Radically Open Dialectical Behavior Therapy (RO-DBT): A Treatment for Problems of Over-Control
Radically Open Dialectical Behavior Therapy (RO-DBT) is a major adaptation of DBT. RO-DBT treatment is a very different experience for both clients & therapists. Like DBT, the foundation of treatment in Radically-Open DBT (RO-DBT) is behavioral principles, a dialectical philosophy, and a focus on learning new skills in all contexts.
How RO-DBT Differs from DBT
Unlike DBT, RO-DBT focuses on treating an avoidant attachment style characterized by abandoning relationships that involve discomfort. By contrast, standard DBT clients have an anxious attachment style characterized by frantic attempts to avoid abandonment. Since all relationships with depth can involve tension at times, this habit of abandoning relationships means people with over-control issues can end up lonely and disconnected. This habit can also mean that people with over-control issues do not stay in treatment when they experience tension with their therapist even though they may be very unhappy and sincerely desire help. Many people with over-control issues may stop & start treatment repeatedly, leading to a cycle that ultimately leads to a feeling of hopelessness & rejection, even if they have been the one to initiate termination of treatment.
How RO-DBT Helps Clients Achieve Change
The main focus of RO-DBT treatment is to increase a client’s social connectedness through improving social signalling, increasing openness to new situations or experiences, and decreasing tendencies to be rigid & rule-driven in behaviors &/or to interact in an aloof manner.
A key element to treatment in RO-DBT is teaching clients how to relax prior to social interactions so they are better able to communicate and connect with others. Specific instructions are provided which allow clients to turn off their tendency to highly monitor themselves and rehearse interactions prior to engaging with others, resulting in less inhibited or disingenuous emotional expression. Clients are encouraged to practice these steps repeatedly during individual sessions, skills classes, & outside of therapy.
Through modeling radical openness, therapists teach an approach to life in which we actively seek the things we want to avoid in order to learn and be able to respond flexibly. There is an emphasis on:
- Cultivating healthy self-doubt
- Sharing internal experiences with others in order to increase connection (vulnerable expression of emotion)
- Participating without planning as a way to increase enjoyment
- Learning to engage with people when there are relationship problems to experience how the process of repair can be relationship-enhancing.
Getting clients to commit early in treatment to approaching problems in the therapy relationship is crucial to keeping clients in treatment long enough for them to experience the benefits of RO-DBT.
How RO-DBT Clients Differ From DBT Clients
On the surface, RO-DBT Clients & DBT clients may look somewhat similar because they may have similar behaviors. At times, both may feel suicidal, attempt suicide, or self-harm (cutting, burning, punching things, overtaking medications, etc). Both may experience relationship difficulties or have temper outbursts. What drives these behaviors is thought to be significantly different.
In standard DBT, client problems are viewed as being driven by emotions temporarily taking over the person; a cycle of emotional under-control. Problem behaviors are mood-dependent and impulsive and allow the person to temporarily get relief from the intense emotions. Unfortunately, these behaviors create new problems, causing a cycle of emotional lack of control, more problems, & more emotions & lack of emotional control. Often problem behaviors are not kept secret from loved ones and loved ones’ responses to these behaviors can accidentally reinforce the behaviors, making the problem behaviors more likely to occur again. These transactions can leave loved ones feeling manipulated and at a loss regarding how to stop the cycle, often leading to the end of relationships.
In Radically Open Dialectical Behavior Therapy, emotional over-control leads to emotional loneliness, which is thought to be the driving factor for problems, including suicidal feelings & behaviors and self-harm. Suicidal feelings & self-harm behaviors are often kept secret and these actions are usually well-planned vs impulsive. The individual may have rituals related to self-harm and may use self-harm to punish themselves for perceived wrongs. Relationship difficulties are often driven by the clients’ tendency to be rigid in how they do things and an insistence that those around them follow their ideas of how things need to be done. Anger outbursts may be less frequent with people outside of the clients’ inner circle and may be driven by a sense that someone has done something improper. Relationships are often ended by the individual when relationship difficulties arise & the individual may struggle forming new relationships. There may be a strong tendency to be competitive and social comparisons can be high, leading to problems with envy and bitterness &/or a pessimistic, discouraged or resentful outlook on life.
A common diagnosis for standard DBT is Borderline Personality Disorder, which is frequently (~85%) accompanied by a co-occurring diagnosis such as depression, a variety of anxiety disorders (e.g. panic disorder, social phobia, post-traumatic stress disorder), substance use disorders, and/or eating disorders. Because there are few disorders that list suicidality or self-harm as criteria and these behaviors are common for both emotional under-control & emotional over-control, Borderline Personality Disorder is a diagnosis that may also be given to someone with over-control issues. More accurately, people with over-control issues often meet criteria for chronic depression, anorexia nervosa, and/or another personality disorders, such as Obsessive-Compulsive Personality Disorder, Avoidant Personality Disorder, Paranoid Personality Disorder, or Schizoid or Schizotypal Personality Disorder. Researchers believe that RO-DBT may be a relatively transdiagnostic treatment since targeting social signalling deficits & low openness in order to increase social connection & flexibility may be effective for a variety of disorders.