Radically Open Dialectical Behavior Therapy
(RO DBT)

What is RO DBT? 

Radically Open Dialectical Behavior Therapy (RO DBT) is a new, evidence based treatment targeting a spectrum of disorders characterized by excessive self control, often referred to as overcontrol (OC). It is supported by 20 years of clinical experience and translational research that parallels established guidelines for treatment development.

What does RO DBT treat? 

Disorders of over control (anorexia nervosa, chronic depression, treatment resistant anxiety disorders, avoidant, paranoid and obsessive-compulsive personality disorders). RO DBT also treats envy, bitterness, resentment, loneliness, social isolation, compulsive fixing, and over thinking.

 What is overcontrol?

Overcontrol means having too much self-control—and like anything in excess, it can become problematic. While self-discipline and restraint can be strengths, too much can lead to disconnection, rigidity, and emotional isolation.


What is self control?

Self-control is the ability to pause or inhibit urges, impulses, behaviors, or desires in order to delay gratification and stay focused on a long-term goal.

 

What are the maladaptive overcontrol core deficits?

Radically Open DBT identifies four key areas where excessive self-control can lead to challenges in daily life and relationships:

1. Low Receptivity and Openness
This includes difficulty being open to new experiences or feedback—especially when it’s unexpected or challenges existing beliefs. It often shows up as avoidance of uncertainty, hyper-vigilance for threats, distrust of others, and a tendency to dismiss constructive criticism.

2. Low Flexible Control
People with overcontrol may rely heavily on rigid routines, perfectionism, and rule-following. They may feel a strong sense of obligation, over-plan or rehearse situations, and believe there’s only one “right” way to do things.

3. Inhibited Emotional Expression and Low Emotional Awareness
This can appear as a flat or inappropriate emotional response (e.g., smiling when upset), downplaying distress, or being disconnected from bodily sensations. Emotions may feel foreign, unrecognizable, or difficult to express authentically.

4. Low Social Connectedness and Intimacy
Individuals may feel distant or “different” from others, struggle with empathy, and frequently compare themselves to others. Relationships can feel strained or superficial, with underlying feelings of envy, loneliness, or isolation.

Am I overcontrolled?

People with an overcontrolled coping style often show strengths that are highly valued in many settings—but when taken to the extreme, these traits can become rigid or isolating.

Common OC traits include:

  • Difficulty relaxing or “switching off”

  • Strong sense of duty and responsibility

  • Tendency to think carefully before acting

  • Over-cautiousness or risk avoidance

  • High attention to detail; often hardworking and perfectionistic

  • Deliberate and measured decision-making

  • Realistic, even skeptical, outlook

  • Dependable and reliable

  • Organized and future-focused

  • Self-disciplined and structured

  • Highly attentive and observant

Is being overcontrolled a bad thing?

Absolutely not! Overcontrolled (OC) traits can be powerful strengths—they’re often what drive success in academics, careers, and achieving long-term goals (yes, even getting us to the moon!). Structure, discipline, and attention to detail can serve us well.

The challenge arises when these traits become rigid or start to interfere with our relationships and emotional well-being. In therapy, our goal isn’t to get rid of these qualities, but rather to embrace what’s working and let go of what’s holding us back. It's about creating space for more flexibility, connection, and alignment with our values.

What does RO DBT treatment look like?

 

Formal Radically Open DBT (RO-DBT) treatment includes weekly individual therapy sessions in combination with a weekly skills class. Research shows that participating in both simultaneously offers the most effective outcomes.

That said, therapy alone, skills class alone, or a modified combination can still be beneficial depending on your unique needs. We’ll work together to find the approach that best supports your goals.

 

Want more information on RO DBT research?

https://www.radicallyopen.net/research-on-ro-dbt