DBT v. RO-DBT – what are they?

This post is for the other providers out there (mostly). I gave a presentation to the Virginia Beach Psychiatric Center recently and this summarizes some of the information shared there.

**BTW, the two adorable doggos pictured are Cleo and Jade, my two dogs who well represent the different personalities that typify clients who work well with these two therapeutic approaches.

Dialectical Behavior Therapy (DBT) and Radically Open Dialectical Behavior Therapy (RO-DBT) are two different modalities, or models of therapy, that people use in individual, group, family, and couples therapy settings and in different levels of care (like inpatient and outpatient).

I have been using DBT for decades, and I have been learning about RO since it emerged on the scene in the last 5 years. The manual for RO was published in 2018, though research has been going on for much longer.

One of the audience questions was about how I describe these modalities in 5 words or less – I did not say it in 5 words, but my answer is this:

DBT focuses on skills training and regulation to minimize disruptive behaviors.
RO-DBT focuses on connectedness, flexibility, and openness for optimizing how you express your personality.
The goal of both is to improve functioning, promote mindfulness, and increase overall satisfaction and subjective happiness.

Similarities

There are some key similarities between the two:

behavioral principles
dialectical philosophy
targets self harm
- impulsive for DBT and planned for RO-DBT
- life threatening behaviors take precedence
mindfulness interventions

But there are also a lot of differences:

DBT	RO-DBT
Radical Acceptance	Radical Openness
Primary population is dys-regulated clients	Primary population is people with disorders of ‘Over Control’
Dialectic is change v. acceptance	Dialectic is control v. openness (as well as flexibility & connection)
Focus is on Regulation	Focus is on Self-Enquiry
Targets Behaviors/ Symptoms	Targets over control (overarching)
Wise Mind	Flexible Mind
Dialectic Interventions/Philosophy Both sides of an argument have a valid point Moving towards acceptance In treatment, this means searching for opposing but true conflicts (needs and wants) that give rise to negative feelings and behaviors	Dialectic Interventions/Philosophy: Everything in life is transient, contradictory Gradual change leads to turning points Everything is connected Change is continual & transactional Centeredness v. Letting Go Irreverence v Compassion
Mindfulness is theme throughout	Silliness or Openness is a theme throughout
Modules: Mindfulness Distress Tolerance Emotion Regulation Interpersonal Effectiveness	Therapeutic Stance: Openness & Receptivity Flexible Control Intimacy & Social Connection
anxious attachment	avoidant attachment
Therapeutic Philosophy:Clients need to do better, try harder, and/or be more motivated to change Direct stance Focuses skills internally Reduce/avoid escalation Therapy interfering behaviors are therapist focus	Therapeutic Philosophy:Clients characterized by over control need to let go of always striving to perform better or try harder Encourages independence and self-enquiry Focuses skills externally Encourages engagement if there is conflict Therapeutic alignment ruptures are therapist focus

Each of them works with different client populations and behaviors

What are the different diagnoses that these modalities are designed to address?

DBT	RO-DBT
Personality Disorders Borderline Narcissistic Histrionic Anti-Social	Personality Disorders Obsessive Compulsive Avoidant Paranoid
Bipolar Disorders	Major Depressive Disorder
Bulimia Nervosa	Anorexia Nervosa
Substance Use Disorders	Social Phobia
	Autism Spectrum Disorders

What are the different behaviors that these modalities are designed to address?

DBT – Under Regulated Behaviors	RO DBT – Over Controlled Behaviors
Emotionally Dysregulated	Reserved/ Restricted Affect
Impulsive	Over-Conscientious
Self Harm	Risk Averse
Mood Swings	Social Signaling Deficit
Volatile Relationships	Limited Social Connection
Reward Sensitivity	High Threat Sensitivity
	Perfectionist

Some of the audience wondered about how this applies specifically to the eating disorder population. The important part of this, in my opinion, if figuring out the underlying trait/personality characteristics that the person hold separate from their eating disorder behaviors. It can occasionally be difficult to figure out! When in doubt, what is the most important is not what the diagnosis says, but what the person believes about themselves. That is what will resonate most with them and generate the most change.

Goals

DBT	RO-DBT
Teaching Skills to help Reduce Reactivity	Education & Self Discovery
Tolerate complexities, confusions, contradictions	Learn how to read & convey appropriate social signaling
Achieve balance	Increase flexibility
Cope with upsetting, intense, or difficult situations and emotions	Be open to new ideas, experiences, etc.
Bring us back to the present when our minds naturally wander	Allow our minds to wander