A young man is in radically open DBT.

What is Radically Open DBT?

March 13, 2024

5 min.

This therapeutic approach focuses on breaking free from rigid patterns of behavior and perfectionism.

By: Charlie Health Editorial Team

Clinically Reviewed By: Dr. Don Gasparini

Learn more about our Clinical Review Process


share icon Facebook logo LinkedIn logo

Table of Contents

In the fast-paced world we live in, many people struggle with feelings of perfectionism, social isolation, or chronic stress. For some, these challenges make it hard to form meaningful connections. That’s where radically open dialectical behavior therapy comes in (RO-DBT). 

A paper outlining the RO-DBT treatment model, published in The National Institute of Mental Health database, outlines how the therapy helps people break free from rigid behaviors, embrace vulnerability, and build deeper connections. Available in person or through online therapy, RO-DBT is a valuable resource for mental health treatment. Keep reading to learn more about RO-DBT, including who it is for, what it involves, and its differences with dialectical behavioral therapy (DBT).

Charlie Health shield logo

DBT is our specialty

Learn more about how we use DBT skills in our virtual IOP.

What is radically open DBT, and who is it for?

RO-DBT, also referred to as radically open DBT, is a specialized therapy developed by Dr. Thomas Lynch that focuses on helping individuals with overcontrolled personality traits. It builds on the principles of traditional DBT but strongly emphasizes promoting social connectedness, emotional expression, and behavioral flexibility.

In RO-DBT, people learn to break free from rigid behavior patterns and perfectionism, embracing vulnerability and spontaneity instead. The therapy encourages “radical openness,” encouraging people to authentically engage with their emotions and experiences. RO-DBT also emphasizes social signaling skills, teaching individuals to navigate social interactions more effectively and build empathy. By developing these skills, participants with chronic depression or anxiety can improve their emotional well-being and form meaningful relationships. 

Who is radically open DBT for?

Whereas DBT was originally designed for those with borderline personality disorder (BPD), RO-DBT is used with a range of people who struggle with perfectionism, rigidity, social isolation, and emotional inhibition. People with the following conditions may benefit from RO-DBT:

  • Personality disorders
  • Treatment-resistant or chronic depression
  • Chronic anxiety
  • Eating disorders
  • Neurodivergence
  • Chronic stress or burnout

Components of radically open DBT treatment

RO-DBT incorporates several key components to help people foster openness, adaptability, and social connection.

Radical openness

The term “radically open” in RO-DBT encourages individuals to embrace vulnerability and break free from rigid behaviors. By fostering openness, RO-DBT empowers individuals to explore new perspectives and challenge self-imposed limitations.


Like standard DBT, RO-DBT emphasizes mindfulness techniques to help individuals become more aware of their thoughts, emotions, and bodily sensations. Mindfulness practices are a skill to promote present-moment awareness and acceptance, allowing individuals to observe their internal experiences without judgment.

Emotion regulation

RO-DBT teaches skills for emotion regulation. Participants learn strategies for identifying and expressing emotions in healthy ways, fostering greater emotional flexibility and authenticity.

Social connectedness

A central focus of RO-DBT is promoting social connectedness and improving interpersonal relationships. Participants learn skills for building rapport, recognizing social cues, and fostering empathy, enhancing their ability to form close social bonds.

Flexibility and adaptability

RO-DBT encourages individuals to cultivate openness and flexibility in their behavior. Participants learn to challenge rigid thinking and behavior patterns, embracing spontaneity to promote personal growth and resilience.


RO-DBT emphasizes the importance of self-compassion and acceptance. Participants learn to treat themselves with kindness and understanding to reduce self-criticism and foster a greater sense of self-worth.

Behavioral experiments

RO-DBT incorporates behavioral experiments to help individuals test new ways of thinking and behaving in real-life situations. These experiments allow participants to gain insight into the effectiveness of their actions.

Therapeutic relationship

Like many other therapy modalities, the therapeutic relationship is a fundamental component of RO-DBT. Therapists provide validation, support, and guidance as individuals navigate their emotional challenges and work toward their therapeutic goals.

A therapist is in a therapeutic relationship with their client in RO-DBT.

What does radically open DBT involve?

Here’s a brief overview of what clients can expect from radically open DBT treatment: 

  • An initial assessment where a therapist explores a person’s personality traits, emotional regulation patterns, and interpersonal difficulties
  • Weekly individual therapy sessions with a trained RO-DBT therapist
  • Behavioral experiments where people explore new ways of thinking and behaving in a safe environment
  • In some cases, clients will participate in a group skills class to learn and practice RO-DBT skills with others 
  • Homework between individual or skills class sessions to reinforce learning and practice new skills
  • Sessions can take place virtually through online therapy or in person

Radically open DBT vs DBT

Dialectical behavior therapy (DBT)

Radically open DBT

A therapy that combines emotional regulation and distress tolerance skills with mindfulness techniques, originally developed to treat borderline personality disorder.

An adaptation of standard DBT, focusing on over-controlled individuals, aiming to promote flexibility, openness, and social connection.

Since RO-DBT derives from traditional DBT, they share common principles, and both aim to improve emotional well-being and interpersonal functioning. That being said, the two therapeutic modalities differ in scope and practice. Here’s an overview of some differences between RO-DBT and DBT. 

Target population

As mentioned, DBT was initially developed for people with BPD and is widely used to treat various mental health conditions, including mood disorders, self-harm behaviors, and substance abuse. In contrast, RO-DBT is specifically designed for people with overcontrolled personality traits, such as those with avoidant personality disorder, obsessive-compulsive disorder (OCD), or treatment-resistant depression.

Emphases on overcontrol

While standard DBT addresses emotional dysregulation and impulsivity common in individuals with BPD, RO-DBT focuses on addressing excessive self-control and emotional inhibition. RO-DBT emphasizes cultivating openness, flexibility, and social connectedness to counteract the negative effects of overcontrol.

Social signaling skills

RO-DBT introduces the concept of social signaling skills, which involves learning how to communicate emotions and intentions in social interactions effectively. These skills are particularly relevant for individuals struggling with social connectedness and building meaningful relationships.

DBT skills at Charlie Health

If you or a loved one are struggling with your mental health, Charlie Health is here to help. Charlie Health offers a virtual Intensive Outpatient Program (IOP) that provides more than once-weekly mental health treatment for young people dealing with complex mental health conditions. Our expert clinicians incorporate evidence-based therapies like dialectical behavior therapy (DBT) into individual counseling, family therapy, and group sessions. With treatment, managing your mental health is possible. Fill out the form below or give us a call to start healing today.

Charlie Health shield logo

Comprehensive mental health treatment from home

90% of Charlie Health clients and their families would recommend Charlie Health

More like this

Young female in a striped blazer with a white shirt and headphones on. She is virtual dialectical behavior therapy (DBT).

DBT Pros and Cons

Charlie Health Editorial Team

A young teenager sits with a therapist. He is facing his fear of therapy.

How to Face Your Fear of Therapy

Charlie Health Editorial Team

Girl smiling talking to her mother

We're building treatment plans as unique as you.