Condition Menu

Radically Open DBT

Our Treatment Approach

Current research is beginning to show that temperament plays a role in the development of mood and anxiety disorders. In Radically Open Dialectical Behavior Therapy, temperament lies on a spectrum, with overcontrolled vs undercontrolled personality types at each end. Here’s what traits each of these distinct personality types might look like:

What is RO DBT?

Radically Open Dialectical Behavior Therapy (RO DBT) is a cutting-edge, evidence-based treatment offering patients a practical framework for learning from their environments, making meaningful changes to connect with others and improving their relationships.

For example, we know that emotionally over-controlled people tend to be perfectionistic, organized and detail-oriented; they avoid risks and view new people and situations as threatening. As a result, these individuals experience social isolation, poor interpersonal functioning and emotional loneliness, as well as higher rates of anxiety and chronic depression.

When working with patients, Pathlight's RO DBT therapists emphasize three core therapeutic areas:

  • Openness: Teaches receptiveness to feedback and constructive criticism; this can be difficult for those with a high sense of control and threat sensitivity
  • Flexibility: Teaches adaptability; this is important because behavior in one situation might not be appropriate in another situation
  • Connectedness: Teaches emotional recognition and emotional expression; these valuable skills support appropriate intimacy and healthy relationships

Radical openness is the core skill of RO DBT, and it involves compassionately exploring our “personal unknown.” In other words, radical openness teaches us to doubt or question ourselves, our beliefs and our behavior in order to learn from our environment. Radical openness enhances our relationships because it models humility and the willingness to learn from what the world has to offer. Radical openness contends that emotional well-being involves three things: openness, flexibility and social connectedness.

Overcontrol and RO DBT

Individuals who live a life of “overcontrol” are prone to certain mental health issues, including depression, anxiety, dissociation, self-harm and eating disorders (self-starvation). Taken to its extreme, a high degree of overcontrol can be damaging and is associated with:

  • Being extremely isolated
  • Having trouble relating to others
  • Experiencing higher rates of anxiety, anorexia nervosa and chronic depression*

In our society, individuals who strive for total control may be lauded for their perceived abilities to “hold it all together.” Their ability to maintain this high amount of self-control — in a world where uncontrolled behavior is often censured — is seen as a plus. Indeed, as children, these individuals may have been told either directly or indirectly to “be perfect.” Growing up, they pursue perfection and may, in fact, achieve a great deal of success. But, inside, they can struggle.

Undercontrolled (UC)

  • Global focused processing
  • High sensitivity to reward
  • Less cautious or sensitive to threat
  • Uninhibited
  • Emotionally expressive; dramatic
  • Actively seek new experiences, sensations and more risk-taking

Treatment for Overcontrol

Radically Open DBT (RO DBT) addresses three different areas that can help overcontrolled individuals achieve a richer and more rewarding emotional life. One area in particular is to help overcontrolled individuals reduce loneliness and connect to others by addressing the following areas of deficit.

Receptivity and Openness — RO DBT helps individuals become more receptive to feedback; feedback and constructive criticism can be difficult for perfectionists to acknowledge; those with a high sense of control find feedback to be quite threatening. Yet, we cannot learn and grow unless we are open to feedback. Also, most people do not like those they perceive as close minded or as “know it all’s.”

Flexibility — RO DBT helps those with overcontrol develop a sense of flexibility — a key to living a full life: life itself requires adaptability because our behavior in one situation might not be appropriate in another situation; we certainly can’t control everything — and trying to do so will inevitably lead to internal strife.

Intimacy and Connectedness — RO DBT teaches emotional recognition and emotional expression — these are important skills often lacking in people who are overcontrolled; these skills help us facilitate healthy and rewarding relationships.

“Overcontrol” or “Undercontrol”?

Like many traits, controlled coping is on a spectrum. A combination of genetic, environmental and learned factors contributes to whether an individual leans one way or the other.

Just as there are those who are overcontrolled, there are those who live a life with an “under-control” style of coping. These people may struggle to control emotions, inhibitions and impulses while enjoying risks, rewards and new experiences. Interestingly, those who live an “under-controlled” life may be more likely to get help, because they themselves — and those around them — are more aware of their demonstrative suffering.

The vast majority of people are what we call “flexibly controlled,” leaning to the overcontrol or undercontrol side — yet having flexibility in their coping and responses. Neither side of the spectrum (over- or under-controlled) is considered better or worse. But, being at an extreme on this spectrum could lead to one’s suffering. RO DBT can help.

Overcontrol and Emotions 

You may read this post and think, “yes, these traits describe me.” Or you may read this post and think, “this somewhat describes me, but I am not emotionally overcontrolled; just last night, I exploded in anger at my husband because he was late picking up our daughter from dance class.”

Many people who live a life of overcontrol, as outlined above, also exhibit an emotional state coined “emotional leakage.” They tend to hold their emotions in so tightly, and for so long, that eventually the dam must burst. Yelling, insults and other intense displays of emotions can occur. Typically, though, emotional leakage only happens in the privacy of one’s own home.

The good news is that emotional leakage is a behavior that can be addressed and managed with the skills taught in Radically Open DBT.

Anorexia and Overcontrol

Most people who have anorexia nervosa are known to have the bio temperament of the overly-controlled.** An extreme restriction of food may serve to numb overcontrolled individuals from discomfort or other experiences of suffering.

Those who are overcontrolled live in a state of feeling constantly threatened. Restrictive eating (a symptom of anorexia) actually helps those who feel constantly threatened numb some of their unpleasant feelings, so they feel less pain. Thus, restrictive eating becomes negatively reinforced because the person gets some relief of their experiences. However, the price they pay for this is they can end up living life like a zombie, not able to connect to others, not able to live their valued goals, just pursuing numbness.

Find an RO DBT therapist

Pathlight is one of only a handful of treatment centers utilizing this valuable innovative new therapy. A number of our clinical leaders have trained directly with RO DBT founder Thomas Lynch, PhD to master this innovative approach. Our treatment team brings this compassionate expertise to the treatment setting to help patients work towards richer, more rewarding emotional lives. Contact us to work directly with one of our knowlegeable RO DBT therapists.

Eating Recovery Center is accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

Organizations that earn the Gold Seal of Approval™ have met or exceeded The Joint Commission’s rigorous performance standards to obtain this distinctive and internationally recognized accreditation. Learn more about this accreditation here.

Joint Commission Seal