Radically Open Dialectical Behavior Therapy (RO-DBT)

Radically Open Dialectical Behavior Therapy (RO DBT) is a cognitive behavioral therapy developed by Dr. Thomas R. Lynch for disorders of overcontrol. 

Excessive self-control is a type of personality that can be identified in early childhood and can lead to social isolation, poor interpersonal functioning, and severe and difficult-to-treat mental health problems (anorexia nervosa, autism disorders, chronic depression, and obsessive-compulsive personality disorder (related to perfectionism, orderliness, and control). 

Individuals with overcontrolled coping set high personal standards, work hard, behave appropriately and frequently sacrifice personal needs to achieve desired goals. Inwardly they often feel “clueless” regarding intimate bonds. Essentially, overcontrol works when it comes to performing individual tasks; however, problems occur when it comes socialization.

The term “Radical Openness” means there are three important aspects of emotional well-being: 

  • Openness;
  • Flexibility; and
  • Social Connectedness.

Radical Openness involves a willingness to doubt or question ourselves and our convictions without falling apart. RO DBT differs from other treatments by focusing on helping with deficits in social-signaling that reduce social connectedness. 

  • A social signal is behavior exhibited in the presence of another person.  We are constantly social signaling when around others (body movements and voice tone) even when we are not trying to do so.
  • Negative results of overcontrol are usually related to social relationships. Overcontrolled individuals see new or unfamiliar situations as dangerous, rather than rewarding, due to biological-temperamental differences and social/historical learning experiences.

  • Consequently, RO DBT targets indirect, hidden, and constrained social signaling as the main source of emotional loneliness, isolation, and misery over problematic internal experiences (negative emotions, harsh self-judgment and distorted thinking).

  •  Treatment strategies include new skills to activate areas of the brain associated with the social-safety system and signal cooperation by deliberately changing body postures and facial expressions (raising eyebrows when stressed), encourage genuine self-disclosure, and break down overlearned expressive inhibitory barriers (skills designed to encourage playful behavior and candid expression).

Components of Out-Patient RO DBT

Although RO DBT has been researched and applied clinically in a wide range of settings, the approaches outlined in the published treatment manuals (Lynch, 2018a; Lynch, 2018b) are derived primarily from an Out-Patient model of treatment delivery. 

Outpatient RO DBT has four components delivered over an average of 30 weeks. The first three components are specific to patients and the final component is specific to the RO DBT therapist.

The components are:

  • Weekly individual therapy (one hour in duration);
  • Weekly skills-training class (2.5 hours in duration with 15-minute break);
  • Telephone consultation (optional); and
  • Therapist participation in RO DBT consultation meetings (optional)_


Dialectical principles are used in RO DBT to encourage cognitively rigid overcontrolled clients to think and behave more flexibly. Self-enquiry requires willingness to question one’s beliefs, perceptions, action urges, and behaviors without falling apart or simply giving in. The dialectical tension involves balancing trusting versus distrusting oneself. 

The synthesis in RO DBT involves being able to listen openly to criticism or feedback, without immediate denial (or agreement), and a willingness to experience new things with an open heart, without losing track of one’s values.

Effectiveness of RO-DBT

RO DBT has been shown to be highly effective in treating chronic forms of depression with rates of full recovery from depression reported as high as 71% in some studies. 

Research has also demonstrated the potential utility of RO DBT in the treatment of severely underweight adults with anorexia nervosa with studies reporting significant increases in body mass index (BMI; weight gain).


Lynch, R.T. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Reno, NV: Context Press, an imprint of New Harbinger Publications.

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