Radically Open DBT


welcome to RODBT Chicago

Cityscape Counseling is excited to be one of the first practices in Chicago to offer Radically Open DBT (RODBT), a “newer” evidence-based treatment for diagnoses such as treatment resistant depression, chronic anxiety, eating disorders and those struggling with extreme perfectionism and excessive self-control.

Is This treatment for you

RODBT was created to help individuals with a specific range of symptoms and personality traits that fall under the umbrella of “overcontrol”. Some examples of overcontrol include perfectionism, rigidity, excessive rule following & frugality, as well as internalizing emotions and showing extreme emotional restraint.

This treatment will not be effective if you are prone to being more “under-controlled”. If you have difficulty managing impulses and find yourself engaging in maladaptive coping such as self-injury and other compulsive behaviors, then you would likely benefit more from traditional DBT where you will have the opportunity to learn skills to better tolerate distress and regulate your emotions. See more about DBT here.

So What the Heck is Radically Open DBT?

RODBT Therapy Chicago

RODBT therapist Chicago client depicted by woman looking stressed sitting by tree

If you are in therapy, have been in therapy, or are considering therapy, then you know that there are a million different types of therapies out there, many of which proclaim to be the best approach of them all. “Just read this book” and boom, you will have lifelong happiness and bliss. You will be cured. Give me a break! It’s hard enough to have crippling anxiety, as just one example, without having to search through hundreds of self-help books and therapists around town who can actually help you get better. It’s hard enough to acknowledge that you need help in the first place. Once you are ready for the help, you just want to get going with the journey. My hope is that, in telling you about this new therapy, I might be able to help you get your journey going a bit sooner.

I am going to tell you about a relatively new approach called RO-DBT. Well, it’s actually over 20 years old, but in the psychology world, it’s considered new. Not only do I believe in the effectiveness of this treatment, but there also are years of research studies to back up its efficacy. So, what the heck is RO-DBT?

Radically Open Dialectical Behavior Therapy (RO-DBT) is an evidence-based treatment that was developed by psychologist Tom Lynch, PhD and his colleagues. With over 20 years of research supporting the efficacy of RO-DBT or “RO” for short, and the release of the long-awaited treatment manual and textbook earlier this year, RO-DBT is quickly becoming a premier treatment across the world. Only a small group of Chicago-based clinicians have received intensive training directly from Dr. Lynch and his team of RO experts, and I am so fortunate to be one of them.

Here is a little bit of history before I really delve into the mechanics of RO-DBT. Many of you have heard of or received traditional Dialectical Behavior Therapy (DBT). This approach was developed by Marsha Linehan, PhD to help those who struggle with impulsive behavior, emotion dysregulation, and unstable/chaotic interpersonal relationships. From an RO framework, we would identify this population as the emotionally undercontrolled, or UC. Standard DBT teaches skills aimed at improving one’s ability to self-regulate in highly distressing situations, and strategies to cope with strong urges to engage in not so healthy or helpful behaviors. DBT has been and continues to be the gold standard treatment recommended for those with Borderline Personality Disorder and other clinical issues that involve high impulsivity and externalizing behaviors. Dr. Lynch and his colleagues learned through years of research and practice, that standard DBT did not sufficiently address the needs of a population that did not fit the UC temperament. DBT principles, along with many other psychological and philosophical models, influenced the need for and inception of something else. And so, RO-DBT was born.

RO-DBT was developed to treat individuals who may present fairly different than the UC population. These are folks who struggle to express their emotions to others, and instead channel their emotions inside. To the outside world, they might appear “very put together”. They might even be given accolades for their ability to appear unaffected by nearly every challenge thrown their way. Unfortunately, many of these individuals suffer greatly on the inside. We describe these individuals as overcontrolled or OC because they have developed excessive self-control, likely from a very young age, and patterns of rigidity that have impaired their ability to flexibly engage with others around them. These are your perfectionists and over-achievers. Those who fall into this category may engage in superficial relationships or avoid deep connection altogether, contributing to extreme loneliness, self-hatred, and often leading to serious mental health issues including clinical depression, anxiety, and eating disorders such as anorexia nervosa.

Fortunately, there is good news. RO-DBT has been shown time after time to improve the lives of so many people who have been suffering in silence.

Radically Open DBT treatment in chicago

Here at Cityscape Counseling in Chicago, RODBT therapy comes in the form of both customized individual counseling sessions and skills classes (“group therapy” format) where core principles are taught.

Themes addressed in rODBT include:

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

Psychological flexibility – The goal of Radically Open DBT


RODBT therapist Chicago

According to Tom Lynch, RODBT Founder, Psychological Health is hypothesized to involve 3 core features:

Receptivity and Openness to new experience and disconfirming feedback in order to learn.
Flexible-control in order to adapt to changing environmental conditions.
Intimacy and social-connectedness (with at least one other person) based on premises that species survival required capacities to form long-lasting bonds and work in groups or tribes.

The above 3 features inform what Tom Lynch refers to as Radical Openness – both a way of behaving and a state of mind that involves “actively seeking our personal unknown in order to learn from an ever-changing environment”

Radical Openness enhances relationships because it models humility and the willingness to learn from what the world has to offer.
Extensive research has shown that suppression of emotions as well as ingenuine emotional expression (incongruency between external expression and actual internal experience) increases the likelihood that others will perceive one as untrustworthy or inauthentic. This, along with a genetic sensitivity to threat can lead to a decrease in one’s social connectedness and an increase in loneliness and psychological distress.

RODBT Teaches


Emotional expression that is context appropriate
Social signaling techniques to enhance social connectedness
Skills that target certain areas of the brain involved with the social safety system
Non-verbal signals of friendliness
Gestures, postures, and facial expressions that communicate relaxation, friendliness, and non-dominance

Check out this blog post written by practice founder Chelsea Hudson, LCPC on the use of RODBT in teaching flexibility.

​You can learn more about RO-DBT at www.radicallyopen.net

References
Lynch, R.T. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Reno, NV: Context Press, an imprint of New Harbinger Publications.
Lynch, R.T. (2018). The Skills Training Manual for Radically Open Dialectical Behavior Therapy: A Clinician’s Guide for Treating Disorders of Overcontrol. Revo, NV: Context Press, an imprint of New Harbinger Publications.
(Boone & Buck, 2003; English & John, 2013; Kernis & Goldman, 2006)

RODBT for Perfectionism and Treatment Resistant Depression

RODBT For Perfectionism

Ever spend hours agonizing over a single sentence in an email? Feel like your stomach twists in knots if your to-do list isn’t pristine? Do you ever have a need to do things in a way that feels just right? Do you live by a set of rules, prefer life to be organized and in order? Do you like things to be symmetrical and correct? If you answered yes, then you might be living in the world of perfectionism.

Where do we see this show up? Perfectionism rears its head everywhere! Students really suffer when their perfectionism makes it near impossible to meet the demands of college coursework while maintaining a social life. Professionals suffer when projects stack up and deadlines fast approach in the attempt to submit something good enough.
Romantic and platonic relationships suffer when we have expectations of ourselves and others that might be unattainable. 

Perfectionism can seem like a good thing – it drives us to achieve, to excel, to be the best of our field. Society puts perfectionism on a pedestal. But here’s the deal: perfectionism usually comes at a cost. The constant pressure to be flawless can lead to anxiety, depression, and a slew of other difficult emotional experiences and forms of coping. We become so fixated on the “perfect” outcome that we miss out on the joy of the journey. And it can be a lonely journey too. 

So, what if there was a way to keep striving for excellence while also finding a way to maintain our mental wellbeing and social relationships? Enter RODBT, or Radically Open Dialectical Behavior Therapy. Think of it as a treatment that can help turn that pressure into something more manageable and ultimately, more fun to be present in.

RODBT teaches a number of skills in particular that increase our openness with others. RODBT encourages us to open up to new experiences, even if they’re messy or uncertain. Remember that time you bombed a presentation but ended up connecting with someone who offered you a dream job? That’s the magic of openness at work. While it might seem scary, deviating from doing things as we always do them can bring a necessary spice to our lives and get us out of the monotony of usual way of doing things.

Flexibility. Perfectionism almost always suggests some kind of rigidity, whether in our thoughts, behaviors, and rules to which we navigate life. But life is full of curveballs that come out of nowhere. RODBT helps us bend with those curveballs, adapting our plans and expectations instead of clinging to a rigid “perfect” scenario. Think of it like switching from uncomfortable high heels to a comfy sneaker – you can still get to your destination, but with much less pain.

Healthy Self- Doubt: We all have that inner critic whispering, “You’re not good enough.” RODBT teaches us to gently question that critic, to replace it with a voice of self-inquiry, asking ourselves “Where did I get the idea that I am not good enough? What is it that I need to learn?” This means acknowledging our limitations without beating up ourselves and focusing on learning and growth instead of self-flagellation.

Remember, RODBT isn’t about becoming a carefree, chaotic, and not giving a damn about the world around us and our responsibilities. It’s about engaging flexible control, which is the ability to strive for your goals without sacrificing your well-being. It’s about dancing barefoot and embracing the journey with all its stumbles and triumphs, and not doing it alone.

RODBT for Treatment Resistant Depression

Radically Open DBT: A Cutting-Edge therapy for Treatment Resistant Depression (TRD)

Treatment-resistant depression (TRD) is a debilitating condition that affects millions of people worldwide. It is characterized by symptoms that persist despite at least two adequate trials of antidepressant medication. For those struggling with this, finding effective treatment can feel like an impossible battle. However, an evidence-based treatment called Radically Open Dialectical Behavior Therapy (RO DBT) has been found to improve the lives of those with this condition. RODBT was developed by Dr. Thomas Lynch and colleagues after exploring the research to determine why standard DBT just wasn’t addressing the unique needs of so many out there. 

Treatment-resistant depression can contribute to significant hopelessness and a range of other concerning symptoms and co-morbid conditions. Given that hopelessness can be a significant aspect of depression in general, when patients attempt every medication out there and every treatment out there with no success, patients may suffer beyond measure. Fortunately, there is a treatment that can be transformative for patients living with this pervasive kind of depression. 

The Benefits of RODBT for Treatment-Resistant Depression (TRD)

There is growing evidence that RO DBT can be an effective treatment for TRD. A recent study found that patients who received RO DBT experienced a significant reduction in depressive symptoms, as well as other improved outcomes.

There are several reasons why RODBT may be particularly helpful for people with TRD. First, the emphasis on openness and vulnerability can help to create a safe space for patients to identify and disclose emotions that may be highly unwanted like shame, guilt, envy, and embarrassment. This can be crucial for people with TRD, who often feel isolated and alone in their suffering.

Second, RODBT teaches patients skills to activate their social safety and decrease threat sensitivity. When we feel safe, we are more likely to want to connect with others, be around others, and experience the benefits of being part of a community. 

Third, RODBT helps patients to identify valued goals associated with relationships. While depression can be very isolative, RODBT encourages patients to be aware of how their social signaling might inadvertently keep them at arms length from others. It helps them to see how slight changes in their signaling (eg affect, behaviors) can significantly improve the quality of their relationships and ultimately improving their symptoms. 

Is Radically Open DBT (RODBT) Right for You?

RODBT is a treatment that can be very helpful for those experiencing a range of diagnoses and symptoms. RODBT is transdiagnostic, which means it addresses underlying personality style. Patients aren’t required to have a specific diagnosis in order for the treatment to be effective. We know that RODBT is specifically helpful for those with an overcontrolled personality style. You can learn more about whether RODBT could help you by checking out radicallyopen.net and our website. 

if you’re looking for an RODBT therapist in chicago, Cityscape counseling would love to work with you.

We know that seeking out therapy can be a daunting endeavor so we’re dedicated to helping you each step of the way. Start by calling or emailing us to set up your first appointment.