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Radically Open Dialectical Behavior Therapy vs. Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) has long been recognized as a highly effective treatment for individuals struggling with emotional dysregulation, interpersonal difficulties, and other challenging conditions. Developed by Dr. Marsha Linehan in the late 1980s, Traditional DBT has become a cornerstone of evidence-based therapy, offering hope and healing to countless individuals worldwide.

However, in recent years, a newer and more innovative approach to DBT has emerged, Radically Open Dialectical Behavior Therapy (RO-DBT). Developed by Dr. Thomas R. Lynch, RO-DBT represents a paradigm shift in the field of mental health treatment, offering a fresh perspective and novel techniques for addressing psychological distress and enhancing well-being.

In this blog, we will explore the Radically Open DBT vs DBT, examining their unique features, treatment approaches, and effectiveness in addressing a wide range of clinical issues. By delving into the nuances of each approach, we aim to provide readers with a comprehensive understanding of these two distinct but complementary modalities, empowering them to make informed decisions about their own mental health journey or the treatment options available to their clients.

RO-DBT vs DBT, are different yet interconnected branches of therapy within the dialectical behavior therapy framework. While DBT primarily targets individuals grappling with intense emotional dysregulation, RO-DBT targets issues stemming from overly rigid self-control and feelings of social detachment. These complementary approaches cater to specific emotional and behavioral challenges, offering tailored interventions to promote well-being and emotional balance.

Understanding Traditional DBT

A. Core principles and components of Traditional DBT

  •  Dialectics: Embracing contradictions and finding balance between acceptance and change.
  • Mindfulness: Cultivating present moment awareness to increase emotional regulation and distress tolerance.
  • Distress Tolerance: Learning coping skills to manage crises and intense emotions without making things worse.
  • Emotion Regulation: Developing strategies to identify, understand, and modulate emotions effectively.
  • Interpersonal Effectiveness: Enhancing communication skills, setting boundaries, and navigating relationships.

B. Target populations and conditions treated

  • Borderline Personality Disorder (BPD): Traditional DBT was originally developed for individuals with BPD and has shown significant efficacy in reducing suicidal behavior, self-harm, and other symptoms associated with the disorder.
  • Mood Disorders: DBT has also been adapted for the treatment of mood disorders such as depression and bipolar disorder, particularly for individuals with co-occurring emotional dysregulation.
  • Substance Use Disorders: DBT skills can be helpful for individuals struggling with substance abuse by providing tools for managing cravings, coping with triggers, and preventing relapse.
  • Eating Disorders: DBT has been incorporated into the treatment of eating disorders, particularly for addressing emotional dysregulation and impulsivity.

Exploring Radically Open DBT

Origins and development of RO-DBT
Radically Open Dialectical Behavior Therapy (RO-DBT) represents a groundbreaking evolution of traditional DBT, offering a fresh perspective on the treatment of emotional and interpersonal difficulties. Developed by Dr. Thomas R. Lynch, RO-DBT emerged from decades of clinical research and innovation aimed at addressing the unique needs of individuals characterized by excessive self-control and overcontrolling tendencies. Drawing upon principles from evolutionary psychology, social signaling theory, and neurobiology, RO-DBT offers a novel approach to promoting openness, flexibility, and social connectedness.

Unique features and differences compared to Traditional DBT
RO-DBT introduces several key concepts and techniques that distinguish it from traditional DBT like: 

1. Emphasis on Overcontrol

  • Unlike traditional DBT, which primarily targets individuals with emotional dysregulation and impulsivity, RO-DBT focuses on those characterized by excessive self-control and perfectionism. By addressing the underlying mechanisms of overcontrol, RO-DBT aims to enhance emotional expression, spontaneity, and social engagement.

2. Social Signaling

A central tenet of RO-DBT is the importance of social signaling in promoting social connectedness and well-being. RO-DBT teaches individuals how to recognize and respond to social cues effectively, fostering deeper connections and reducing feelings of loneliness and isolation.

3. Targeting Inhibition System Dysfunction

RO-DBT incorporates interventions specifically designed to address dysfunction within the brain’s inhibition system, which plays a crucial role in regulating emotions, behaviors and social interactions. By targeting these underlying mechanisms, RO-DBT aims to promote greater emotional flexibility and adaptability.

4. Integrative Treatment Approach

RO-DBT integrates elements of mindfulness, distress tolerance, and emotion regulation from traditional DBT with new strategies tailored to the unique needs of overcontrolled individuals. This integrative approach allows for a more comprehensive and personalized treatment experience.

Target populations and conditions treated

RO-DBT is particularly well-suited for individuals who exhibit traits of overcontrol, including perfectionism, rigidity, and social withdrawal. This may include individuals with diagnoses such as avoidant personality disorder, obsessive-compulsive disorder, anorexia nervosa, and treatment-resistant depression. Additionally, RO-DBT may benefit individuals who have not responded adequately to traditional DBT or other forms of therapy.

Practical Considerations and Implementation

Accessibility and availability of Traditional DBT and RO-DBT programs

The accessibility and availability of Traditional DBT and RO-DBT programs vary depending on geographical location, healthcare infrastructure, and funding resources. Traditional DBT programs may be more widely established and accessible in many regions, particularly for individuals with diagnoses like borderline personality disorder. In contrast, RO-DBT programs may be less prevalent but are increasingly being implemented in specialized treatment centers and clinics.

Training requirements for therapists and practitioners

Therapists and practitioners interested in implementing Traditional DBT or RO-DBT must undergo specialized training to effectively deliver these treatment modalities. Training requirements typically include participation in workshops, seminars, and supervision sessions led by certified DBT trainers or RO-DBT experts. Therapists may need to complete formal certification programs or meet specific competency standards to ensure fidelity to the treatment model.

Cost-effectiveness and insurance coverage

The cost-effectiveness of Traditional DBT and RO-DBT programs can vary depending on factors such as treatment duration, intensity, and the availability of insurance coverage. Traditional DBT programs often involve structured, time-limited interventions delivered in group or individual formats, which may be covered by insurance plans or offered at sliding scale fees. RO-DBT programs may require additional resources for specialized training and implementation, potentially impacting affordability and reimbursement rates.

Considerations for choosing between Traditional DBT and RO-DBT

When deciding between Traditional DBT and RO-DBT, several factors should be considered, including the individual’s diagnosis, treatment goals, and preferences, as well as the availability of trained therapists and program resources. Traditional DBT may be preferred for individuals with borderline personality disorder or emotion dysregulation, while RO-DBT may be more suitable for those with overcontrol traits or specific conditions like avoidant personality disorder or anorexia nervosa. Ultimately, the choice between Traditional DBT and RO-DBT should be guided by the unique needs and circumstances of each individual client.

Case Studies and Real-Life Examples

Traditional DBT Case Studies

Case Study 1: Borderline Personality Disorder (BPD) Patient

  • Description: A patient diagnosed with BPD undergoing traditional DBT treatment.
  • Treatment Approach: Core principles and techniques of traditional DBT applied.
  • Outcome: Reduction in suicidal behavior, self-harm, and symptom severity observed.

Case Study 2: Emotion Dysregulation and Impulsivity

  • Description: An individual struggling with emotion dysregulation and impulsivity receiving traditional DBT.
  • Treatment Approach: Utilization of mindfulness, distress tolerance, and emotion regulation skills.
  • Outcome: Improvement in emotion regulation skills and reduction in impulsive behaviors noted.

RO-DBT Case Studies

Avoidant Personality Disorder (AvPD) Client

  • Description: A client with AvPD undergoing RO-DBT treatment.
  • Treatment Approach: Emphasis on addressing overcontrol tendencies and enhancing social connectedness.
  • Outcome: Increased openness, improved social functioning, and reduction in avoidant behaviors observed.

Obsessive-Compulsive Disorder (OCD) Individual

  • Description: An individual with OCD benefiting from RO-DBT interventions.
  • Treatment Approach: Targeting rigid self-control and perfectionism using RO-DBT techniques.
  • Outcome: Reduction in OCD symptoms, increased flexibility, and improved quality of life reported.

Comparative Analysis

Treatment Progress and Outcomes Comparison

  • Comparative review of treatment progress and outcomes between traditional DBT and RO-DBT.
  • Assessment of similarities and differences in treatment response based on case studies and clinical data.

Considerations for Clinical Practice

  • Recommendations for therapists when selecting between traditional DBT and RO-DBT based on individual client needs.
  • Insights into integrating elements from both approaches to optimize treatment outcomes.

The Bottom Line

The comparison between Radically Open Dialectical Behavior Therapy (RO-DBT) and Traditional DBT sheds light on the distinct yet complementary approaches to addressing emotional and interpersonal difficulties. Traditional DBT, rooted in principles of acceptance and change, has proven effective for individuals with borderline personality disorder and emotion dysregulation. On the other hand, RO-DBT offers a novel perspective tailored to individuals characterized by overcontrolling tendencies, promoting flexibility, openness, and social connectedness. Therapists, patients, and individuals seeking treatment must carefully consider the unique features and goals of each approach when deciding on the most suitable intervention.


While Traditional DBT may be preferred for individuals with impulsivity and intense emotions, RO-DBT offers promise for those struggling with perfectionism, rigidity, and social withdrawal. Future research is needed to explore the comparative effectiveness of these approaches across diverse populations and conditions, paving the way for more personalized and targeted interventions in the field of mental health. For personalized recommendations and guidance on selecting the most appropriate therapy for your needs, consult Relevance Recovery, a qualified mental health professional today.

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