By Michelle Quilter, PsyD, CASAC, DBT-LBC

Traditional Dialectical Behavior Therapy (DBT) was developed in the early 1980s by Marsha Linehan to treat individuals with Borderline Personality Disorder (BPD). Individuals suffering from BPD often struggle with intense, difficult to manage negative emotions and are considered to be under controlled.

What is traditional DBT?

There are four modules in traditional DBT:

• Mindfulness
• Distress Tolerance
• Emotional Regulation
• Interpersonal Effectiveness

DBT and the biosocial theory of Borderline Personality Disorder, which is the framework for the development of DBT, is based on dysregulation. DBT aims to reduce the five types of dysregulation which include emotional, interpersonal, self, behavioral and cognitive. Managing dysregulation is accomplished by increasing mindfulness and developing impulse control through the application of the various skills that are presented in the DBT skills training.

Individuals with cluster B personality disorders, also known as “dramatic erratic” personality disorders benefit from DBT. Individuals who are under controlled often present with an anxious attachment style. The clients tend to desire a bond with the therapist, and they fear abandonment. These under controlled individuals have high rates of self-harm and suicidal behaviors which are typically unplanned, impulsive and mood dependent. They typically do not keep these behaviors a secret from others.

What is RO-DBT?

In contrast to traditional DBT, RO-DBT targets individuals struggling with excessive self-control, also known as over controlling, and some of the disorders that it targets are chronic depression, anorexia nervosa, and obsessive-compulsive disorder. Personality disorders, known as cluster A and cluster C types, are treated with RO-DBT. These individuals display an avoidant attachment style, do not desire attachment with the therapist and will abandon the relationship with ease especially if there is a conflict.

The core problems in RO-DBT is social signaling deficits, low openness, and aloofness. Clients in RO-DBT suffer from suicidal and self-harm behaviors but unlike the under controlled population, these individuals tend to plan the behavior ahead of time and keep it secret from others. For this group, the aforementioned behaviors are rule-governed and not mood dependent. In RO-DBT, the therapeutic focus is external versus internal and includes increasing social signaling, openness, and social connectedness skills. The emphasis of the treatment is on self-discovery versus impulse control.

Both treatments use behavioral principles and a dialectical philosophy, and both also provide the treatment based on a hierarchy. Traditional DBT addresses life-threatening behavior, therapy interfering behaviors and then the quality of life interfering behaviors. RO-DBT addresses life-threatening behaviors, therapeutic alliance ruptures, and maladaptive over controlled social signaling. The third level of the hierarchy in RO-DBT specifically addresses inhibited and disingenuous emotional expression, hyper detail-focused and overly cautious behaviors, rigid and rule-governed behaviors, aloof and distant style of relating, and high social comparisons, envy, and bitterness. Both treatments also utilize mindfulness practice; DBT focusing on Zen Buddhism and RO-DBT drawing from Malamati Sufism.

DBT at Lifeskills South Florida

Both DBT and RO-DBT are evidence-based and have extensive research to support their efficacy. When deciding whether to recommend DBT or RO-DBT to a client, exploring the level of self-control that they possess would be key in determining the appropriate treatment.

At Lifeskills South Florida, we offer DBT through a comprehensive Linehan compliant 13-week program, as well as auxiliary DBT groups for those focusing on other clinical pathways. Our clinicians are certified by the Marsha Linehan institute for advanced skills in the use of DBT. For Lifeskills South Florida, having intensively trained clinicians reinforces, expands, and strengthens our current DBT program. For our clients, it improves the quality of DBT programming that we offer. We strive to ensure our staff are highly trained and responsible in providing comprehensive DBT skills.

For more information on our programs, call our admissions team today at 954-953-1742 or complete our contact form. Let Lifeskills help you take the next step towards recovery.