Radically Open Dialectical Behaviour Therapy (RO DBT)

What is RO DBT?

Radically Open Dialectical Behaviour Therapy (RO DBT) is an evidence-based psychological treatment developed specifically for people experiencing difficulties associated with excessive self-control, emotional inhibition and psychological overcontrol.

While traditional Dialectical Behaviour Therapy (DBT) primarily addresses difficulties associated with emotion dysregulation and behavioural undercontrol, RO DBT focuses on a different pattern: too much control.

People with an overcontrolled coping style are often highly responsible, conscientious and able to delay gratification. They may appear calm, capable and successful to others while privately experiencing significant emotional distress, loneliness or disconnection.

They may find it difficult to:

– relax or be spontaneous
– express emotions openly
– allow themselves to be vulnerable
– adapt when plans or expectations change
– tolerate mistakes or uncertainty
– develop close and emotionally connected relationships
– accept feedback or alternative perspectives
– recognise when rules or high standards have become unhelpful
– communicate their internal emotional experience to others.

RO DBT aims to help people develop greater openness, flexibility, emotional expression and social connectedness while retaining the strengths that can accompany self-control.

What is Overcontrol?

Self-control is usually considered a strength.

It allows us to plan, persist, regulate impulses, delay gratification and work towards long-term goals.

However, it is possible to have too much of a good thing.

Overcontrol refers to a pattern in which self-control becomes so strong or rigid that it interferes with emotional wellbeing, relationships and the ability to adapt to changing circumstances.

People with an overcontrolled style may have extremely high personal standards and place considerable importance on doing things correctly.

They may carefully monitor what they say and do, avoid taking interpersonal risks and suppress emotional expression.

This can make someone appear highly competent and independent.

Internally, however, they may experience considerable anxiety, self-criticism, loneliness or emotional distress.

Overcontrol can involve patterns such as:

– perfectionism
– excessive planning and preparation
– rigid routines
– strong rule-governed behaviour
– difficulty adapting to unexpected change
– excessive caution
– emotional inhibition
– difficulty showing vulnerability
– high levels of self-criticism
– discomfort with uncertainty
– difficulty asking others for help
– limited emotional expression
– difficulty relaxing or being playful
– social withdrawal
– feeling different from or disconnected from others.

The difficulty is not simply that someone has “too much self-control”.

The more important issue is whether rigid self-control has begun to interfere with flexibility, openness and social connection.

Who Can RO DBT Help?

RO DBT was developed for people experiencing psychological difficulties associated with maladaptive overcontrol.

Research into RO DBT has particularly focused on chronic and difficult-to-treat conditions where excessive self-control, emotional inhibition and social disconnection are prominent.

RO DBT may be considered for people experiencing difficulties associated with:

– chronic depression
– treatment-resistant depression
– anorexia nervosa and restrictive eating difficulties
– perfectionism
– excessive self-criticism
– obsessive-compulsive personality traits
– chronic anxiety associated with excessive control
– emotional inhibition
– rigid or inflexible thinking and behaviour
– social withdrawal or isolation
– difficulties developing close relationships
– some presentations of autism where maladaptive overcontrol is also present.

Importantly, a diagnosis alone does not determine whether someone is overcontrolled.

Two people with the same diagnosis may have very different coping styles and may therefore require different treatment approaches.

Assessment is an important part of determining whether RO DBT is appropriate.

How is RO DBT Different from Standard DBT?

Although RO DBT developed from the broader DBT tradition and shares some terminology with standard DBT, the two treatments address significantly different patterns of behaviour.

Traditional DBT was developed primarily for difficulties associated with undercontrol.

Undercontrolled patterns can include:

– intense and rapidly changing emotions
– impulsive behaviour
– difficulties inhibiting emotional responses
– unstable relationships
– acting quickly when distressed
– self-harm or other behaviours used to regulate overwhelming emotions.

RO DBT primarily targets overcontrol.

Overcontrolled patterns may include:

– excessive emotional inhibition
– perfectionism
– rigidity
– excessive caution
– difficulty adapting to change
– restrained emotional expression
– high threat sensitivity
– difficulty being vulnerable
– social withdrawal or emotional loneliness.

This distinction matters.

A person struggling with insufficient behavioural control may benefit from learning greater emotional and behavioural regulation.

Someone who is already excessively controlled may not benefit from simply being taught even more control.

RO DBT therefore focuses on developing greater flexibility, openness, emotional expression and social connection.

The Central Goals of RO DBT

RO DBT focuses on three core areas associated with psychological health:

Receptivity and Openness to New Experiences and Feedback

Psychological flexibility requires the ability to consider that our first interpretation may not always be completely accurate.

RO DBT helps people become more receptive to feedback, new information and experiences that challenge existing expectations.

Being radically open does not mean automatically agreeing with other people.

Instead, it involves developing the willingness to ask:

“What might I be missing?”

This capacity for self-enquiry is central to RO DBT.

Flexible Control

RO DBT does not aim to eliminate self-control.

Self-control can be extremely valuable.

Instead, treatment focuses on developing flexible control – recognising when control is useful and when it may be more effective to loosen control, experiment, adapt or tolerate uncertainty.

The goal is flexibility rather than simply replacing control with impulsivity.

Intimacy and Social Connectedness

A major emphasis of RO DBT is the importance of social connection.

Humans are fundamentally social beings, and our emotional wellbeing is strongly influenced by whether we experience ourselves as connected to other people.

Someone can interact with people every day and still feel profoundly lonely.

RO DBT therefore looks beyond simply increasing the number of social interactions.

Treatment focuses on developing genuine emotional connection, openness and intimacy.

Social Signalling: A Key Difference in RO DBT

One of the most distinctive aspects of RO DBT is its emphasis on social signalling.

We communicate with other people through much more than words.

Facial expressions, tone of voice, posture, eye contact, gestures and the timing of our responses all communicate information about how we are feeling and whether we are open to connection.

Someone may genuinely care about another person but communicate this in a highly controlled or restrained way.

For example, a person might feel pleased to see someone while maintaining a neutral facial expression and formal tone of voice.

The internal message may be:

“I’m really happy you’re here.”

But the social signal received by the other person may be:

“I’m not particularly interested in seeing you.”

Neither person necessarily intends for this disconnection to occur.

RO DBT helps clients become more aware of the signals they send and how those signals influence relationships.

Emotional Expression and Vulnerability

For many overcontrolled people, vulnerability can feel uncomfortable, risky or unnecessary.

They may have learned that emotions should be private, that problems should be handled independently or that showing uncertainty is a sign of weakness.

RO DBT takes a different perspective.

Appropriate emotional expression can communicate important information to other people and help create trust and closeness.

Treatment therefore helps people experiment with communicating emotions more openly and authentically.

This does not mean sharing everything with everyone.

Healthy openness involves learning when, where, how and with whom vulnerability is appropriate.

Radical Openness

Radical openness is more than simply being open-minded.

It involves actively seeking information that might challenge our existing beliefs, expectations or behaviours.

This can be particularly challenging when we strongly believe that our interpretation is correct.

RO DBT encourages a stance of curiosity.

Rather than immediately asking:

“How can I prove that I’m right?”

we might ask:

“Is there something here that I could learn?”

Radical openness involves recognising that we cannot learn something new if we assume we already know everything we need to know.

This does not mean abandoning our values, accepting inappropriate behaviour from others or assuming other people are always correct.

It means developing sufficient psychological flexibility to consider new information without automatically defending against it.

Self-Enquiry

Self-enquiry is an important RO DBT practice.

Rather than immediately trying to change an uncomfortable thought or emotion, self-enquiry encourages curiosity about what that experience might reveal.

A person might ask:

“What is it about this feedback that feels threatening to me?”

“What might I be avoiding?”

“Is there something here that I don’t want to acknowledge?”

“What could I learn from this experience?”

The purpose is not self-criticism.

It is cultivating curiosity about ourselves and becoming more willing to discover information that may help us grow.

Perfectionism and RO DBT

Many people with an overcontrolled coping style hold themselves to extremely high standards.

High standards are not inherently problematic.

They can contribute to achievement, persistence and excellence.

Difficulties arise when standards become so rigid that mistakes feel intolerable or personal worth becomes dependent upon performance.

This may lead to:

– excessive checking
– procrastination
– difficulty completing tasks
– avoiding situations where failure is possible
– excessive preparation
– harsh self-criticism
– difficulty delegating
– frustration when others approach tasks differently
– difficulty celebrating achievements because attention immediately shifts to what could have been better.

RO DBT helps people examine whether their standards are serving their goals or whether rigid adherence to those standards has begun to interfere with wellbeing and relationships.

RO DBT and Relationships

People with overcontrolled coping styles often care deeply about their relationships.

However, excessive inhibition can make it difficult for other people to recognise that care.

Someone may avoid expressing affection because it feels uncomfortable.

They may solve problems rather than validate emotions.

They may withdraw when upset rather than communicate.

They may avoid asking for support because they do not want to burden others.

Over time, these patterns can unintentionally create distance.

RO DBT therefore places significant emphasis on learning how to communicate:

– warmth
– openness
– interest
– vulnerability
– playfulness
– affection
– willingness to cooperate.

The goal is not to change someone’s personality.

It is to increase the range of ways they can communicate and connect with others.

RO DBT Skills Training

RO DBT generally includes structured skills training.

Skills focus on areas such as:

– radical openness
– self-enquiry
– flexible responding
– understanding social signalling
– increasing emotional expression
– reducing unhelpful inhibition
– recognising social safety
– developing intimacy and connection
– managing envy, bitterness and resentment
– responding more flexibly to feedback
– increasing playfulness and spontaneity
– understanding when excessive control is interfering with valued goals.

Skills are practised outside sessions so they can increasingly become part of everyday life.

Individual RO DBT Therapy

Individual RO DBT therapy provides an opportunity to understand the client’s particular patterns of overcontrol and how these influence their emotional wellbeing and relationships.

Treatment is collaborative.

The therapist and client examine behaviours and situations in detail and explore opportunities for greater openness, flexibility and connection.

Importantly, the aim is not to turn a highly controlled person into an impulsive person.

Instead, therapy helps clients develop a broader behavioural repertoire so they can respond differently depending upon what a situation requires.

RO DBT and Autism

Some autistic people may also experience patterns associated with overcontrol, including rigidity, emotional inhibition, difficulties adapting to unexpected change or social disconnection.

However, autism and overcontrol are not the same thing.

RO DBT should not be used with the goal of making an autistic person appear more neurotypical or suppressing natural autistic characteristics.

Where RO DBT is considered for an autistic person, careful assessment is important to determine whether maladaptive overcontrol is genuinely contributing to distress or reduced quality of life.

Treatment should respect neurodiversity and focus on the person’s own goals, wellbeing, relationships and quality of life.

RO DBT and Eating Disorders

RO DBT has particular relevance to some restrictive eating disorder presentations where excessive control, rigidity, perfectionism and emotional inhibition are prominent.

For some people, rigid rules around eating may form part of a broader pattern of excessive control that is also evident in other areas of life.

Treatment may therefore address not only eating-related behaviours but also broader patterns involving perfectionism, emotional inhibition, inflexibility and social connection.

RO DBT does not replace appropriate medical, nutritional or multidisciplinary eating-disorder care when this is required.

Is RO DBT Right for Me?

RO DBT may be worth considering if you recognise a longstanding pattern of being highly controlled, perfectionistic, emotionally inhibited, rigid or socially disconnected, particularly when these patterns are interfering with your relationships or quality of life.

You might appear capable and “together” to other people while internally experiencing significant distress.

You may have previously completed therapy and understand your difficulties extremely well intellectually, yet still find it difficult to change how you respond emotionally or interpersonally.

You may also have been told that you need better emotion regulation when your difficulty is actually that you regulate and inhibit yourself too much.

This is why assessment matters.

At DBT Clinics Australia, we assess patterns of both undercontrol and overcontrol rather than assuming that everyone experiencing emotional difficulties requires the same treatment.

Depending upon your needs, we may recommend standard Dialectical Behaviour Therapy (DBT), Radically Open Dialectical Behaviour Therapy (RO DBT), another psychological treatment, or an integrated approach.

DBT or RO DBT?

If you are unsure whether DBT or RO DBT is more appropriate, you do not need to work this out yourself before seeking help.

Assessment can help identify the patterns contributing to your difficulties.

As a broad distinction:

DBT generally focuses on difficulties involving emotional and behavioural undercontrol.

RO DBT generally focuses on difficulties involving maladaptive overcontrol.

The distinction is more complex than simply being “emotional” versus “not emotional”, which is why an individual assessment is recommended.

Looking for RO DBT Therapy?

DBT Clinics Australia specialises in Dialectical Behaviour Therapy (DBT) and Radically Open Dialectical Behaviour Therapy (RO DBT).

Our clinicians provide assessment to help determine whether RO DBT is appropriate for you and which treatment approach best matches your individual needs.

RO DBT treatment may include individual therapy, structured skills training and coordinated psychological care.

Book an initial assessment with DBT Clinics Australia to discuss whether RO DBT may be right for you.