What is the difference between Standard DBT and RO-DBT?

The main differences between Standard Dialectical Behavior Therapy (DBT) and Radically Open Dialectical Behavior Therapy (RO-DBT) are in the target populations the therapies are meant to treat and focuses of the therapies themselves.

1. Target Populations:

• Standard DBT: Originally developed by Dr. Marsha Linehan to treat individuals with suicidal ideation, self-harming behaviors, and borderline personality disorder (BPD), DBT has been adapted for other conditions, such as anxiety disorders, depression, and substance use. Standard DBT is most helpful for people who experience emotional dysregulation, intense mood swings, and a pattern of unstable relationships.

• RO-DBT: RO-DBT is a newer, modified form of DBT, developed by Dr. Thomas Lynch, designed to treat individuals with overcontrol. Though individuals with overcontrol may experience suicidal ideation, self-harming urges, and “emotional leakage”, most of their emotional expression is self-contained. People with overcontrol tend to be self-disciplined, perfectionistic, and emotionally restrained. They may struggle with rigidity, social isolation, and difficulty expressing emotions. RO-DBT is often used for conditions such as anxiety, avoidance, depression, obsessive-compulsive personality disorder (OCPD), anorexia nervosa, and chronic depression. It is also often indicated for ASD.

2. Core Focus:

• Standard DBT: Focuses on helping individuals with emotional dysregulation, impulsivity, and behaviors such as self-harm, suicidal ideation, or unhealthy coping strategies. The main goal is to help clients regulate their emotions, tolerate distress, and improve interpersonal relationships.

• RO-DBT: Focuses on helping individuals with overcontrol by increasing flexibility, openness, and social connectedness. The main aim is to help clients become more emotionally expressive, let go of rigid perfectionism, and engage in more adaptive behaviors. RO-DBT helps clients to experience vulnerability and increase social engagement rather than suppressing emotions and avoiding risk.

3. Therapeutic Approach:

• Standard DBT: Involves a balance of acceptance and change, emphasizing mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. It teaches skills for managing intense emotions, making decisions in the moment, and developing healthy relationships.

• RO-DBT: Also involves acceptance and change, but focuses on addressing issues such as rigid thinking, emotional avoidance, and social disconnection. It encourages clients to open up emotionally, take risks in social interactions, and challenge their need for perfectionism and control. RO-DBT places a higher emphasis on social signaling and understanding social cues.

4. Key Differences in Approach:

• Standard DBT: Focuses on accepting intense emotions and learning to regulate and express them in healthy ways.

• RO-DBT: Focuses on changing emotional avoidance and learning to express vulnerability and engage in social situations. It emphasizes creating a balance between self-control and openness.

5. Skills Training:

• Standard DBT: Includes four main modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.

• RO-DBT: Also includes skills training, but the core skills for RO-DBT are more centered around openness to experience, social signaling, and flexibility. It helps clients tolerate uncertainty and accept emotional vulnerability.

Summary:

• Standard DBT is geared toward individuals with emotional dysregulation, such as those with borderline personality disorder, and focuses on regulating intense emotions. It is best for those who experience the need for greater attachment but may sabotage their interactions with their emotional intensity.

• RO-DBT is designed for individuals with overcontrol (e.g., perfectionism, emotional suppression), such as those with OCPD or anorexia, and focuses on fostering openness, flexibility, and social engagement. It is best for those who may sabotage relationships or situations by abandoning them vs tolerating imperfections.

• Both therapies use elements of standard DBT principles, but are adapted for different emotional experiences and goals.