Dr Karen Li
What is RO-DBT?

Radically Open Dialectical Behaviour Therapy (RO DBT)

RO DBT is a new evidence-based treatment for patients with emotional over-control.  ‘Self-control’ is usually seen as a good thing, however too much self-control can cause difficulties.  Excessive self-control is associated with social isolation and poor interpersonal relations and it contributes to conditions like anorexia nervosa, obsessive-compulsive personality disorder, chronic depression and autistic spectrum disorders.

We don’t see the world as it is… we see the world as we are

You can have too much self-control!

Over- control is seen as a problem of emotional loneliness – not necessarily lacking contact with others……but lack of social connectedness with others.

We are social beings and we know that 3 core components of emotional well-being are:

  1. Openness to feedback, even when this is challenging
  2. Flexibility in our responses, to ever changing demands
  3. Communication of our emotions, recognising that expressing emotion is crucial when forming close interpersonal bonds

    RO-DBT treatment strategies aim to build:

    1. Flexible responding to the demands of the moment
    2. Emphasis on the importance of authentic emotional expression to build positive interpersonal relationships
    3. Self enquiry into our usual responses
    4. Ability to manage unexpected or challenging feedback

    Are you the sort of person who is some of the following: dutiful, avoids risk and novelty, plans ahead, struggles to really connect with others, follow rules, feels unappreciated, struggles to relax and be playful?

    Would you like help to learn how to be more:

    1. Receptive and Open
    2. Flexible
    3. Socially Connected

      Self-inquiry involves healthy self doubt.

      Would this make it easier to meet your goals in life?

      Who is the Treatment For?  

      Patients who have a diagnosis of Chronic Depression, Treatment-Resistant Anxiety Disorders, Anorexia Nervosa, Avoidant, Paranoid and Obsessive Compulsive Personality Disorders and Autistic Spectrum Disorders. 

      Are you likely to suffer from maladaptive over control? Take this questionnaire and see if you have majority A or B responses.


      How is RO DBT different from standard DBT?

      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 their differences 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 between RO DBT and standard DBT include:

        RO DBT DBT
      Target population Emotionally overcontrolled patient populations, such as anorexia nervosa, chronic depression, and obsessive compulsive personality disorder Emotionally undercontrolled patient populations, such as borderline personality disorder, substance misuse, or bipolar disorder
      Primary treatment targets Social signaling deficits, low openness, and interpersonal aloofness Emotional dysregulation and poor impulse control
      Role of bio-temperament Emphasizes how bio-temperament influences perceptual and regulatory biases that clients bring into social situations and addresses these directly Bio-temperament not directly addressed or focused on in standard DBT
      Mindfulness practices Informed by Malamati Sufism Informed by Zen Buddhism
      Therapeutic stance Less directive, encourages independence of action and thought Uses external contingencies, including mild aversives, and takes a direct stance in order to stop dangerous, impulsive behavior
      Radical Acceptance vs Radical openness Radical Openness is actively seeking the things one wants to avoid in order to learn—challenging our perceptions of reality, modelling humility, and a willingness to learn. Radical Acceptance is “letting go of fighting reality.”

      Several other differences between RO DBT and standard DBT exist and are well-articulated here.

      Is RO DBT effective?

      RO-DBT is now practised in the UK, Europe, and North America, and is increasingly recognised as effective for patients who exhibit emotional over-control. The efficacy of RO-DBT has been informed by experimental, longitudinal, and correlational research, including two randomized controlled trials (RCTs) of refractory depression with comorbid OC personality dysfunction that provided the foundation of the development of the RO-DBT treatment manual (Lynch et al., 2007; Lynch, Morse, Mendelson, & Robins, 2003), one non-controlled trial with adult anorexia nervosa inpatients (Lynch et al., 2013), a case series open-trial applying Radical Openness skills alone plus standard DBT with adult AN outpatients (Chen et al., 2015), and one non-randomized trial targeting treatment resistant overcontrolled adults (Keogh et al, 2016), while the mechanisms of change and efficacy for treatment of refractory depression and comorbid OC personality disorders are being investigated via the large multi-site RCT ‘REFRAMED’ (www.reframed.org.uk Lynch). For more information about RO DBT research, see http://www.radicallyopen.net/research-on-ro-dbt/ .

      What are the components of outpatient RO DBT?

      1. Weekly individual therapy (one hour in duration, can be with any RO DBT trained practitioner)
      2. Weekly skills training class (24 x 1.5 hour classes: there are 4 modules with 6 classes in each module)

      What is RO-DBT?