Living with ADHD or OCD: How DBT and RO-DBT Can Help

Living with ADHD (Attention Deficit Hyperactivity Disorder) or OCD (Obsessive-Compulsive Disorder) can feel overwhelming. Both conditions affect how you think, feel, and behave, often making daily life a challenge. Dialectical Behavior Therapy (DBT)—created by Dr. Marsha Linehan—offers practical, evidence-based tools to manage symptoms and improve emotional well-being. Meanwhile, Radically Open DBT (RO-DBT)—developed by Dr. Thomas Lynch—has shown effectiveness in treating overcontrolled behaviors common in OCD, helping individuals open up, reduce rigidity, and connect more authentically.

This post explores effective DBT and RO-DBT strategies tailored for people with ADHD and OCD, providing clear steps to build better focus, reduce anxiety, and gain control over intrusive thoughts and impulses.

Understanding DBT, RO-DBT and Their Role in ADHD and OCD

DBT, developed by Marsha Linehan, is a type of cognitive-behavioral therapy that helps people regulate emotions, tolerate distress, and improve relationships. It combines acceptance and change strategies, teaching skills in four main areas:

• Mindfulness

• Distress Tolerance

• Emotion Regulation

• Interpersonal Effectiveness

For individuals with ADHD, DBT helps manage impulsivity, improve attention, and reduce frustration.

For those with OCD, Radically Open Dialectical Behavior Therapy (RO-DBT)—developed by Dr. Thomas R. Lynch—offers a powerful framework for treating emotional overcontrol, a pattern common in individuals who struggle with perfectionism, rigidity, and excessive self-restraint. Unlike standard DBT, which focuses on managing impulsivity and emotional intensity, RO-DBT is designed for people who feel too inhibited, avoid emotional expression, or rely heavily on control to feel safe—patterns that often underlie obsessive-compulsive tendencies.

RO-DBT emphasizes that emotional loneliness, rather than emotional dysregulation, is often at the core of overcontrolled disorders like OCD. The therapy aims to increase psychological flexibility, social openness, and authentic emotional expression—helping clients replace rigid control with curiosity, spontaneity, and genuine connection.

Mindfulness to Improve Focus and Awareness

Mindfulness is the foundation of both DBT and RO-DBT. It means paying attention to the present moment without judgment.

For ADHD, mindfulness improves concentration and reduces distractibility.

For OCD, it helps notice obsessive thoughts without reacting or engaging in compulsions.

Practical Mindfulness Exercises

• Breathing Focus: Spend 3-5 minutes focusing on your breath. Notice the sensation of air entering and leaving your body. When your mind wanders, gently bring it back.

• Body Scan: Slowly move your attention through your body from head to toe, noticing sensations without trying to change them.

• Observe Thoughts: Imagine your thoughts as clouds passing by. Watch them without grabbing on or pushing them away.

  
  

These exercises build awareness and create space between impulse and action.

Distress Tolerance Skills to Handle Urges and Anxiety

Both ADHD and OCD can cause intense urges—whether impulsive actions or compulsions. Distress tolerance skills help you survive emotional crises without worsening them.

Key Distress Tolerance Techniques

• TIP Skills: Use Temperature (hold ice or splash cold water), Intense Exercise (jumping jacks), and Paced Breathing to calm your nervous system.

• Self-Soothing: Engage your senses with comforting activities like listening to music, smelling a favorite scent, or wrapping yourself in a soft blanket.

• Distraction: Shift your focus by doing a simple task, reading, or calling a friend until the urge passes.

  
  

Using these tools prevents impulsive reactions and compulsive behaviors. For OCD, combining these with RO-DBT self-enquiry helps replace control with curiosity and openness.

Emotion Regulation to Manage Mood Swings and Frustration

ADHD often comes with emotional highs and lows, while OCD brings anxiety and guilt. Emotion regulation skills teach how to identify, understand, and change these intense emotions.

Steps to Regulate Emotions

• Name the Emotion: Label what you feel (e.g., anger, sadness, anxiety). Naming emotions reduces their power.

• Check the Facts: Ask yourself if your feelings match the situation or if they are influenced by past experiences or OCD thoughts.

• Opposite Action: If you feel like avoiding or reacting angrily, try doing the opposite. For example, if you want to isolate, reach out to someone instead.

Interpersonal Effectiveness to Build Stronger Relationships

ADHD and OCD can strain relationships due to misunderstandings or rigidity. DBT teaches how to express needs clearly and maintain healthy boundaries, while RO-DBT emphasizes openness and social connection.

Tips for Better Communication

• DEAR MAN: Describe the situation, Express your feelings, Assert your needs, Reinforce the benefits, Mindfully stay focused, Appear confident, Negotiate if needed.

• GIVE: Be Gentle, act Interested, Validate the other person’s feelings, use an Easy manner.

• FAST: Be Fair, no Apologies for your needs, Stick to your values, be Truthful.

  
  

Practicing these skills builds empathy, clarity, and trust.

Combining DBT with ADHD; and OCD with RO-DBT and Their Treatments

DBT and RO-DBT complement other treatments such as medication, exposure therapy for OCD, or ADHD coaching. They equip you with emotional regulation, flexibility, and resilience skills that medication alone cannot provide.

Example: Using DBT with OCD Exposure Therapy

When facing a feared situation, use mindfulness to stay present, distress tolerance to manage anxiety, and emotion regulation to prevent avoidance. This combination strengthens your ability to face fears without compulsions.

Real-Life Example of DBT in Action

Sarah, who has ADHD, struggles with impulsive spending. She uses DBT mindfulness to recognize urges and TIP skills to ground herself. In contrast, Mark, who has OCD, practices RO-DBT’s openness exercises to release control when rituals' urges arise—choosing curiosity over perfection. Both find a growing sense of calm and confidence.

Tips for Starting DBT and RO-DBT Practice at Home

• Set aside 10 minutes daily for mindfulness exercises.

• Keep a journal to track emotions and urges.

• Create a distress tolerance kit with items like stress balls, scented candles, or music playlists.

• Practice interpersonal skills in low-stakes conversations.

• Seek a DBT or RO-DBT therapist or group for guided support.

  
  

DBT and RO-DBT offer practical, evidence-based paths for managing ADHD and OCD. By cultivating mindfulness, emotion regulation, and openness, you can respond to life’s challenges with greater clarity, flexibility, and peace.

If you want to learn more about DBT or RO-DBT, our providers at the Mindful Steph Center for DBT Therapy and Training offer both standard DBT, DBT adapted for neurodivergent individuals, and Radically Open DBT (RO-DBT). Taking the first step toward therapy or skills training can open the door to lasting change.