Occupational Therapy

Discovering Radically Open-Dialectical Behaviour Therapy (RO-DBT)

I’ve had an interest in using psychological approaches in occupational therapy for some time. Last year, I completed a six-month course in Cognitive Analytic Therapy skills – training that still influences my practice. This year, I’m learning something new: Radically Open Dialectical Behaviour Therapy (RO-DBT).

RO-DBT, developed by Professor Thomas Lynch, is an adaptation of standard DBT, designed for people with disorders of overcontrol (OC).

Self-control—inhibiting acting on urges, impulses, and desires—is highly valued in most societies, and failures in self-control characterize many of the personal and social problems afflicting modern civilization. However, too much self-control can be equally problematic. Overcontrol (OC) or excessive inhibitory control has been linked to social isolation, poor interpersonal functioning, hyper-perfectionism, rigidity, risk aversion, lack of emotional expression, and the development of severe and difficult-to-treat mental health problems, such as chronic depression, anorexia nervosa, and obsessive compulsive personality disorder. – Lynch et al. (2013)

Some of the differences I’ve encountered so far between RO-DBT and standard DBT are:

  • ‘Emotional loneliness’ is the core problem for OC, rather than ’emotional regulation’ in standard DBT
  • RO-DBT is based on principles from Malamati-Suffism (rather than Zen Buddhism)
  • The goal of RO-DBT is to decrease overcontrol (rather than decreasing dyscontrol)
  • New states of mind: ‘Fixed Mind’, ‘Fatalistic Mind’ and ‘Flexible Mind’
  • A new skills module: ‘Radical Openness’ (this isn’t the same as ‘radical acceptance’)
  • An additional mindfulness “how” skill
  • Some modifications to interpersonal effectiveness skills
  • Additional emotional regulation skills targeting tendencies towards masking of inner feelings, envy, resentment, revenge, bitterness and social comparison
  • Communication strategies e.g. ‘smuggling’
  • The treatment hierarchy differs in that ‘therapeutic alliance ruptures’ are given higher priority than ‘therapy interfering behaviours’

Although I’m still in the early stages of my RO-DBT training, I’m really excited to learn more about it. I can see lots of applications and think it will be very valuable when interwoven with my occupational therapy practice.

  • Developing my skills in therapeutic use of self – for example in attending to and working through therapeutic alliance ruptures
  • Enhancing my ability to support individuals to work towards their occupational goals, for example through a structure for developing skills of engaging in novel behaviour, being more playful and spontaneous and forming more intimate relationships
  • Influencing my clinical reasoning for treatment priorities, in particular around working with individuals with high medical risk (this is discussed in more detail in Lynch et al.‘s 2013 article)
  • Giving me the language to express concepts that I already use in my work
  • Increasing my own openness through practicing these skills

I can’t wait to see how this list will grow as I learn more about RO-DBT and begin to apply it to my clinical work!


Lynch, T.R., Gray, K.L.H., Hempel, R.J., Titley, M., Chen, E.Y. and O’Mahen, H.A. (2013) ‘Radically Open-Dialectical Behavior Therapy for Adult Anorexia Nervosa: Feasibility and Outcomes from an Inpatient Program‘, BMC Psychiatry, 13, DOI: 10.1186/1471-244X-13-293 [Open Access]. (Accessed: 4 July 2014)

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