Radically Open Dialectical Behavior Therapy
Radically Open Dialectical Behavior Therapy (RO DBT) is designed for clients with overcontrol disorders such as refractory depression, anorexia nervosa, and obsessive-compulsive personality disorder. The goal of RO DBT is for participants to overcome their rigid beliefs, strong rule-governed behavior, and high moral certitude by developing a radically open mindset. A team of RO DBT providers, including therapists and skills trainers, aims to help participants decrease social isolation and “build a life worth sharing” by developing three capacities: openness, flexibility, and social connectedness.
RO DBT typically includes four key components: (1) individual therapy, (2) optional between-session telephone coaching, (3) recommended therapist consultation team meetings, and (4) skills training classes, but skills training classes may be delivered on their own. During individual therapy, participants and therapists establish target behaviors to increase or decrease (e.g., increasing social connectedness and decreasing overly cautious and hypervigilant behavior) and identify alternative behaviors to use in specific situations. During the optional between-session telephone coaching component, therapists can provide as-needed support to help participants avoid harmful behaviors or to celebrate the successful implementation of new skills. During the recommended therapist consultation team meetings, therapists and skills instructors discuss any implementation challenges and receive support designed to improve their capacity to treat patients.
During the skills training class component, skills instructors cover twenty behavioral skills with groups of clients, including openness, flexibility, social connectedness, and mindfulness. Openness skills help participants practice being receptive to new experiences and feedback that contradicts their worldview. Flexibility skills emphasize adapting to changing environmental conditions. Social connectedness skills focus on building intimacy and social bonds with other people. Mindfulness skills decrease physiological distress and activate feelings of safety and affiliation.
RO DBT is rated as a supported practice because at least one study carried out in a usual care or practice setting achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome.
Date Last Reviewed (Handbook Version 1.0): May 2024
Sources
The following sources informed the program or service description, target population, and program or service delivery and implementation information: the program or service manual, the program or service developer’s website, and the studies reviewed.
This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, download the Handbook of Standards and Procedures, Version 1.0
Target Population
RO DBT is designed for clients with overcontrol disorders such as refractory depression, anorexia nervosa, and obsessive-compulsive personality disorder.
Dosage
Teams of therapists and skills instructors deliver RO DBT for 30 weeks. The four RO DBT components are designed to be delivered concurrently throughout the duration of the program. RO DBT skills training classes can also be delivered on their own, with the skills instructor providing an orientation to the program and asking the client to commit to treatment.
Therapists and participants meet once a week for individual therapy sessions, typically lasting 1 hour.
Two skills instructors typically deliver 2.5-hour weekly sessions to groups of 7–9 participants. Skills instructors typically teach 20 different skills over a 30-week period, which includes teaching two cycles of the 4 mindfulness skills.
Recommended therapist consultation team meetings, which include both therapists and skills instructors, occur for 1.5–2 hours weekly throughout the treatment period.
Therapists may offer telephone coaching calls with participants or exchange text messages as needed between individual therapy sessions, but this is optional.
Location/Delivery Setting
Recommended Locations/Delivery Settings
Therapists and skills instructors deliver RO DBT in clinical settings, including therapists’ offices, outpatient clinics, and inpatient and residential treatment centers.
Location/Delivery Settings Observed in the Research
- Mental Health Center, Treatment Center, Therapist Office
Education, Certifications and Training
Therapists are typically licensed mental health professionals. Skills instructors are commonly psychotherapists, counselors, case managers, social workers, other clinical staff, or psychiatric nurses.
There are two training pathways for RO DBT providers. The RO DBT practitioner pathway provides comprehensive training in RO DBT including both individual therapy and skills training class. The RO DBT skills instructor pathway is tailored specifically to skills class instructors and excludes content for providing individual therapy. Both training pathways have three levels: (1) foundational information about RO DBT, (2) in-depth information on RO DBT application in therapeutic settings, and (3) an in-person workshop to practice delivering RO DBT. Levels 1 and 2 are offered via on-demand webinar segments. To receive a certificate of completion, training participants must complete quizzes and evaluations following each webinar segment. The Level 3 in-person workshop involves a 3,5-day training for the RO DBT practitioner pathway or a 2-day training for the RO DBT skills instructor pathway. Trained RO DBT providers can access supplementary trainings through live and on-demand webinars.
Program or Service Documentation
Book/Manual/Available documentation used for review
The following two resources are used to implement RO DBT:
Lynch, T. (2018). Radically Open Dialectical Behavior Therapy: Theory and practice for treating disorders of overcontrol. Context Press.
Lynch, T. (2018). The skills training manual for Radically Open Dialectical Behavior Therapy: A clinician’s guide for treating disorders of overcontrol. Context Press.
Available languages
The RO DBT manual is currently available in English, Italian, Spanish, and Swedish.
Other supporting materials
For More Information
Website: https://www.radicallyopen.net/
Phone: +31 627 353 467
Email: support@radicallyopen.net
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Radically Open Dialectical Behavior Therapy |
|---|---|
| Identified in Search | 2 |
| Eligible for Review | 1 |
| Rated High | 1 |
| Rated Moderate | 0 |
| Rated Low | 0 |
| Reviewed Only for Risk of Harm | 0 |
| Outcome | Effect Size
 and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
|---|---|---|---|---|
| Adult well-being: Parent/caregiver mental or emotional health |
0.42
16 |
1 (13) | 169 |
Favorable:
8 No Effect: 5 Unfavorable: 0 |
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.
| Outcome | Effect Size
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| Adult well-being: Parent/caregiver mental or emotional health |
0.42
16 |
1 (13) | 169 |
Favorable:
8 No Effect: 5 Unfavorable: 0 |
- |
| Study 13295 - RO DBT vs. TAU (Lynch, 2020) | |||||
| Hamilton Depression Rating Scale |
0.65
*
24 |
- | 154 | - | 0 |
| Hamilton Depression Rating Scale |
0.26
10 |
- | 160 | - | 5 |
| Hamilton Depression Rating Scale |
0.21
8 |
- | 136 | - | 11 |
| Acceptance and Action Questionnaire – II |
0.37
*
14 |
- | 160 | - | 0 |
| Acceptance and Action Questionnaire – II |
0.51
*
19 |
- | 149 | - | 5 |
| Acceptance and Action Questionnaire – II |
0.54
*
20 |
- | 139 | - | 11 |
| Emotional Approach Coping Scale |
0.29
11 |
- | 164 | - | 0 |
| Emotional Approach Coping Scale |
0.64
*
23 |
- | 155 | - | 5 |
| Emotional Approach Coping Scale |
0.58
*
21 |
- | 150 | - | 11 |
| Modified Scale for Suicidal Ideation |
0.19
7 |
- | 169 | - | 0 |
| Patient Health Questionnaire – 9 |
0.47
*
18 |
- | 159 | - | 0 |
| Patient Health Questionnaire – 9 |
0.39
*
15 |
- | 146 | - | 5 |
| Patient Health Questionnaire – 9 |
0.32
12 |
- | 134 | - | 11 |
*p <.05
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Version 1.0, Section 5.10.4 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by authors in response to author queries to assign study ratings and calculate effect sizes and statistical significance (see Section 7.3.2 in the Handbook of Standards and Procedures, Version 1.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents.
Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.
Full citations for the studies shown in the table are available in the "Studies Reviewed" section.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 13295 - RO DBT vs. TAU | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Dorset, Hampshire and North Wales, UK. | 2012 | 55% Aged between 35 and 55 years | 97% White | 66% Female | 100% Major depressive disorder; 87% with at least one Axis I disorder; 79% with at least one Axis II disorder; 4% No psychiatric comorbidity | -- |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated High
Study 13295Lynch, T. R., Hempel, R. J., & Dunkley, C. (2015). Radically Open-Dialectical Behavior Therapy for disorders of over-control: Signaling matters. American Journal of Psychotherapy, 69(2), 141-162. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.141
Shearer, J., Lynch, T. R., Chamba, R., Clarke, S., Hempel, R. J., Kingdon, D. G., O'Mahen, H., Remington, B., Rushbrook, S. C., Russell, I. T., Stanton, M., Swales, M., Watkins, A., Whalley, B., & Byford, S. (2019). Refractory depression - cost-effectiveness of Radically Open Dialectical Behaviour Therapy: Findings of economic evaluation of RefraMED trial. BJPsych open, 5(5), Article e64. https://doi.org/10.1192/bjo.2019.57
Lynch, T. R., Hempel, R. J., Whalley, B., Byford, S., Chamba, R., Clarke, P., Clarke, S., Kingdon, D. G., O'Mahen, H., Remington, B., Rushbrook, S. C., Shearer, J., Stanton, M., Swales, M., Watkins, A., & Russell, I. T. (2020). Refractory depression — Mechanisms and efficacy of Radically Open Dialectical Behaviour Therapy (RefraMED): Findings of a randomised trial on benefits and harms. The British Journal of Psychiatry, 216(4), 204-212. https://doi.org/10.1192/bjp.2019.53
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Not Eligible for Review
Study 13269
Keogh, K., Booth, R., Baird, K., Gibson, J., & Davenport, J. (2016). The Radical Openness Group: A controlled trial with 3-month follow-up. Practice Innovations, 1(2), 129-143. https://doi.org/10.1037/pri0000023
This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).