DBT vs. RO-DBT: Which Therapy Is Right for Me?
Finding the right therapy feels daunting when emotional struggles consume daily life. Dialectical Behavior Therapy (DBT) and Radically Open DBT (RO-DBT) share common roots yet address vastly different emotional challenges. Recognizing how these treatments differ helps clarify which path might work best.
What Is DBT?
Dr. Marsha Linehan created Dialectical Behavior Therapy in the late 1980s after traditional approaches failed her most challenging patients with Borderline Personality Disorder. The results speak volumes: 88% of patients with BPD experience decreased symptoms after completing treatment, while 75% no longer meet diagnostic criteria.
This therapy tackles what happens when emotions run wild. People describe feeling hijacked by their feelings, unable to think clearly when distressed. DBT combines mindfulness from Eastern traditions with practical Western psychology techniques. Research confirms participants show moderate effect sizes for reducing suicidal behaviors and hospitalizations compared to standard care.
Treatment involves four pillars: weekly individual sessions, group skills classes, phone coaching during crises, and team meetings for therapists. Each piece matters. Individual therapy addresses personal struggles while groups teach concrete skills. Phone coaching bridges the gap when life gets messy between sessions. Long-term studies show 87% of people maintain their progress two years later.
Success extends beyond BPD. People with depression, anxiety, PTSD, eating disorders, and addiction benefit from DBT's four skill areas: staying present through mindfulness, getting needs met without damaging relationships, surviving crises without making them worse, and managing emotions instead of being controlled by them.
What Is RO-DBT?
Dr. Thomas Lynch developed Radically Open DBT for a different population entirely. While standard DBT helps people with too little emotional control, RO-DBT serves those with too much. Studies document recovery rates reaching 71% for treatment-resistant depression.
Lynch noticed certain patients getting worse with traditional DBT. These individuals already controlled themselves extensively. They needed permission to loosen up, not more structure. RO-DBT addresses five patterns: hiding emotions, obsessing over details, following rules rigidly, keeping others at arm's length, and constantly comparing themselves to others.
"Radical openness" forms the treatment's heart. This means questioning your own certainty, staying curious about being wrong, and genuinely wanting to learn from others. Over 25 years of research backs this approach across multiple conditions and age groups.
The therapy particularly helps people with autism spectrum conditions. Studies show participants with ASD achieve better outcomes than neurotypical participants, with meaningful improvements in distress levels. Many high-functioning individuals discover they've been performing "normal" rather than feeling genuinely connected to others.
Key Differences Between DBT and RO-DBT
These therapies target opposite problems. DBT helps when emotions feel chaotic and unmanageable. RO-DBT helps when emotions feel locked away and relationships seem impossible.
Target Populations
DBT fits people who:
Get swept away by intense feelings
Act on impulses they later regret
Fear abandonment intensely
Feel empty or uncertain about identity
Hurt themselves or others when overwhelmed
RO-DBT suits those who:
Set impossibly high standards through perfectionism
Feel lonely despite seeming successful
Think in black-and-white terms
Struggle expressing authentic emotions
Avoid risks that might lead to failure or judgment
Treatment Approaches and Mechanisms
DBT teaches damage control. When emotions spike, you learn skills to ride out the storm without destroying relationships or harming yourself. The therapy assumes you need more structure and better coping strategies. Skills include opposite action (doing the opposite of what emotions demand), distress tolerance (surviving painful situations), and interpersonal effectiveness (asking for what you need while keeping relationships intact).
RO-DBT works differently. Instead of containing emotions, it encourages expression. Therapists watch for subtle facial changes, voice shifts, and body language that reveal hidden feelings. The assumption is that emotional well-being requires authentic connection with others, not just individual coping skills.
Standard DBT asks "How can you manage these overwhelming feelings?" RO-DBT asks "How can you share your inner world so others can truly know you?" The first builds walls for protection; the second removes walls for connection.
Conditions Treated
Each therapy addresses distinct mental health patterns:
Standard DBT treats:
Borderline Personality Disorder with documented strong effect sizes
Bipolar disorder's emotional regulation challenges
PTSD when combined with trauma-focused approaches
Substance abuse, especially with co-occurring personality disorders
Self-injury and suicidal behaviors
RO-DBT addresses:
Depression that resists other treatments
Anorexia nervosa, showing significant weight restoration and low dropout rates
Obsessive-Compulsive Personality Disorder
Autism spectrum social communication difficulties
Anxiety rooted in perfectionism and avoidance
The difference reflects each therapy's core assumption. DBT assumes the problem is too much emotional chaos. RO-DBT assumes the problem is too little emotional expression and social connection.
Which Therapy Is Right for You?
Your emotional style matters more than specific symptoms. Do you explode or implode under stress? Do people see you as too intense or too distant?
Choose DBT if emotions regularly overwhelm your ability to function. Your relationships may swing between extremes - either desperately clinging or angrily pushing away. You might engage in behaviors that provide temporary relief but cause long-term damage: cutting, drinking, explosive arguments, or impulsive spending. Friends might describe you as passionate but unpredictable.
Choose RO-DBT if you keep emotions tightly controlled while feeling increasingly isolated. Others may see you as capable and put-together, but internally you feel disconnected and misunderstood. You avoid emotional risks, prefer structured environments, and struggle with spontaneity. You might excel academically or professionally while feeling like an outsider socially.
Some people show mixed patterns, requiring careful evaluation to determine which style dominates and causes more problems.
Making the Decision
Professional assessment remains crucial since self-evaluation has limitations. Trained therapists can spot patterns you might miss or minimize. They'll examine your emotional responses, relationship history, coping strategies, and family background.
The evaluation process considers trauma history, cultural factors, and previous treatment experiences. Sometimes people need different approaches at different life stages. Someone might benefit from DBT skills during a crisis period, then transition to RO-DBT for longer-term relationship work.
Your readiness for change also matters. DBT requires commitment to stopping dangerous behaviors and learning new skills. RO-DBT requires willingness to question long-held beliefs and risk vulnerability in relationships. Both demand patience since meaningful change takes time.
Finding the right fit means matching your specific patterns with the therapy designed to address them. Success depends less on trying harder and more on trying differently.
Ready to discover which approach matches your needs? Contact Us for a Free Assessment to discuss your situation with our team at DBT Center of Long Beach.
FAQs
How long does each type of therapy take?
Standard DBT typically requires 12 months of treatment, though some programs offer shorter 6-month options. RO-DBT generally involves 30+ weeks of combined individual sessions and skills classes. Treatment duration may vary based on individual progress and needs.
Can I switch between DBT and RO-DBT?
While both therapies share dialectical principles, they target different problems and use distinct approaches. Your therapist can assess whether switching treatments would benefit your situation. Some individuals might benefit from sequential treatment approaches based on their evolving needs.
Are these therapies covered by insurance?
Many insurance plans cover DBT and RO-DBT as they are evidence-based treatments. Coverage varies by provider and plan. Contact your insurance company to verify benefits and check with treatment centers about accepted insurance plans and payment options.
What happens in a typical therapy session?
Standard DBT sessions focus on behavioral analysis, skill application, and crisis management. RO-DBT sessions emphasize social signaling, emotional expression, and challenging rigid thinking patterns. Both approaches include individual therapy and group skills training components.
How do I know if I have overcontrol or undercontrol issues?
Professional evaluation is the most reliable way to determine your emotional control patterns. Generally, undercontrol involves frequent emotional overwhelm and impulsive actions, while overcontrol includes emotional suppression and rigid behavioral patterns. A qualified therapist can assess your presentation and recommend appropriate treatment.
