Radically Open Dialectical Behavior Therapy (RO DBT)

What is Radically Open Dialectical Behavior Therapy (RO DBT)?

Radically Open Dialectical Behavior Therapy (RO DBT) is an evidence-based treatment developed specifically to treat problems of overcontrol, such as anorexia nervosa, treatment resistant depression and obsessive-compulsive personality disorder. At the core of an overcontrolled personality and coping style is the tendency to have too much self-control, exhibiting as behavioral and cognitive inflexibility, high inhibition of emotion, perfectionism, and a lack of social connectedness. 

Radical Openness 

Radical openness is the core philosophical principle as well as the core skill in RO DBT. It means actively seeking areas of our lives that we want to avoid or may find uncomfortable, in order to learn. It involves purposeful self-enquiry and a willingness to be wrong, with an intention to change if needed. The term “radical openness” suggests that there are three important aspects of emotional well-being: openness, flexibility, and social connectedness.

RO DBT holds that “facts” and “truth” can often be misleading because we “don’t know what we don’t know,” life is constantly in flux, and there many factors that influence us as humans that we aren’t aware of. Radical openness involves a willingness to doubt or question ourselves and our convictions without becoming emotionally dysregulated. It can also help to improve relationships as it models humility and the willingness to learn from what the world has to offer. RO DBT differs from other treatments by focusing on deficits in social signaling that reduce social connectedness.

Social Signals

A social signal is any behavior a person exhibits in the presence of another person, regardless of its intention. For example, sometimes a yawn is just a yawn and not because someone is disinterested. As humans, we are constantly socially signaling when we are around others. This happens through body movements, expressing emotions, body language and voice tone. Even when we are consciously trying not to social signal, it happens. Silence can be just as powerful as incessant talking.

Overcontrolled individuals see new or unfamiliar (especially social) situations as dangerous, rather than rewarding, due to biological-temperamental differences and past experiences. They tend to hide expressions of emotion making it harder for others to know their true intentions, something that is essential to forming close social bonds. Consequently, RO DBT targets indirect, hidden, and constrained social signaling as the main source of emotional loneliness, isolation, and misery over problematic internal experiences (e.g., negative emotions, harsh self-judgment, distorted thinking).  Treatment strategies are designed to enhance social connectedness; including new skills to activate areas of the brain associated with the social-safety system and to signal cooperation by deliberately changing body postures and facial expressions. This then encourages genuine self-disclosure and breaks down overlearned behaviors or patterns that inhibit expression.

Thus, when it comes to long-term health, what a person feels or thinks internally is considered less important in RO DBT, whereas how a person communicates and socially signals and their ability for social connectedness are given priority.

When you are lonely, it’s hard to feel happy, no matter how much you try to accept or change your circumstances. From the beginning of time, revealing intentions and emotions to others was essential to creating strong social bonds that were the cornerstone of human tribes. In the long run, we are tribal beings, and we want to share our lives with other members of our species. Essentially, when we feel part of a tribe, we naturally feel safe and worry less. RO DBT is designed to help clients learn how to make this a reality.