Although an increasing number of individuals have heard of Dialectical Behavior Therapy (DBT), quite a few people are unsure about the difference between Dialectical Behavior Therapy and Radically Open Dialectical Behavior Therapy (RO DBT). DBT is a more comprehensive and well-established treatment than RO DBT. DBT was created by Marsha Linehan and now has over 30 randomized controlled trials validating its efficacy in helping individuals with intense emotion dysregulation. DBT is also a more comprehensive treatment that was designed with individual therapy, group therapy, a consultation team, and phone coaching. However, it is important to note that RO DBT has also implemented several of these components, including optional phone coaching. Thomas Lynch developed RO DBT after working with clients who struggled with their emotions but who also had a high degree of self-control, emotional suppression, perfectionism, and a high need for structure. This blog post will describe the difference between undercontrol and overcontrol as well as some of the core skills differences in DBT versus RO DBT.
In the RO DBT manual (Lynch, 1993), individuals who have an overcontrolled personality or style of coping are described as having too much self-control. This tendency toward excessive self-control is correlated with mental health disorders such as autism spectrum, anorexia nervosa, obsessive-compulsive personality disorder, and depression. Individuals with overcontrolled personalities may also struggle with their relationships, in part due to difficulties with exercising flexibility, with low receptivity to openness. Overcontrolled characteristics may have originally evolved to be adaptive in social situations by enhancing individuals’ ability to delay gratification, perform well, value self-sacrifice, and follow the rules. Nevertheless, it is the extent to which these characteristics manifest in situations that require flexibility and openness to build connection, where individuals with overcontrolled personalities struggle. On the contrary, individuals with low self-control (undercontrolled personalities), may be more likely to struggle with impulsivity and difficulty regulating their outward expression of emotional reactions.
Similarities
Perhaps, the main similarity between DBT and RO DBT is that both treatments have a strong focus on emotions. In DBT, therapists are emotion-focused and help clients develop ways to understand and accept their emotions, as well as ways to regulate their emotional dysregulation. Generally, at least in Stage 1 DBT, clinicians expect to help individuals gain more control over their emotions, thereby decreasing emotional dyscontrol, which could manifest as screaming, harming oneself, or impulsive use of substances. In comparison, RO DBT helps clients to understand emotions by understanding five emotionally relevant cues: safety cues, novelty cues, rewarding cues, threatening cues, and overwhelming cues. RO DBT then proceeds to use strategies to help clients increase their sense of social safety and help clients relax.
Differences
A key difference between DBT and RO DBT is that DBT teaches radical acceptance, whereas RO DBT teaches radical openness. Radical acceptance is a skill where individuals practice accepting things just as they are in the present moment or how they were in the past. Radical acceptance can be helpful for reducing emotional intensity by helping an individual to stop fighting reality. RO DBT describes radical openness, whereby individuals practice moving from a closed mindset to an open stance where they are willing to learn new information. Clients use self-inquiry to move from a closed mindset to a more flexible and open mindset, opening themselves up by asking themselves curious questions. Both skills lead to greater peace and reduced suffering.
If you are interested in DBT or RO DBT, talk with your therapist about your options. If you have a therapist who is familiar with both treatments, they may be able to conduct further assessments to determine which treatment is appropriate for you. At Cincinnati Center for DBT (CCDBT), there are several clinicians who can help you make an informed decision about how to proceed.
References
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy: Theory and practice for treating disorders of overcontrol. New Harbinger Publications.
About the Author
Samuel Eshleman Latimer (he/his), Psy.D., is a clinical psychologist that specializes in effective conflict management and dialectical behavior therapy. Samuel also works to help individuals, couples, and families decrease interpersonal suffering and manage challenges associated with borderline personality disorder. Samuel believes that people do not need to choose between learning effective techniques that are based on science and developing warm, genuine relationships, as both of these styles complement each other. Click Here to learn more about Samuel’s experience and therapeutic style.