Radically open DBT

1. Introduction

Version followed: Lynch's published RO DBT (2018 theory-and-practice text and 2018 Skills Training Manual, 30-lesson skills curriculum). I worked from what is reported of these books in the 2015 description by Lynch, Hempel and Dunkley, the REFRAMED trial protocol (Lynch et al., 2015), the 2018 Behavior Therapist special issue, and materials from the RO DBT institute (radicallyopen.net). The two 2018 books themselves are not drawn on. The 2015 paper lists an earlier ordering of the skills lessons; where it differs from the 2018 list, I follow the 2018 list and note the difference. [source: Lynch, Hempel & Dunkley 2015; Lynch et al. 2015 REFRAMED protocol; BT special issue 2018]

Radically Open Dialectical Behavior Therapy (RO DBT) is a transdiagnostic treatment developed by Thomas R. Lynch from standard DBT. It is for disorders of overcontrol (OC): chronic or refractory depression, anorexia nervosa, obsessive-compulsive and avoidant personality features, and similar presentations. OC is described as too much inhibitory self-control. Its features are high threat sensitivity, low reward sensitivity, high detail-focus and inhibited, often disingenuous emotional expression. The core problem is framed as emotional loneliness, not dysregulation. The model of change is that people bond through social signals. OC clients send closed, guarded or ambiguous signals, so others find them hard to trust and keep them at a distance. Change comes from relaxing inhibitory control, becoming more receptive and flexible, and expressing emotion openly. Summed up as open expression = trust = social connectedness, this lets the client rejoin the 'tribe'. Standard DBT aims to increase control in undercontrolled clients; RO DBT aims to loosen it. [source: Lynch, Hempel & Dunkley 2015; Vanderbleek & Gilbert 2018; Gilbert, Hall & Codd 2020]

2. Framework

Format (outpatient standard). The standard course runs about 30 weeks [source: Lynch, Hempel & Dunkley 2015; Gilbert et al. 2020]:

weekly individual therapy of about 1 hour;
a weekly skills class of about 2.5 hours, with homework review, a short break and new teaching;
optional between-session telephone or text contact;
a weekly therapist consultation team, highly recommended.

In the REFRAMED trial this meant 29 individual sessions of 50 to 60 minutes and 27 skills classes of 2.5 hours (including a 15-minute break) over 29 weeks, or about 7 months. Clients kept their antidepressants but were asked not to start other psychotherapy during treatment. [source: REFRAMED protocol]

Skills classes usually start after the second individual session, around week 3. [source: Psychology Tools article; BT special issue 2018]

Phase 0: Assessment of overcontrol. Goal: confirm that OC, not undercontrol (UC), is the dominant coping style, since the treatment loosens control rather than building it [source: Gilbert et al. 2020; Vanderbleek & Gilbert 2018]:

Questionnaires: the Brief Overcontrol Scale (adults), the OUT-Ma (adolescents) and the parent-rated Overcontrol in Youth Checklist.
Clinical interview: described as essential.
Criteria for moving on: see the Assessment intervention in section 4.

Phase 1: Orientation and commitment (up to 4 individual sessions). Four tasks [source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]:

Get agreement that overcontrolled coping is a core problem.
Get a commitment that the client will discuss any wish to drop out in session before dropping out.
Orient the client to the neurobiosocial theory.
Orient the client to the mechanism of change: open expression leads to trust, which leads to connectedness.

The therapist also links the client's values (for example, close relationships) to goals, which serve as the means. The therapist says that they practise radical openness themselves and invites disagreement.

Moving on: the client sees OC coping as a core problem. Perfect agreement or compliance is explicitly not required.

Phase 2: Working phase (session 5 onward). Individual sessions follow a target hierarchy [source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]:

Imminent life-threatening behaviour. Drop other agendas and assess and manage risk.
Alliance ruptures. The client feels misunderstood, or treatment feels irrelevant. Unlike standard DBT, ruptures rank above other therapy-interfering behaviour, and the therapist owns the repair.
OC social-signalling deficits and related overt behaviours, organised under the five OC themes (section 4).

Targets are tracked daily on a diary card and revised as treatment goes on. A strong alliance is not expected until about session 14. Signs that it has formed are:

several ruptures that were repaired;
more reciprocal, less formal signalling;
open disagreement without the client withdrawing.

If no ruptures or repairs have happened by about session 14, assume the relationship is superficial.

Moving between targets is moment-to-moment: a higher-order target that appears in session takes over immediately.

Skills curriculum (runs alongside, 30 lessons). The 2018 lesson titles and their grouping are listed in the skills entries of section 4. [source: BT special issue 2018; Psychology Tools article]

Ending. Lesson 30 is an integration week. The sources give no dedicated end-phase protocol for individual therapy. [uncertain]

Adaptations. The sources mention these variants, but their protocols are not drawn on [uncertain]:

inpatient and outpatient anorexia nervosa programmes;
adolescents;
group-only RO for mixed inpatients (Booth et al.);
forensic settings with violent offenders (Hamilton et al.);
RO-couple and RO-multi-family protocols, which add psychoeducation, skills, dialectical thinking and self-enquiry for carers.

[source: BT special issue 2018; Lynch, Hempel & Dunkley 2015]

3. Guiding principles

[source for this section unless noted: Lynch, Hempel & Dunkley 2015; Lynch 2018 'Tribe Matters' in the BT special issue; Heat on/Heat off blog post]

Radical openness is the core skill and stance. Notice cues that are unexpected or contradict you; ask what you might learn instead of explaining, defending or regulating; then respond flexibly and humbly. Practically: treat your own urge to defend as information.
Social signalling matters more than inner experience. Target what the client shows others, not distorted thoughts or private feelings. Practically: in every analysis, ask how this signal would affect someone's wish to get close.
Emotional loneliness is the core problem; the tribe is the remedy. The therapist acts as a 'tribal ambassador' [source: Gilbert et al. 2020]. Practically: link every target to connection with others, not to symptom relief alone.
Psychological health has three parts: receptivity and openness, flexible control, and intimacy and connectedness [source: PPA 2026 handout reproducing Skills Manual Handout 1.4]. Practically: use these three as the yardstick for progress.
Misery is often hidden. OC clients look composed and compliant. Practically: do not read a calm face or 'I'm fine' as low distress or low risk.
Less directive than standard DBT. Encourage the client to think and act independently. Practically: ask for the client's view first, and reward them for disagreeing with you.
Engage conflict; treat ruptures as growth. Practically: welcome teasing, disagreement and complaints as signs of trust, and initiate repair yourself.
The therapist models openness. OC clients rarely believe adults are allowed to play, be fallible or show emotion. Practically: disclose your own small lapses, admit errors and use expressive, varied nonverbal signals.
Signal nondominance and social safety. Use a relaxed, open posture like an old friend's, a lighter voice and qualifiers such as 'Is it possible…?'. Practically: use the Big Three + 1 on yourself before and during difficult moments.
Balance heat-on and heat-off. Alternate direct attention (heat-on) with breaks from it (heat-off), and use playful irreverence with compassionate gravity. Practically: pull attention away briefly when the client freezes, then return to the topic kindly.
Self-enquiry over impulse control. Practically: assign questions to sit with, not answers or regulation strategies.
Let go of compulsive striving. Practically: assign non-productivity, play and novelty as legitimate homework.
Reward candour and spontaneous emotion. Practically: thank the client for the 'gift of truth' when they disclose something hard.
Perfect agreement is never required. Practically: settle for 'willing to try' and expect disagreement.
Values guide behaviour; goals are the means. Practically: anchor commitment to what the client values, such as closeness, not to symptom targets.
Target the self-control style, not the diagnosis. Two clients with the same diagnosis may need opposite strategies [source: Vanderbleek & Gilbert 2018]. Practically: re-check OC vs UC whenever progress stalls.
Therapists practise what they teach. Practically: keep up your own self-enquiry and bring it to the consultation team or virtual team [source: Lynch, Hempel & Dunkley 2015].
Dialectical and behavioural foundations stay in place. The theory text has a chapter on dialectical and behavioural strategies [source: Regina Library contents note]. Their specific adaptations were not reviewed. [uncertain]

4. Intervention inventory

Note on wording: all example language is my own illustration, labelled (illustrative), unless shown as a short quote with its source. I name skills by their manual titles, but did not reproduce the handout or worksheet text.

A. Assessment, orientation and commitment

4.1 Assessing overcontrol versus undercontrol

Purpose / when: At intake, and again whenever treatment stalls. RO DBT is for OC clients. A UC client given 'loosen your control' work could get worse [synthesis].
Steps:
1. Give the Brief Overcontrol Scale to adults. Its clinical cut-offs were still being tested in 2020, so use it alongside the interview, not as a gate. For adolescents use the OUT-Ma, which is still in validation. For children around 5 to 6, use the parent-rated Overcontrol in Youth Checklist.
2. In the interview, look at the style of signalling, not the list of symptoms. OC presents as inhibited, controlled and mood-independent. UC presents as dramatic, disinhibited and mood-driven.
3. Ask about public versus private behaviour. OC clients often hold emotion in public, then 'leak' it in private, for example rage at home.
4. If a client endorses UC-sounding symptoms (self-harm, emptiness, identity disturbance), ask how each one shows to others, in what setting and how strongly. For example, a self-injury that is planned and hidden fits OC.
5. Note the subtype. 'Overly disagreeable' clients prize fairness, correctness and competence (OCPD-like). 'Overly agreeable' clients prize peace and being liked (avoidant-like).
6. The theory text describes an OC global prototype rating approach, but its procedure is not drawn on. [uncertain]
Example language (illustrative): 'When you're upset, what would someone sitting across the table actually see?' 'Is it different at home with the door closed?'
Watch for:
- Clients who rate themselves as 'fine' while showing a flat face and brief answers.
- Mistaking a quiet UC client for OC. The pattern of coping across contexts is what decides it.

[source: Gilbert, Hall & Codd 2020; Vanderbleek & Gilbert 2018; BT special issue 2018]

4.2 Orientation to the neurobiosocial theory

Purpose / when: Sessions 1 to 4. Gives the client a non-blaming account of why they are over-controlled, and a reason to work on signalling.
Steps:
1. Explain biotemperament: high threat sensitivity, low reward sensitivity, strong inhibitory control and a detail-focused way of processing.
2. Explain the social side: family or culture rewarded self-control and punished open emotion and mistakes.
3. Explain the coping it produced: masking, caution and aloofness.
4. Then make the core link. Masked expressions make others uneasy, so they keep their distance, which leaves the client lonely.
5. Ask the client to check this against their own life.
Example language (illustrative): 'Some people are born with a nervous system that spots threat fast and gets less buzz from reward. Add a family that prized getting it right, and you learn to keep your face still. The trouble is, other people read a still face as "something's off".'
Watch for: Polite agreement with no emotional engagement. Probe for the client's own examples.

[source: Lynch, Hempel & Dunkley 2015; REFRAMED protocol]

4.3 Orientation to the mechanism of change and to treatment structure

Purpose / when: Sessions 1 to 4. Makes social signalling the shared focus.
Steps:
1. Present open expression = trust = connectedness. The point is that people trust those who show what they feel.
2. Describe the structure: individual sessions, skills classes, diary cards, optional texts, and how long the treatment lasts.
3. Explain that ruptures and disagreement are expected and welcome.
Example language (illustrative): 'This treatment works less on how you feel inside and more on what you show. We trust people whose faces we can read.'
Watch for: Clients who hear this as 'be more emotional'. Clarify that the aim is flexible and genuine expression, not more expression for its own sake [synthesis].

[source: Lynch, Hempel & Dunkley 2015]

4.4 Commitment strategies

Purpose / when: Sessions 1 to 4, and later whenever motivation drops.
Steps:
1. Get agreement that OC coping is a core problem. Do not insist on full agreement.
2. Ask for a specific commitment: before dropping out, the client will come and talk about wanting to.
3. Separate values (for example, wanting close relationships) from goals (the means).
4. Tie treatment targets to those values.
Example language (illustrative): 'People like you often decide quietly that therapy isn't working and just don't come back. Would you be willing to tell me first, even if it feels rude?'
Watch for: Over-agreeable compliance, where the client commits easily but means little. Check by asking what might make them want to quit.

[source: Lynch, Hempel & Dunkley 2015]

4.5 Therapist disclosure of own radical-openness practice

Purpose / when: Orientation, and later during ruptures. Models fallibility and makes disagreement safe.
Steps:
1. Tell the client that you practise radical openness yourself, including being open to criticism.
2. Invite them to tell you when you get something wrong.
3. Later, share a small, true personal lapse that is relevant to the client's target.
Example: In the 2015 paper, a therapist disclosed pouting during arguments and denying it, and said that admitting it made it harder to keep doing. The client then disclosed secretly undermining others, which revealed an envy and bitterness target.
Example language (illustrative): 'I'm not immune to this. When I'm hurt, I can go quiet and pretend I'm not. Naming it out loud has helped me stop.'
Watch for: The disclosure has to serve the client. Keep it short, then hand the floor back.

[source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]

B. Individual-therapy strategies

4.6 Targeting by the five OC themes

Purpose / when: From about session 5. Turns broad OC into specific, observable social-signalling targets.
Steps:
1. Go through the five themes with the client and collect real examples for each:
  - inhibited or disingenuous emotional expression (frozen or insincere expressions, rarely laughing, silent treatment, pouting);
  - hypervigilant, overly cautious, detail-focused behaviour (tense voice, checking for safety cues, correcting others' errors);
  - rigid, rule-governed behaviour (moral certainty, perfectionism, compulsive planning, redoing others' work);
  - aloof and distant relating (walking away from conflict, dismissing feedback, rarely apologising);
  - envy and bitterness (secret competitiveness, martyrdom, harsh gossip, resentment).
2. Turn each example into an observable behaviour the client can count on the diary card.
3. For every target, ask how the signal would affect someone's wish to bond.
4. Prefer overt signals (for example, 'walked out of the meeting without speaking') to internal states.
Example language (illustrative): 'When you correct your colleague's spelling in front of others, what do you think it tells her about how you feel about her?'
Watch for:
- Targets drifting toward thoughts and feelings.
- Clients choosing 'safe' targets. Envy and bitterness targets often emerge only after trust forms.

[source: Lynch, Hempel & Dunkley 2015 (Table 2); Gilbert et al. 2020]

4.7 Diary card

Purpose / when: Every week. It tracks targets and picks the behaviour for the session's chain analysis.
Steps:
1. Build the card around the client's own social-signalling targets and any life-threatening behaviour.
2. Review it at the start of each session.
3. Pick the most relevant problem behaviour of the week for a chain analysis.
4. Revise targets as new ones appear.
Example language (illustrative): 'Looking at the week, which moment do you think cost you the most in closeness?'
Watch for: Perfectionistic, over-detailed cards. Reinforce honesty over completeness [synthesis]. The official card's layout is not drawn on. [uncertain]

[source: Lynch, Hempel & Dunkley 2015; RO DBT chain-analysis course page]

4.8 Chain and solution analysis of social signalling

Purpose / when: Most working-phase sessions. Explains what led to a maladaptive social signal and what kept it going, then builds solutions.
Steps: These are the six steps as the institute's course describes them. Its exact wording was not available. [uncertain]
1. Pick a problem behaviour from the diary card. Check it is a social signal, or that it is relevant to one. The course warns of common therapist errors in choosing the signal.
2. Identify contributing factors, such as vulnerabilities.
3. Identify the prompting event.
4. Map every link between event and behaviour: thoughts, emotions, body sensations, urges and actions.
5. Identify the consequences: short-term reinforcers and long-term costs to connection.
6. Pick the most maladaptive link or links and build solutions. The institute calls this the 'RO DBT Social Signaling Solution Analysis Protocol'. Typical solutions are:
  - outing oneself, using a script;
  - the Awareness Continuum, to own one's perceptions of others' intentions;
  - the Flexible Mind ADOPTS questions, to decide whether to accept or decline feedback;
  - Big Three + 1 and other skills.
7. Rank the solutions by how likely each is to improve connectedness.
Example language (illustrative): 'Let's slow the tape down. Right before you said "Fine" and left the room, what was happening in your chest? And what did your face do?'
Watch for: Clients analysing in intellectual detail to avoid feeling. Signs that it is working: the client starts to spontaneously notice their own signals and how others respond.

[source: RO DBT chain-analysis course page; Lynch, Hempel & Dunkley 2015]

4.9 In-session signal awareness

Purpose / when: Throughout every session. The client's live signals are the most direct material you have.
Steps:
1. Track micro-expressions, gaze, posture, voice tone, speech rate and length of answers.
2. When something shifts, name it tentatively and ask about it. Do not interpret.
3. Link it back to the client's targets.
Example language (illustrative): 'I noticed your answers got shorter after I mentioned your sister. Did you notice that too?'
Watch for: Overdoing it, which feels like surveillance. Balance it with heat-off (4.12).

[source: BT special issue 2018; Lynch, Hempel & Dunkley 2015]

4.10 Targeting indirect and disguised signals

Purpose / when: When the client communicates through hints, sighs, silence or ambiguous statements. Lynch calls some of these 'pushbacks'; the 2015 skills list includes a lesson on them.
Steps:
1. Notice the indirect signal, for example 'I'm not like other people', which may carry 'I'm better than other people'.
2. Ask the client what message the signal might send.
3. Explore what the client wants from the other person.
4. Practise saying it directly.
Example language (illustrative): 'When you say you're "just different", could it be that part of you also means "above it"? I'm guessing. Correct me.'
Watch for: A rupture. Use qualifiers and be ready to repair (4.11). The theory text's full classification of pushback and 'don't hurt me' responses is not drawn on. [uncertain]

[source: BT special issue 2018; Lynch, Hempel & Dunkley 2015]

4.11 Alliance-rupture repair (seven steps)

Purpose / when: Immediately, whenever the client seems to feel misunderstood or treatment seems irrelevant to them. Ruptures are the second-highest target, after life-threatening behaviour. Cues include:
- sudden flatness, shorter answers or a change in eye contact;
- over-polite agreement;
- missed homework accompanied by a shrug.
Steps:
1. Drop the current agenda, even a chain analysis.
2. Take heat off: briefly look away so the client can settle.
3. Signal friendliness and cooperation: lean back, breathe slowly, give a slight closed-mouth smile and raise your eyebrows.
4. Name the change you noticed and invite candour, for example by asking whether they noticed it too.
5. Slow down. Reflect back what you hear and check you have it right.
6. Reinforce the disclosure: thank them for the 'gift of truth'.
7. Before going back to the agenda, check that the client is re-engaged.
Keep the repair under about 10 minutes. The therapist owns the repair and never blames the client.
Example language (illustrative): 'Can I pause us? Something shifted just then. You went quieter. Did you notice it too? I may have missed something important.'
Watch for:
- The client denying anything happened. Accept that lightly and stay curious.
- No ruptures by about session 14, which suggests the alliance is superficial.
- Signs it is working: the client complains or disagrees openly later, without withdrawing.

[source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]

4.12 Heat-off and heat-on

Purpose / when: To manage how much direct attention an OC client can take. Praise, direct focus and being looked at can trigger shutdown.
Steps:
1. Set up the room:
  - keep it cool, with a fan if needed;
  - angle the chairs at about 45 degrees so eye contact can break naturally;
  - have a side table for water and papers, which gives natural regulation breaks.
2. When the client shows strain, take heat off:
  - look away briefly or turn to the diary card;
  - lean back and lighten your voice;
  - use qualifiers ('Is it possible…?', 'Could it be…?').
3. Then put heat back on kindly. Staying heat-off too long tells the client they can't cope. Heat-on can mean direct questions, playful irreverence or compassionate gravity.
Example language (illustrative): (looking at your notes) 'Let me just jot that down…' Then, after a pause, looking up: 'Okay, back to it. You were saying you went silent at dinner.'
Watch for: Rumination or freezing, which means heat-off is needed. Endless heat-off is also a problem, because it colludes with avoidance.

[source: Heat on/Heat off blog (radicallyopen.net); Lynch, Hempel & Dunkley 2015]

4.13 Big Three + 1 (activating social safety)

Purpose / when: Therapist self-regulation during tense moments. Also a client skill to use before or during social interactions and feedback, from the Activating Social Safety lesson. The idea is to shift physiology from defensive arousal toward a social-safety state, which relaxes the face and voice.
Steps:
1. Lean back in the chair.
2. Take a slow, deep breath.
3. Give a cooperative closed-mouth smile.
4. Raise your eyebrows (the '+1').
The skills worksheet pairs a closed-mouth smile and raised eyebrows with slower, deeper breathing.
Example language (illustrative): 'Before you walk into that meeting, try this: sit back, one slow breath, a small closed-lip smile and lift your eyebrows. Notice whether your face feels different.'
Watch for: A forced, 'fake' smile. Coach it to be relaxed and brief. Check whether the client's tension drops and whether others respond more warmly; ask them to observe this as homework.

[source: Heat on/Heat off blog; PPA 2026 handout (Skills Manual Worksheet 1.B); Lynch, Hempel & Dunkley 2015]

4.14 Playful irreverence, compassionate gravity and therapeutic teasing

Purpose / when: To loosen rigid seriousness, model nondominant playfulness, and challenge maladaptive behaviour without lecturing. Use once some trust exists.
Steps:
1. Respond to a rigid statement with gentle, affectionate exaggeration or humour, signalled clearly as friendly through a smile and raised eyebrows.
2. Watch the reaction.
3. Switch to compassionate gravity (a slower, serious, warm tone) when the client is really hurting.
4. Welcome the client teasing you back as a sign of trust.
Example language (illustrative): (smiling) 'So the dishwasher has to be loaded in the one correct, scientifically proven way? Fascinating. Who else in the house knows the secret?'
Watch for: Teasing that lands as contempt, which causes a rupture; repair at once. Signs it is working: the client laughs, or teases back.

[source: BT special issue 2018; Heat on/Heat off blog. Specific teasing procedure: theory text [uncertain]]

4.15 Self-enquiry (individual practice and journal)

Purpose / when: The central radical-openness practice. Use it when the client feels resistance, irritation, numbness or an urge to defend or explain, or when facing feedback or a 'myth'. The aim is to learn from the discomfort, not to regulate it away.
Steps:
1. Find your 'edge': the place of tension or of not knowing.
2. Turn toward it and ask a question. Do not answer it immediately. 'Is there something here to learn?' is a core question [source: Lynch, Hempel & Dunkley 2015].
3. Use further questions as prompts, for example:
  - whether bodily tension means you are not open;
  - whether you are explaining, defending or discounting automatically;
  - whether you need the other person to change first;
  - whether your agreement is real or just a way to avoid conflict.
4. Practise for short periods, about 5 minutes, and be suspicious of quick answers.
5. Write what emerges in an RO self-enquiry journal.
Example language (illustrative): 'Rather than deciding whether your boss was right, could you carry one question this week, "What might I need to learn here?", and jot down whatever comes up, especially what you'd rather not see?'
Watch for: Self-enquiry turning into self-criticism or rumination. The aim is curiosity, not blame. Signs it is working: the client's questions get sharper and they get less defensive in session.

[source: PPA 2026 handout (Skills Manual Handouts 1.2 to 1.3, Worksheet 1.A); Luoma 2018 blog; Lynch, Hempel & Dunkley 2015]

4.16 Self-enquiry with a partner

Purpose / when: In session, in the skills class, or with a trusted other. Helps the client stay at their edge instead of justifying.
Steps: These follow Luoma's institute blog guidance, which is secondary to the manual. Allow about 5 minutes per person.
1. The speaker 'outs' a recent emotional event in 1 to 2 minutes, without justifying or defending it.
2. The listener does not soothe, validate, cheerlead, reassure or problem-solve.
3. After 1 to 2 minutes, the listener asks whether the speaker is at their edge. If not, they ask what would get them there, and what the speaker might need to learn or ask themselves.
4. The listener writes the questions down and keeps checking whether the speaker is still at the edge.
5. At the end, the listener asks which question hit the edge hardest.
6. Both reflect: how much did the speaker defend, and how much did the listener want to fix?
7. The speaker takes the written questions home and practises with them alone 2 to 3 times over the next few days.
Example language (illustrative): 'Are you at your edge right now, or have you drifted into explaining?'
Watch for: The therapist sliding into validation or advice. Trying to do self-enquiry 'right' is itself material for self-enquiry.

[source: Luoma 2018, Tips on How to do Self-Enquiry with Another Person]

4.17 Outing oneself

Purpose / when: As a solution in solution analysis, and in daily life. Reveals inner experience openly, which builds intimacy and invites feedback on blind spots.
Steps:
1. Notice an urge, such as to pout, withdraw or go silent, or something you learned in self-enquiry.
2. Use Big Three + 1 to settle.
3. Tell the other person briefly what is going on for you, without blaming and without asking them to fix it.
4. Listen to their response.
5. The institute teaches a script for this. Its text is not drawn on. [uncertain]
Example language: 'I want to let you know what's going on for me right now' (Johnson, RO DBT blog, 2019). An illustrative continuation: '…I notice I want to go quiet and sulk, and I don't really want to.'
Watch for:
- Outing that is really a complaint in disguise.
- Outing that demands reassurance.
- Signs it is working: others respond with more warmth and their own disclosure.

[source: Luoma 2018 blog; Johnson 2019 blog; RO DBT chain-analysis course page; PPA 2026 handout]

4.18 Behavioural exposure to tribal participation

Purpose / when: OC clients have low reward sensitivity, so social contact can feel unrewarding as well as threatening. This pairs brief social participation with real (consummatory) reward.
Steps: a detailed protocol is not drawn on. What follows is my working version [synthesis] [uncertain]:
1. Plan short, low-stakes social participation.
2. Build in something genuinely enjoyable.
3. Use Big Three + 1 beforehand.
4. Afterwards, savour what was pleasant instead of reviewing errors.
Example language (illustrative): 'Ten minutes at the coffee morning, then notice one thing you actually enjoyed. No post-mortem.'
Watch for: The client turning it into a performance task.

[source: BT special issue 2018 (named only)]

4.19 Between-session contact and celebration texts

Purpose / when: OC clients rarely use crisis coaching. Contact serves mainly to build connection and to generalise skills.
Steps:
1. Offer brief phone or text contact.
2. Encourage the client to text to celebrate using a skill or to 'out' a new insight.
3. Reply briefly and warmly.
Example language (illustrative): 'If you try the eyebrow-raise at work and something nice happens, text me. I'd genuinely like to hear.'
Watch for: The client never using it. That is a possible aloofness target.

[source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]

4.20 Therapist consultation team and personal practice

Purpose / when: Every week. Therapists practise radical openness themselves, which reduces burnout, improves empathy and protects adherence.
Steps:
1. Meet weekly, in person or online. REFRAMED teams met for 1.5 to 2.5 hours.
2. Each therapist outs their own edges and self-enquiry.
3. Review session video for adherence. REFRAMED videotaped all sessions and rated a sample.
4. Clinicians without a team should use a virtual team or supervision.
Example language (illustrative): 'My edge this week: I noticed I wanted my client to agree with me, and I got clipped with her.'
Watch for: The team turning into case management without personal practice.

[source: Lynch, Hempel & Dunkley 2015; REFRAMED protocol; BT special issue 2018]

C. Skills-class interventions (2018 curriculum, 30 lessons)

Lesson numbers follow the 2018 list as reported in the BT special issue and the Psychology Tools article. Lessons 11 to 14 (mindfulness) are repeated as lessons 23 to 26. The 2015 paper's earlier list orders some lessons differently; for example, it puts loving-kindness near the end. Where a skill's own handout is not drawn on, the entry says so.

4.21 Running the skills class

Purpose / when: Weekly, 2.5 hours. Teaches the skills and gives live practice in open, playful social signalling.
Steps:
1. Open with a brief mindfulness or 'Participate without Planning' exercise (4.30).
2. Review homework, with each member outing successes and difficulties.
3. Take a short break.
4. Teach the new lesson with demonstrations and practice.
5. Set homework, usually a worksheet plus a real-world signalling experiment.
Example language (illustrative): 'Who's willing to tell us about a homework attempt that went badly? Those are usually the most useful.'
Watch for: Members who are perfectionistic, report only polished successes, or compete. The instructor models fallibility and playfulness [synthesis].

[source: BT special issue 2018; Lynch, Hempel & Dunkley 2015]

4.22 Radical openness: Flexible Mind DEFinitely and the myths of a closed mind (Lesson 1)

Purpose / when: The foundational skill, used whenever the client feels closed, tense, irritated or numb in response to something new or to feedback. RO is needed 'only when we are closed'.
Steps:
1. D: Acknowledge the distress or unwanted emotion. Note the situation, body sensations and who was present.
2. E: Use self-enquiry to learn from it (4.15). Turn toward the discomfort instead of immediately regulating, distracting, fixing or accepting it. Spend about 5 minutes on it.
3. F: Respond flexibly and with humility, fitting the moment and taking others' needs into account.
4. Myth work: choose one 'myth of a closed mind' from the worksheet. These are beliefs such as being certain whenever you feel right, or that changing means betraying your values. Practise self-enquiry on it for a week and record what emerges in the journal.
Example language (illustrative): 'Which of these myths do you secretly agree with? Let's not argue with it. Just carry it around this week and ask what holding it protects you from.'
Watch for: Intellectual agreement without any felt edge.

[source: PPA 2026 handout (Skills Manual Worksheets 1.A and 1.B, Handouts 1.2 to 1.4); Lynch, Hempel & Dunkley 2015]

4.23 Understanding emotions and how emotions help (Lessons 2 and 6)

Purpose / when: Early lessons. They correct OC beliefs that emotions are weak or dangerous, and teach that emotional expression serves to communicate and to bond.
Steps: Teach the emotion model and the OC myths about emotions. Have clients list the expressions they suppress and what each would communicate if shown. Assign noticing one suppressed expression per day. The detailed handout content is not drawn on. [uncertain]
Example language (illustrative): 'What would your friend learn about you if your face had shown that disappointment?'
Watch for: Clients agreeing in principle but staying unexpressive. Link this to the signalling homework.

[source: Lynch, Hempel & Dunkley 2015; REFRAMED protocol; BT special issue 2018]

4.24 Activating social safety (Lesson 3)

Purpose / when: Before social situations or feedback, to turn on the social-safety system and turn down defensive arousal. 'Changing physiology to change social behaviour.'
Steps: Teach and practise Big Three + 1 (4.13): slow, deep breathing, a closed-mouth smile and raised eyebrows. Use it before entering a situation and while listening. The full lesson may include further bottom-up techniques not drawn on here. [uncertain]
Example language (illustrative): 'Let's all try it now and notice what happens in the face and shoulders.'
Watch for: Clients using it to look calm while staying closed inside. It is meant to support openness, not masking [synthesis].

[source: Lynch, Hempel & Dunkley 2015; PPA 2026 handout; BT special issue 2018]

4.25 Loving-kindness meditation (Lesson 4)

Purpose / when: To strengthen social-safety states, openness and connectedness. RO mindfulness practice draws on Malamati Sufism.
Steps: Lead a guided practice of wishing well to self and others, then debrief what was noticed. The exact RO script and phrases are not drawn on, so do not attribute specific wording to Lynch. [uncertain]
Example language (illustrative): 'Bring to mind someone you care about, and silently offer them a simple wish for their wellbeing…'
Watch for: Clients judging their performance at the meditation. Treat that as material for self-enquiry.

[source: Psychology Tools article; Lynch, Hempel & Dunkley 2015]

4.26 Engaging in novel behaviour; going opposite to seriousness (Lesson 5)

Purpose / when: To loosen rigidity and the habit of compulsive productivity, and to increase reward from new experience.
Steps:
1. Each week, assign small novel behaviours: a new route, an unfamiliar food, or a change in routine.
2. Assign deliberate non-productivity, such as an hour with no goal.
3. Assign 'being a little bit silly', usually in class first.
4. Use opposite action to over-seriousness.
5. Debrief what was learned, not how well it was done.
Example language (illustrative): 'Your homework is to waste twenty minutes on purpose and notice what your mind says about it.'
Watch for: The client turning novelty into another achievement task.

[source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]

4.27 Understanding OC coping, rejection, self-conscious emotions and social signalling (Lessons 7 to 9)

Purpose / when: To link OC coping to social exclusion, to normalise shame and embarrassment as signals that maintain bonds, and to teach how nonverbal signals shape trust.
Steps:
1. Review the client's OC coping and what it costs socially.
2. Teach that subtle facial and bodily signals are picked up and mirrored by others, through micromimicry and the mirror-neuron system.
3. Run signalling experiments, for example deliberately showing more expression or less, and noting how people respond.
4. The detailed lesson content is not drawn on. [uncertain]
Example language (illustrative): 'This week, notice one conversation where you showed a little more on your face than usual. What did the other person do?'
Watch for: Clients concluding that others are at fault. Steer them back to their own signal.

[source: REFRAMED protocol; BT special issue 2018; Lynch, Hempel & Dunkley 2015]

4.28 Flexible Mind is DEEP: values (Lesson 10)

Purpose / when: Clarifies values, especially connection to others, as the motive for change.
Steps: Identify core values. Compare them with current OC behaviour. Pick behaviours that serve those values. What the letters of DEEP stand for is not given in the sources. [uncertain]
Example language (illustrative): 'If closeness is a value, which of this week's signals moved you toward it?'
Watch for: Values stated as rigid rules.

[source: Psychology Tools article; BT special issue 2018; Lynch, Hempel & Dunkley 2015]

4.29 OC states of mind: Fixed, Fatalistic and Flexible Mind (Lesson 11, repeated as Lesson 23)

Purpose / when: Helps clients recognise two closed-minded states and move toward the open one.
Steps: Teach the three states:
- Fixed Mind resists change ('I already know').
- Fatalistic Mind gives up through silence, bitterness or shutting down.
- Flexible Mind is the synthesis: open to change without falling apart.
Have clients label which state they are in when an edge appears, then apply self-enquiry.
Example language (illustrative): 'Was that Fixed Mind, "I'm right and that's that", or Fatalistic Mind, "Whatever, it's pointless"?'
Watch for: Mislabelling Fatalistic Mind as acceptance.

[source: Lynch, Hempel & Dunkley 2015]

4.30 Mindfulness 'what' skills: Awareness Continuum and Participate without Planning (Lesson 12, repeated as 24)

Purpose / when: Builds spontaneous, unrehearsed expression and shared play.
Steps:
1. Awareness Continuum: in pairs or in class, practise stating moment-to-moment inner experience aloud without rehearsing it. The institute also teaches it for owning perceptions of others' intentions (4.8).
2. Participate without Planning: run short, unpredictable group activities of about 60 seconds that require everyone to join in together at once, for example nonsense speech with arm-waving. The instructor joins in fully.
3. The 2015 paper also lists observe, one-mindfully and effectively, adapted for OC.
Example language (illustrative): 'Just say what you're aware of, starting with "I'm aware of…". No editing, no need for it to make sense.'
Watch for: Clients opting out or 'observing' instead of joining in. The instructor's own visible silliness lowers that barrier.

[source: Lynch, Hempel & Dunkley 2015; RO DBT chain-analysis course page]

4.31 Mindfulness 'how' skills: with self-enquiry; awareness of harsh judgments (Lessons 13 and 14, repeated as 25 and 26)

Purpose / when: The core 'how' skill is to take every practice 'with self-enquiry'. A second skill is awareness of harsh judgments: noticing how self-critical or judgmental states show in posture, eye contact and voice, and what that signals.
Steps:
1. During any practice or interaction, ask what you might need to learn from it.
2. Notice a judgment.
3. Notice its bodily and facial expression.
4. Ask what it communicates to others.
Example language (illustrative): 'When you were judging yourself just then, what was your face doing? What might I have read from it?'
Watch for: Judging oneself for judging. Gently name it and move on.

[source: Lynch, Hempel & Dunkley 2015; Psychology Tools article]

4.32 Interpersonal integrity: Flexible Mind REVEALs (Lessons 15 and 16)

Purpose / when: For moments when the client feels an urge to signal indirectly, such as pouting, the silent treatment or pushing back, instead of being direct.
Steps: These follow a 2019 institute blog example. The meaning of each letter is my inference from the blog, not confirmed against the manual. [uncertain]
1. Notice the edge in the body.
2. Recognise the urge.
3. Examine it through self-enquiry: what am I trying to signal or control?
4. Check it against your values.
5. Activate social safety with Big Three + 1.
6. Engage directly by outing yourself.
7. Afterwards, adopt any feedback and keep learning.
Example language: 'I want to let you know what's going on for me right now' (Johnson 2019).
Watch for: Direct statements that still carry a covert demand to be validated.

[source: Johnson 2019 blog; Psychology Tools article]

4.33 Kindness first and foremost; being assertive with an open mind (Lessons 17 and 18)

Purpose / when: To express needs and disagreement in a way that keeps the relationship. The 2015 version adapted DBT's DEAR MAN and GIVE FAST skills.
Steps: Put signalling kindness and goodwill first. Then state your view or request clearly, while staying open to being wrong. The lesson's specific procedure is not drawn on. [uncertain]
Example language (illustrative): 'I value working with you, and I see this differently. Can I tell you how, and then hear what I'm missing?'
Watch for: Kindness used as a polite mask that suppresses the actual request.

[source: Psychology Tools article; Lynch, Hempel & Dunkley 2015]

4.34 Using validation to signal social inclusion; signalling empathy (Lessons 19 to 21 range)

Purpose / when: OC clients often fail to signal that they understand or accept others.
Steps: Teach and role-play ways to show you have understood and accept the other person. The 2015 list included 'seven ways to signal empathy' and the acronym 'Flexible Mind Validates'. The items are not drawn on. [uncertain]
Example language (illustrative): 'That sounds exhausting. No wonder you snapped.'
Watch for: Validation delivered with a flat face. The nonverbal signal carries the message.

[source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]

4.35 Enhancing social connectedness: Intimacy Thermometer, levels of intimacy, Match + 1 (Lessons 20 and 21 range)

Purpose / when: For aloof or isolated clients building closer relationships step by step.
Steps:
1. Map current relationships by level of intimacy (Intimacy Thermometer).
2. Choose a relationship to deepen.
3. Use Match + 1. As I understand it, this means matching the other person's level of self-disclosure, then going one small step further. That reading comes from my background knowledge; no source defines it. [uncertain]
4. Repeat, and review how the other person responds.
Example language (illustrative): 'She told you her week was rough. Match that, then add one small true thing about your own week.'
Watch for: Over-disclosing all at once, or never taking the '+1'.

[source: Lynch, Hempel & Dunkley 2015]

4.36 Learning from corrective feedback: Flexible Mind ADOPTS (Lesson 22 range)

Purpose / when: When receiving criticism, to decide openly whether to accept or decline it, instead of automatically rejecting it or caving in.
Steps:
1. Use Big Three + 1.
2. Thank the person or take time.
3. Work through the 12 accept-or-decline questions, alone or with the therapist.
4. Act on the decision.
5. Out the result if appropriate.
The 12 questions and what the letters of ADOPTS stand for are not drawn on; do not improvise them. [uncertain]
Example language (illustrative): 'Before you decide your manager is wrong, let's run it through the feedback questions.'
Watch for: Accepting all feedback in order to please people, which is overly agreeable OC.

[source: Lynch, Hempel & Dunkley 2015; RO DBT chain-analysis course page; Johnson 2019 blog]

4.37 Flexible responding and stall tactics

Purpose / when: In charged exchanges, for example an upsetting email.
Steps:
1. Take time before deciding. For a charged message, waiting two to three days is suggested.
2. Tell the other person you need time to think. Stalling means pausing to reflect, not dropping the issue.
3. Block blame and give the benefit of the doubt.
4. Ask whether this detail will matter in the long run.
5. Use the intimacy-guiding questions: persist or suspend, inhibit or disinhibit, express or hold back, reveal or edit.
Example language (illustrative): 'Thanks for raising this. I want to give it proper thought and come back to you on Thursday.'
Watch for: Stalling that turns into avoidance.

[source: PPA 2026 handout (Skills Manual Worksheet 1.B)]

4.38 Envy, resentment, cynicism, bitterness and resignation (Lessons 27 and 28)

Purpose / when: Targets the fifth OC theme, often once trust has formed.
Steps:
1. Teach how envy and bitterness work and what social signals they send: secret competitiveness, martyrdom, harsh gossip.
2. Help the client out envious urges.
3. Work on the social comparisons involved.
4. The detailed skill steps are not drawn on. [uncertain]
Example language (illustrative): 'Envy is normal. What matters is what you do with it. Is there someone you've been quietly keeping score against?'
Watch for: Shame leading to denial. Use your own disclosure (4.5) to make it safe.

[source: Lynch, Hempel & Dunkley 2015; REFRAMED protocol]

4.39 Learning to forgive; learning to grieve (Lesson 29)

Purpose / when: For letting go of long-held grievances and grieving losses, including the cost of years of overcontrol.
Steps: Teach that forgiveness means letting go of the grievance, not condoning the harm. Practise grieving the losses. The manual steps are not drawn on. [uncertain]
Example language (illustrative): 'What would letting go of this grudge cost you, and what might it give back?'
Watch for: Forced or premature forgiveness.

[source: Lynch, Hempel & Dunkley 2015; BT special issue 2018]

4.40 Integration week (Lesson 30)

Purpose / when: The end of the curriculum. Consolidates the skills and plans how to keep them going.
Steps: Review which skills helped most, plan ongoing practice and out what each member has learned. The format is my synthesis. [synthesis] [uncertain]
Example language (illustrative): 'Which one skill would you most want to still be using a year from now?'
Watch for: Polished summaries that hide doubts.

[source: BT special issue 2018]

4.41 Involving family and partners (RO-couple and RO-multi-family)

Purpose / when: When partners or carers keep up or reinforce OC patterns, or when the client is an adolescent.
Steps: Offer the RO-couple or RO-multi-family protocol: psychoeducation about OC, skills training, dialectical thinking and self-enquiry for family members. The session structure is not drawn on. [uncertain]
Example language (illustrative): 'We'd like the people closest to you to learn the same skills, so the house speaks one language.'
Watch for: Family members using the RO language to criticise the client.

[source: Lynch, Hempel & Dunkley 2015]

5. Handling problems

Only the steps tagged with a source come from the sources; the rest is my synthesis, tagged [synthesis].

Hidden suicidality or self-harm. OC clients often hide distress. Self-harm, when present, tends to be planned and private.

Life-threatening behaviour is target 1: drop the agenda and assess and manage risk, as the manual directs. [source: BT special issue 2018; Lynch, Hempel & Dunkley 2015]
Ask directly and routinely, not only when the client looks upset. Use standard structured risk assessment and a written safety plan. [synthesis]
Where indicated, do lethal-means counselling: safe storage, or removal by a trusted person. [synthesis]
A calm face is not evidence of low risk. [synthesis]

Silent dropout. Get the dropout commitment in orientation [source: Lynch, Hempel & Dunkley 2015]. After a missed session, contact the client warmly and without blame, and treat the absence as a possible unrepaired rupture, not a lack of motivation [synthesis].

Superficial alliance (no ruptures by about session 14). The sources read this as a sign the relationship is still polite and not real [source: BT special issue 2018; Lynch, Hempel & Dunkley 2015]. Raise it directly, invite criticism of you or of the treatment, use your own disclosure (4.5), and increase heat-on with playful irreverence [synthesis].

Ruptures. Repair at once using the seven steps (4.11). Own your part and never blame the client [source: Lynch, Hempel & Dunkley 2015]. If the client denies anything happened, accept that lightly and say you will check again if you notice it, so the topic stays open without pressure [synthesis].

Compliance without engagement (overly agreeable subtype). Signs are:

quick agreement with everything;
perfect homework that changes nothing;
'You're right.'

Treat agreement as possible conflict avoidance and use the self-enquiry question about whether agreement is real [source: PPA 2026 handout]. Reward disagreement openly [source: Lynch, Hempel & Dunkley 2015]. Ask the client to tell you one thing they disliked about the session [synthesis].

Argumentative or certain clients (overly disagreeable subtype, Fixed Mind). Do not argue to win. Label Fixed Mind lightly (4.29), take heat off, and use the RO qualifiers ('Is it possible…?'). Assign self-enquiry on the relevant closed-mind myth instead of debating it [source: PPA 2026 handout; Heat on/Heat off blog]. Show that you can be wrong yourself [source: Lynch, Hempel & Dunkley 2015].

Overwhelm or shutdown in session (freezing, rumination, monosyllables):

take heat off: break eye contact, turn to paperwork, lean back;
use Big Three + 1 yourself;
then return kindly, so the client is not left with the message that they can't cope.

[source: Heat on/Heat off blog] If shutdown is severe or dissociative, slow down further and agree on a signal for 'too much' [synthesis].

Non-adherence to homework.

Chain-analyse the non-completion as a possible social signal, for example passive protest [source: chain-analysis course page (method); application synthesis].
With perfectionistic clients, check whether the task was too big or done 'secretly' to a perfect standard.
Assign smaller, playful tasks.
Praise honest reports of failure. [synthesis]

Intellectualised self-enquiry (neat answers, no edge). Shorten the practice. Ask whether they are at their edge; be suspicious of quick answers; move toward the discomfort, and stop explaining [source: Luoma 2018 blog; PPA 2026 handout].

Stuck: little change in signalling after several months. Work through these checks [synthesis unless tagged]:

Re-check OC versus UC; a mislabelled client may need standard DBT or another approach [source: Vanderbleek & Gilbert 2018; Gilbert et al. 2020].
Check that the targets are observable social signals, not internal states.
Do more live practice in session, such as role-plays of outing and signalling experiments.
Look for unaddressed envy or bitterness.
Take the case to the consultation team.

Skills-class difficulties.

Refusal to join 'Participate without Planning': the instructor joins in fully first and keeps it brief and non-evaluative [source: Lynch, Hempel & Dunkley 2015 (instructor modelling)].
Competition, envy or quiet contempt between members: name it as normal OC material and invite members to out it.
Domination by one member: redirect firmly but warmly. [synthesis]

Envy or hostility toward the therapist. Treat it as a rupture and as valuable target material. Thank the client for the candour [source: Lynch, Hempel & Dunkley 2015 ('gift of truth')]. Avoid defending yourself [synthesis].

The therapist's own overcontrol or irritation. Notice your urges to win, correct or withdraw. Practise self-enquiry, and out it in the consultation team or a virtual team [source: Lynch, Hempel & Dunkley 2015]. RO DBT expects therapists to practise what they teach.

Comorbidity and other treatments. In REFRAMED, clients continued prescribed antidepressants and were asked not to start other psychotherapy [source: REFRAMED protocol]. For anorexia nervosa, deliver RO DBT within a programme that has medical monitoring and nutritional care; RO DBT does not replace these [synthesis]. Inpatient and outpatient AN programmes exist, but their protocols are not drawn on [uncertain].

Practitioner readiness. Training runs either as two one-week intensives six months apart (REFRAMED: 10 days) or as blended online and in-person learning. Proficiency needs ongoing supervision of videotaped sessions and peer consultation [source: Gilbert et al. 2020; REFRAMED protocol]. Use this guide alongside the manuals and formal training, not instead of them [synthesis].

Sources

Sources:

Lynch, Hempel & Dunkley (2015). Radically Open-Dialectical Behavior Therapy for Disorders of Over-Control: Signaling Matters. American Journal of Psychotherapy
Southampton ePrints record for the 2015 paper (full text restricted)
Lynch et al. (2015). REFRAMED trial protocol, BMJ Open 5(7):e008857
[The Behavior Therapist 41(3), 2018: RO DBT special issue (Lynch 'Tribe Matters'; Vanderbleek & Gilbert; Hempel et al.; Booth et al.; Hamilton et al.)](https://radicallyopen.net/resources/The Behavior Therapsist 41n3 - RO DBT Special Issue.pdf)
Gilbert, Hall & Codd (2020). RO DBT: social signaling, transdiagnostic utility and current evidence. Psychology Research and Behavior Management
Psychology Tools: Using RO DBT to treat problems of overcontrol
Radically Open blog: Heat on/Heat off
Johnson (2019). Doing Flexible-Mind REVEALs in the heat of the moment, Radically Open blog
Luoma (2018). Tips on How to do Self-Enquiry with Another Person, Radically Open blog
PPA 2026 handout W34: RO DBT Openness and Self-Enquiry (reproduces Skills Manual Handouts 1.2 to 1.4, Worksheets 1.A and 1.B)
RO DBT institute course page: Chain and Solution Analyses in RO DBT (Level 2 Part 12)
Regina Public Library catalogue: contents of Lynch (2018) theory text