DIAGNOSIS: Depression
TREATMENT: Radically Open Dialectical Behavior Therapy for Disorders of Overcontrol

2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Modest Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Strength of Research Support

Empirical Review Status
2015 Criteria
(Tolin et al. Recommendation)
Very Strong
Insufficient Evidence
Treatment pending re-evaluation
1998 Criteria
(Chambless et al. EST)

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Brief Summary

  • Basic premise: Radically Open Dialectical Behavior Therapy or RO DBT significantly differs from other treatment approaches, most notably by linking the communicative functions of emotional expression to the formation of close social bonds and via skills targeting social-signaling, openness and flexible responding. RO DBT is the first treatment in the world to prioritize social-signaling as the primary mechanism of change.
  • Essence of therapy: RO DBT is a transdiagnostic treatment targeting a spectrum of disorders characterized by excessive inhibitory control or overcontrol (OC). Overcontrol is associated with social isolation, loneliness, poor interpersonal functioning, and severe and difficult-to-treat mental health problems, such as anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder (e.g., Lynch & Cheavens, 2008; Zucker et al., 2007). Individuals with disorders of overcontrol are often quietly suffering, even though their suffering may not be apparent. RO DBT treatment involves both individual treatment sessions and skills training classes and centers 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; and high social comparison and envy/bitterness.
  • Length: The recommended and researched duration for outpatient treatment is approximately 30 weeks of concurrent individual RO DBT therapy sessions and skills training classes.

Treatment Resources

Editors:R. Trent Codd, III, Ed.S.; Roelie Hempel, PhD

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals
Books Available for Purchase Through External Sites

Training Materials and Workshops

  • Radically Open is the official training company for RO DBT. They offer introductory, intensive, and comprehensive online and offline training for mental health professionals wanting to develop Radically Open DBT services for patients with severe and difficult-to-treat mental health problems.

Measures, Handouts and Worksheets

Smartphone Apps

  • Grow RO app is a companion or stand-alone application for iPhones to help people with RO DBT skills, diary card tracking, social safety activation and self-enquiry.

Video Demonstrations

Videos Available for Purchase Through External Sites

Video Descriptions

Clinical Trials

Meta-analyses and Systematic Reviews

Other Treatment Resources