Not every client who comes to The Center is “out of control.” RO DBT significantly differs from other treatment approaches, including standard DBT, by postulating that some clients have “too much of a good thing,” namely, too much self-control. Being over-controlled (OC) is connected to an overly activated fight-or-flight response, which interferes with proper social-signaling and a central human need: interpersonal connection. This core problem of emotional loneliness is seen as the basis for common symptoms or disorders among OC clients, like emotional distress, chronic anxiety and depression, disordered eating, self-harm and suicidal behaviors.

Radical Openness is the fundamental philosophical principle and core skill in RO DBT. Radical Openness is a way of behaving, but it is also a state of mind informed by three features: openness, flexibility, and social connectedness. Radical Openness involves actively seeking one’s personal unknown in order to learn from an ever-changing environment. It also enhances relationships by modeling humility and a willingness to learn.

RO DBT treatment involves both individual treatment/coaching sessions and skills training classes, centering around five OC themes:

• Inhibited and disingenuous emotional expression
• Hyper-detailed focused and overly cautious behavior
• Rigid and rule-governed behavior
• Aloof and distant style of relating
• High social comparison and envy/bitterness

The skills address these themes by targeting two primary areas: (1) social-signaling or appropriate emotional expression and (2) changing neurophysiological arousal by activating the brain’s social safety system. Because these mechanisms of change are first mirrored or modeled after the therapist, a major emphasis in RO DBT is the therapist’s own practice of RO DBT.

Like DBT, RO DBT is grounded in a neurobiosocial theory—that OC biotemperament-based threat sensitivity combines with socially-learned tendencies to mask inner feelings to produce OC coping styles that result in social loneliness, which is the basis of psychological distress.