Q&A

Radically Open Dialectical Behavior Therapy

Overcontrol disorders such as anorexia and Obsessive-Compulsive Personality Disorder can be difficult to treat. Learn how RO DBT can help with psychologist and DBT expert Thomas Lynch.

Thomas Lynch is Professor Emeritus of Clinical Psychology at the University of Southampton and a Fellow of the British Psychological Society. He earned his PhD in clinical psychology from Kent State University in 1996 and completed postdoctoral training at Duke University. From 1998 to 2007 he directed Duke’s Cognitive Behavioral Research and Treatment Program. His honors include the John M. Rhoades Psychotherapy Research Endowment, and he is a Beck Institute Scholar.

Lynch’s best-known contribution is radically open dialectical behavior therapy (RO DBT), a treatment for disorders of excessive self-control such as chronic depression and anorexia nervosa. In the RefraMED trial, RO DBT reduced symptoms of treatment-resistant depression immediately after therapy. He set out the approach in Radically Open Dialectical Behavior Therapy (2018).

In this Q&A, Dr. Lynch explains how RO DBT differs from standard DBT, which disorders count as overcontrolled, whether trauma work should come first, and how the treatment targets perfectionism and social aloofness.

What is RO DBT?

Radically Open Dialectical Behavior Therapy (RO DBT) is an evidence-based treatment targeting a spectrum of disorders characterized by excessive self-control, often referred to as overcontrol (OC). It is supported by 25+ years of clinical experience and translational research and differs significantly from other treatment approaches, most notably by linking the communicative functions of emotional expression to the formation of close social bonds and via skills targeting social-signaling and changing neurophysiological arousal. RO DBT treatment involves both individual treatment sessions and skills training classes. You can read more here Radically Open DBT

What does RO DBT do that DBT doesn't?

RO DBT treats overcontrolled disorders (e.g., chronic depression, anorexia, obsessive compulsive personality disorder) whereas DBT treats undercontrolled disorders, with borderline personality disorder being the quintessential undercontrolled disorder. The differences between the two treatments include (but are not limited to) a new mechanism of change, significantly different treatment targets and 30 new skills not used in DBT. You can sign up for our mailing list and watch a free video explaining the major differences between the two here (and you can always unsubscribe later)

What are overcontrol disorders?

Examples include obsessive compulsive personality disorder, paranoid personality disorder, avoidant personality disorder, dependent personality disorder, anorexia nervosa, schizoid and schizotypal personality disorder, autism spectrum disorders, chronic depression, treatment resistant anxiety and internalizing disorders in general.

If people have learned over control and hiding inner emotions to survive trauma, is it better for them to do trauma work or an approach like this?

The amount a person leans to overcontrol is determined by a mixture of temperament (genetics) and environmental influences. Overcontrolled problems can be exacerbated by trauma but without a thorough assessment of the individual, it is difficult to provide a definitive answer. If a person leans heavily towards overcontrol we recommend they begin with RO DBT, whereupon the therapist can make a determination of how to best address trauma issues within the context of treating overcontrol. Preliminary results with veterans in the US using RO DBT has shown a significant decrease in trauma related symptoms with over controlled clients who had previously not responded to other trauma treatments.

Would RODBT be appropriate for maladaptive perfectionism, particularly for college and middle/high school students? I am a school counsellor.

Yes, we have a lot of school/college counsellors using RO DBT with great success, targeting hyper-perfectionistic students.

How can RO DBT address NSSI when the function is communication of need or depth of emotion to others?

Apologies, this question needs more space than permitted to answer fully. With regard to NSSI, the RO DBT text book (Lynch 2018) covers how RO DBT treats suicidal and non-suicidal self-injury (pages 109 – 118 and 401 – 404).

I'm wondering if radically open DBT has even been used to help people who are controlling in their romantic relationships?

We don’t have any research data on this topic as of yet, although I am in the process of writing a book that is focussed on how to adapt RO DBT for couples therapy. A little openness in a relationship is not a bad thing!

How can DBT work with OCPD ?

RO DBT considers OCPD a quintessential overcontrolled disorder and the rigid rule-governed behavior that characterises OCPD is a core target in the treatment.

I was wondering if your content on social signalling would be useful for people who are really socially anxious and come across as cold, aloof and unfriendly?

Yes, socially anxious and aloof and distant responding is a core target in RO DBT and are prototypical difficulties that respond well to RO DBT

Do you have a treatment manual for therapists?

Yes, there are actually two; the RO DBT textbook (Lynch 2018) provides a guideline for individual therapy whereas the RO skills manual provides the complete set of RO skills (30 lessons) with user friendly handouts and worksheets.

I feel like I am subtly punished by everyone when I express negative emotion? Am I warped in perceiving others reaction to me or am I just an unlikeable person? I observe others being accepted for being vulnerable. I saw that this treatment can help with feeling like an outsider. Would you recommend it for me? Does it have to be done in a group setting or can it be done one-on-one?

Although I am not able to answer personal clinical questions, I can say that RO DBT is designed to help people who feel ostracised and lonely – using a mixture of individual therapy and training in new skills.

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