat certain mental disorders that are associated with overcontrol.3 It’s been used to treat mental health problems including:


RO DBT has been shown to be effective in treating the disorders mentioned above. Evidence-based findings include:

  • A study involving a group of adolescents with eating disorders, RO DBT led to improvements in body image, depressive symptoms, social connectedness, and emotional expression.4
  • A randomized trial found that RO DBT helped people with treatment-resistant depression, resulting in fewer depressive symptoms and greater psychological flexibility 18 months after starting treatment.5
  • RO DBT has been found to be an effective intervention for ASD in routine clinical settings.6
  • RO DBT may help with perfectionist tendencies as shown through a case study, which highlights the experience of a patient who found significant relief from dysfunctional levels of perfectionism symptoms associated with an eating disorder.7

Is RO DBT right for you?

RO DBT may help some people, but it isn’t for everyone. If you’re wondering whether it’s right for you, you can start by considering your personality traits and symptoms.

Do you find yourself over-controlling or overly rigid in your thinking? Are you overly sensitive to criticism, struggling with perfectionism, or experiencing chronic anxiety? If so, RO DBT might be a good fit.

Keep in mind that standard DBT is also an option. Before deciding, ask yourself:

Am I struggling with overcontrol or emotional regulation? If overcontrol is the main issue you’re facing, RO DBT might be best suited to your needs. For emotional regulation, DBT could be the way to go.

Do I have a specific diagnosis? If you have BPD, standard DBT will likely be the better choice. If you have treatment-resistant depression or ASD, RO DBT is worth considering. If you don’t have a specific diagnosis but identify with overcontrolling behaviors, RO DBT could be worth exploring.

Am I willing to commit to therapy? Both DBT and RO DBT require a significant time commitment. Consider if you’re ready for regular sessions and homework assignments before choosing which one to pursue.

Lastly, remember that no therapy is one-size-fits-all. It’s worth consulting with a mental health professional to discuss your specific needs and explore the right therapy option for you.

Visit our therapist directory to connect with a licensed professional skilled in RO DBT or another specialty. They can recommend the best course of action based on your circumstances and preferences.

About the author

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