What Is Radically Open Dialectical Behavior Therapy?

Radically Open Dialectical Behavior Therapy (RO-DBT) is a new evidence-based therapy for people who are overcontrolled. A counterintuitive idea behind the therapy is that it’s possible to have too much self-control.  Self-control refers to our ability to restrain acting on our urges, emotions, and wants in favor of longer term goals. Most of the time, self-control is good, but some people can suffer from excessive self-control. For these people, inhibiting and controlling impulses and emotions has become so habitual and automatic that they have problem relaxing control when needed. This can result in overcontrolled people being overly inhibited, perfectionistic, cautious, and feeling exhausted by social interactions.

Where does overcontrol come from?

Overcontrol comes from a combination of genetic/biological factors and social and family experiences. Bio-temperamental factors include high threat sensitivity, low reward sensitivity, high inhibitory control, and high detail-focused processing. In more plain language, this means that people who eventually become overcontrolled are born with a tendency to:

• notice the difficult things in life
• be more sensitive
• be more anxious
• feel fewer positive emotions
• have higher capacities for self-control
• tend to notice details that others are less likely to notice.

These biotemperamental factors combine with experiences with family, school, peers, or culture to produce overcontrol. Life experiences that contribute to overcontrol are those that teach the person that:

• it’s very important to not make mistakes
• showing weakness or vulnerability is dangerous or bad
• it’s important to stay in control at all times
• winning or succeeding is very important

Some people tend to have more of the biotemperamental factors, while some have more of the environmental factors, and some people have a lot of both. The more of these factors the person has, the more extreme their overcontrol is likely to be.

What does overcontrol look like?

It’s important to note that overcontrol is not just one trait, but a confluence of traits that all come together in this overarching concept. Some people will have more of the traits than others, but there are a number of things that overcontrolled people tend to have in common:

Overcontrolled people have a hard time relaxing their habitual emotional inhibition. People who are overcontrolled tend to be good at inhibiting their emotion-based impulses (for example, delaying gratification) and avoiding expressing emotions they don’t want to express (for example, by masking inner feelings). This often becomes so habitual that they can’t voluntarily relax inhibitory control in situations that call for flexibility, such as those that call for open expression of emotion or unrehearsed responses, for example dancing, parties, meeting new people, during play, or on a romantic date. High inhibitory control often leads overcontrolled people to prefer structured situations and order and to avoid novelty or situations where there are not clear rules about how to behave or where the outcome is uncertain. They will often find being around others for long is exhausting. This can also lead to perfectionism, a strong sense of duty or social obligation, rehearsing extensively before social situations, and high moral certitude (for example, feeling like there’s a right way to do things).

Overcontrolled people often feel lonely and lack a sense of belonging or closeness. They may have friends (perhaps even a lot of them), but don’t feel like any of those friends truly understand them. Alternately, they may not feel particularly close to anyone or may avoid social situations for the most part. They often feel like they are different from others and feel unsure about how to make friends or get closer to people. It’s also common that they may be unsure if relationships are really worth the trouble or effort.

Overcontrolled people tend to mask their expression of emotions or only share socially-acceptable emotions. This can often result in expressions of emotion that are not well-matched to the context, for example having a flat facial expression when a co-worker expresses excitement or gives them a complement. Or they may tend toward insincere or incongruent expression of emotion, for example, smiling when upset or laughing at a joke they did not find funny. As a result, many overcontrolled people may have difficulty knowing what they feel or tend to be stoic and not report distress.They may also engage in a lot of social comparison and, as a result, tend to be quite critical of themselves or others.

Overcontrolled people often find feedback difficult and are rigid and rule-governed. They are often closed off to new experiences, reluctant to try new things if unsure of the outcome, and avoid uncertainty or unplanned risks. They can be suspicious of the motives of others and tend to hide their true feelings until they get to know someone better. They may tend to have a knee-jerk reaction to defend themselves from critical feedback or may do things to avoid getting feedback because it’s so painful.

How does RO-DBT work?

RO-DBT emerged from 20 years of research into how to help people who suffer because of excessive overcontrol. The treatment pulls together experimental, longitudinal, and treatment outcome research in the form of this novel treatment. This website has an overview of the research behind RO-DBT. The most common mental health problems characterized by overcontrol are chronic depression, anorexia, and obsessive-compulsive personality. RO-DBT is meant to reach out these folks who are often suffering in silence, with few, if any others knowing how bad they are hurting.

RO-DBT is strongly informed by basic research on the facilitative and communicative functions of emotions in facilitating close social bonds. According to the theory, bio-temperamental differences combine with experience to lead overcontrolled individuals to engage in behavior that interferes with the formation of close social bonds, resulting in social isolation, loneliness, and distress. RO-DBT focuses on changing social signaling so that emotional expression is more appropriate to the social context. More appropriate emotional expression then results in increased trust and desires to affiliate from others and thereby increased social connectedness.

RO-DBT is typically delivered over 30 sessions of concurrent individual therapy and skills classes. It’s an active and structured therapy in which people learn concrete skills that they can adapt to their own lives and immediately put to use.

What is radical openness?

RO-DBT aims to develop radical openness, which has three components:

1. Acknowledging stimuli that are disconfirming, unexpected, or incongruous, which are often associated with distress or unwanted emotion. This is in contrast to automatically explaining, defending, accepting, regulating, distracting, or denying what is happening in order to feel better.
2. Self-inquiry, which involves asking oneself good questions in order to learn. This involves intentionally seeking ones’ personal unknown in order to learn from a constantly changing environment.
3. Responding flexibly by doing what is effective in the moment, in a manner that signals humility and accounts for the needs of others.

How is RO DBT different than DBT?

Dialectical Behavior Therapy (DBT) was created back in the early 90s specifically to help people who were chronically suicidal and emotionally dysregulated, often people diagnosed with borderline personality disorder. RO DBT is a new treatment that branched off from DBT in the early 2000s and is focused on the problems of people who are emotionally overcontrolled, basically the polar opposite of who DBT is intended to help. You can read a detailed breakdown of the difference here. 

How do I find an RO-DBT therapist?

A list of therapists around the world who have completed the RO-DBT intensive training can be found on this website. Intensive training involves two, one-week long training events approximately six months apart with therapists encouraged to get follow up supervision. We typically run an RO-DBT skills class here at Portland Psychotherapy, but there are also other local therapists on the website listed above.

If you are a therapist wanting to learn more about RO-DBT, you can buy the book here.