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.
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:
|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|
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
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|
Openness & Receptivity
Intimacy & Social Connection
|anxious attachment||avoidant attachment|
|Therapeutic Philosophy:Clients need to do better, try harder, and/or be more motivated to change|
Focuses skills internally
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?
|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|
|Self Harm||Risk Averse|
|Mood Swings||Social Signaling Deficit|
|Volatile Relationships||Limited Social Connection|
|Reward Sensitivity||High Threat Sensitivity|
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.
|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|
I hope that helps you understand the differences! Feel free to email me if you would like to learn more!
- The Expanded Dialectical Behavior Therapy Skills Training Manual, 2nd Edition: DBT for Self-Help and Individual & Group Treatment Settings by Lane Pederson, Cortney Pederson
- The Radically Open DBT Workbook for Eating Disorders: From Overcontrol and Loneliness to Recovery and Connection by Karyn D. Hall, Ellen Astrachan-Fletcher
- The Skills Training Manual for Radically Open Dialectical Behavior Therapy: A Clinician’s Guide for Treating Disorders of Overcontrol by Thomas R. Lynch PhD
- The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, … (A New Harbinger Self-Help Workbook) by Matthew McKay PhD, Jeffrey C. Wood PsyD
- DBT® Skills Training Handouts and Worksheets, Second Edition by Marsha M. Linehan
- DBT Self Help