What Is RO-DBT? Understanding Radically Open Dialectical Behavior Therapy
- Katie Watson
- 18 hours ago
- 6 min read
Written by Katie Watson, LMSW, LCSW
In my work as a therapist, I often meet people who are doing everything “right” on the outside. They are reliable, high-functioning, thoughtful, and deeply conscientious. It is obvious to see the many strengths and depth brought forward. And yet internally, many of them feel burnt out, stuck, disconnected, exhausted, or alone in ways that are hard to put into words.
Over time, I have found that these individuals often benefit from approaches that are not focused on gaining more control, insight, or productivity but on gently restoring flexibility, safety, and connection. One of the models I use for this work is Radically Open Dialectical Behavior Therapy (RO-DBT).
What Is RO-DBT?
Radically Open Dialectical Behavior Therapy (RO-DBT) is an evidence-based treatment developed to support individuals with over-controlled coping styles. Over-control is not a diagnosis and it is not a character flaw. It is a pattern of responding to the world with high levels of self-control, emotional restraint, and rigidity often learned early in life. All too often while hearing they may be feeling totally 'out of control'.
In my clinical work, I frequently see this mindset of 'over-control' develop in environments where:
Emotional expression was discouraged or unsafe
Being capable, compliant, or high-achieving was required
Mistakes carried significant consequences
Vulnerability did not feel supported
These patterns often begin as adaptive responses. At some point, however, they can begin to limit emotional expression, spontaneity, and meaningful connection. RO-DBT is designed to help individuals expand their capacity for openness, flexibility, and social connection while honoring the role control once played.
A Trauma-Informed Understanding of Overcontrol
From a trauma-informed perspective, overcontrol makes sense.
Many clients I work with learned early that staying composed, self-reliant, or emotionally contained was the safest way to move through the world. These strategies may have protected them from harm, criticism, or rejection. Over time, however, the nervous system can remain locked in these patterns even when safety has increased.
Overcontrolled coping may show up as:
Emotional numbness or difficulty accessing feelings
Chronic self-criticism or internal pressure to perform
Difficulty resting, receiving help, or expressing needs
Loneliness despite being in relationships
Rigid routines or rules that feel hard to loosen
Feeling misunderstood or “different,” even with people who care
RO-DBT does not aim to remove control. Instead, it helps people develop choice — learning when control is supportive and when flexibility might allow for more ease or connection.
Who Might Benefit From RO-DBT?
RO-DBT can be especially helpful for individuals who:
Feel stuck despite previous therapy
Appear high-functioning but feel internally distressed
Experience chronic anxiety, depression, or loneliness
Struggle with perfectionism or rigidity
Find vulnerability or emotional expression challenging
Experience eating disorders or disordered eating rooted in control
Long for connection but feel unsure how to access it
Many of these individuals have had their struggles minimized because they “seem fine.” RO-DBT offers a framework that takes their internal experience seriously.
How RO-DBT Differs From Traditional DBT
Traditional DBT was developed to support individuals who experience intense emotional reactivity and impulsive behaviors. RO-DBT was designed for the opposite pattern emotional inhibition and excessive self-control.
Rather than focusing primarily on emotional containment, RO-DBT emphasizes:
Building social safety and connection
Increasing emotional expression in manageable, intentional ways
Practicing openness and flexibility
Understanding how subtle social signals affect relationships
The goal is not to force vulnerability or reduce structure prematurely, but to help individuals experience safe, attuned connection at a pace that respects their nervous system.
RO-DBT Through a Trauma-Informed Lens
In my work, I am intentional about never treating control as something to be taken away. Many clients learned early that control was protective. My role is not to dismantle what once kept someone safe, but to help them expand their options so openness and connection can become possible when and if they choose.
At Carmel Therapy Network, RO-DBT is always practiced within a trauma-informed framework. This means we:
View coping strategies as adaptive, not pathological
Prioritize nervous system safety and regulation
Collaborate rather than prescribe
Respect pacing, readiness, and choice
Avoid pushing emotional exposure before safety is established
RO-DBT and Eating Disorder Treatment
RO-DBT can be particularly helpful in eating disorder treatment when behaviors are driven by rigidity, perfectionism, or emotional inhibition rather than impulsivity.
In these cases, eating behaviors may function as:
A way to manage emotions without expressing them
A source of predictability or identity
A means of maintaining control in overwhelming environments
RO-DBT supports clients in gently exploring new ways of relating to food, emotions, and relationships while honoring how these patterns developed. When appropriate, therapy is integrated with nutrition counseling as part of a multidisciplinary, trauma-informed approach.
What RO-DBT Sessions Look Like
RO-DBT sessions are structured yet flexible and emphasize collaboration and curiosity. Sessions may include:
Skills focused on openness and social connection
Exploration of how control shows up in daily life
Mindfulness practices oriented toward flexibility rather than suppression
Gentle experimentation with new behaviors
Ongoing reflection on safety, pacing, and readiness
Clients are never asked to abandon coping strategies before alternatives feel accessible and supportive.
The VARIE Skill: Practicing Openness at a Pace That Respects Safety
One of the core skills taught in RO-DBT is VARIE, a structured and compassionate way to practice openness without overwhelming the nervous system. Rather than pushing change through force or willpower, VARIE helps individuals approach new behaviors with curiosity, consent, and flexibility.
In my work, I often emphasize that this skill is not about “doing more” or “trying harder.” It is about learning how to approach change in a way that feels intentional, respectful, and grounded in safety.
V – Verify one’s willingness to try something new
Change in RO-DBT begins with willingness, not pressure. This step invites clients to pause and ask whether they are open to experimenting even in a small way. If the answer is no, that information is respected. Readiness matters.
A – Check the accuracy of one’s hesitancy, aversion, or avoidance
Hesitation often carries important information. Rather than assuming avoidance is a problem, this step encourages gentle reflection: Is this hesitation based on current risk, or on past experiences that no longer fully apply? The goal is understanding, not self-criticism.
R – Relinquish compulsive planning, rehearsal, or preparation
Many overcontrolled individuals cope by extensively planning, rehearsing, or preparing in order to feel safe. While these strategies once served an important role, they can sometimes prevent spontaneous connection. This step involves practicing “good enough” preparation and allowing some uncertainty to exist.
I – Activate one’s social safety system and initiate the new behavior
RO-DBT places strong emphasis on social safety. Before initiating a new behavior, clients are encouraged to ground themselves, notice cues of safety, and orient toward connection. The behavior itself is often small and intentional rather than dramatic or overwhelming.
E – Non-judgmentally evaluate the outcome
Afterward, the focus is not on success or failure, but on observation. What was learned? What felt supportive? What felt challenging? This step helps reduce shame and builds trust in the process of experimentation rather than perfection.
(Lynch, 2018, Worksheet 5.A)
Why VARIE Is Trauma-Informed
From a trauma-informed perspective, VARIE respects the reality that openness can feel risky for individuals whose nervous systems learned that control was protective. Rather than asking clients to abandon coping strategies abruptly, VARIE supports gradual, consent-based experimentation that builds confidence and choice over time.
I often remind clients that openness is not an obligation. It is a skill that becomes accessible when safety is present. VARIE provides a roadmap for exploring that process with care.
Is RO-DBT the Right Fit?
RO-DBT may be a good fit if you:
Feel emotionally shut down or disconnected
Carry a strong inner critic
Feel pressure to hold everything together
Want therapy that balances structure with depth
Are curious about building connection in ways that feel safer
A consultation can help determine whether RO-DBT or another integrative approach is the best fit for your needs and goals.
Our Approach at Carmel Therapy Network
At Carmel Therapy Network, we believe healing happens in the context of safety, respect, and connection. RO-DBT is one of several evidence-based modalities we use to support complex and nuanced presentations with care and intention.
Treatment is always individualized, trauma-informed, and collaborative. We work at your pace, honoring both where you have been and where you hope to go.
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