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.


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 AcceptanceRadical Openness
Primary population is dys-regulated clientsPrimary population is people with disorders of ‘Over Control’
Dialectic is change v. acceptanceDialectic is control v. openness (as well as flexibility & connection)
Focus is on RegulationFocus is on Self-Enquiry
Targets Behaviors/ SymptomsTargets over control (overarching)
Wise MindFlexible 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 throughoutSilliness or Openness is a theme throughout
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
Therapeutic Stance:
Openness & Receptivity
Flexible Control
Intimacy & Social Connection
anxious attachmentavoidant 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?

Personality Disorders
Personality Disorders
Obsessive Compulsive 
Bipolar DisordersMajor Depressive Disorder
Bulimia NervosaAnorexia Nervosa
Substance Use DisordersSocial Phobia
Autism Spectrum Disorders

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

DBT – Under Regulated BehaviorsRO DBT – Over Controlled Behaviors
Emotionally DysregulatedReserved/ Restricted Affect
Self HarmRisk Averse
Mood SwingsSocial Signaling Deficit 
Volatile RelationshipsLimited Social Connection
Reward SensitivityHigh 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 ReactivityEducation & Self Discovery
Tolerate complexities, confusions, contradictionsLearn how to read & convey appropriate social signaling
Achieve balanceIncrease flexibility
Cope with upsetting, intense, or difficult situations and emotionsBe open to new ideas, experiences, etc.
Bring us back to the present when our minds naturally wanderAllow our minds to wander

I hope that helps you understand the differences! Feel free to email me if you would like to learn more!