DANGER 
IDEATION
REDUCTION
THERAPY (DIRT)
FOR OBSESSIVE-COMPULSIVE WASHERS
A Comprehensive Guide to Treatment
Tamsen St Clare, Ross G. Menzies, Mairwen K. Jones
DIRT is a unique
new evidence-based treatment program designed to specifically reduce
expectancies of danger or threat in OCD washers. Unlike many traditional
OCD treatments, DIRT is based on the rationale that the therapist should
provide as much factual information as possible to decrease the expectancy
of illness or disease and thus reduce the high dropout rate seen in
conventional OCD
exposure and response prevention programs.
DIRT consists of
six discrete treatment components aimed at reducing the number of intrusive
thoughts experienced and concurrently allowing the client to successfully
change the remaining thoughts and beliefs related to illness and contamination.
The treatment includes attentional focussing, cognitive restructuring,
corrective information, microbiological experiments, filmed interviews,
and a probability of catastrophe task. The
book includes a resource CD with patient handouts and a DVD of interviews.
BUY
ONLINE NOW (SECURE
SITE)
Within
Australia — AUD$148.50 plus
$10.00 Postage & Handling
Overseas
— AUD$135.00 plus $20.00 Postage and Handling
Universal
Currency Converter Services 
OVERVIEW
DIRT
is a comprehensive treatment package that has been designed to specifically
reduce expectancies of danger (threat) in OCD washers. It consists
of six discrete treatment components.The
attentional focussing component is aimed at reducing the number of
intrusive thoughts experienced, and the remaining components work concurrently
to allow the client to successfully change the remaining thoughts and
beliefs related to illness and contamination. The six treatment components
are listed below.
Attentional
Focussing. Clients are taught a focussing task that is designed to
decrease the intrusiveness of obsessional thoughts through increasing
the ability to attend to competing stimuli.
Cognitive
Restructuring Clients are taught to identify and restructure irrational
or unhelpful thoughts related to contamination and disease.
Corrective
Information. Clients
are presented with: (1) a variety of fact sheets concerning feared
contaminants and illnesses; (2) information about the nature and
function of the immune system, and; (3) information relating to disease
and illness rates in specific populations.
Microbiological
Experiment. Clients
are presented with the results from a series of microbiological experiments
involving contact with anxiety-provoking stimuli such as the inside
of a garbage bin and cat fur.
Filmed
Interviews. Clients
are presented with a number of filmed interviews depicting various
workers who have had frequent contact with OCD relevant contaminants.
The absence of compulsive behaviour and work related disease in these
professionals is emphasised.
Probability
of Catastrophe task. Clients
are asked to compare their global estimates of the probability of specific
negative outcomes with the probability that all the steps necessary
for that outcome will occur concurrently.
Differences
between DIRT and standard
Cognitive Therapy packages for OCD
- The inclusion of Attentional Focussing. Standard
cognitive therapy packages for OCD (eg Salkovskis & Warwick,
1985; Salkovskis & Westbrook, 1989) do not include an attentional
focussing component. They teach the client to restructure beliefs without
attempting to reduce the number of intrusions through meditation-like
procedures.
- The exclusive focus on threat expectancies relating to illness/disease. Other
cognitive packages for OCD tend to target variables such as inflated
personal responsibility and perfectionism. In accordance with findings
from our cognitive mediation studies (Jones & Menzies,
1997a) the focus of DIRT is exclusively on cognitions relating to illness
/ disease. The title of our program (Danger Ideation Reduction Therapy)
was chosen to continually remind clinicians of the exclusive focus
of treatment - the reduction of threat expectancies relating to illness
/ disease.
- Direct challenging of negative automatic thoughts that relate
to illness / disease. Many
cognitive packages ignore surface level cognitions relating to illness.
We argue that in the majority of cases the client’s
belief in their surface level cognitions (e.g., If I touch that door handle
I will get cancer of the spleen) is the problem, and should
therefore be the target of therapy.
- The (repeated)
provision of factual information to provide assurance of the real
likelihoods of various outcomes. The
issue of assurance provision is a contentious one within the OCD
treatment literature. The majority of OCD treatment packages will not
comment on the likelihood of danger occurring to the client if he / she
engages in anxiety-inducing tasks. A standard response to questions about
whether a client will become ill by engaging in a task would resemble: “you
may get sick, you may not. This is about learning to live with the risk”.
The rationale behind this is that a key feature of OCD is intolerance
to uncertainty, and that provision of reassuring information is feeding
into that intolerance. In our opinion, refusal to provide relevant factual
information, (such as the likelihood of becoming ill from engaging in
certain behaviours) may well contribute to the high dropout rates seen
in ERP programs for OCD. In our experience, many OCD washers have such
an inflated expectancy that certain behaviours will lead to illness,
that they are unable to tolerate the risk, and therefore drop out of
traditional treatments.The
DIRT approach provides an alternative to the traditional perspective
on this issue. We believe that the therapist should provide as much factual
information as possible, as this will decrease the expectancy of illness
/ disease that is driving the disorder. The emphasis should be firmly
on educating the client about the probability and cost of becoming ill.
We should note that whilst we do attempt to provide accurate information
about likelihood, at no stage do we indicate that the client can know that
they will not become ill from engaging in a particular task (unless the
task involves no risk whatsoever, e.g., contracting rabies when standing
20 feet from a dog). At no stage do we indicate that the client has complete
control over the occurrence of illness. In short, whilst we attempt to
provide our clients with accuracy, we do not attempt to provide them
with certainty. For this reason, we do not believe that DIRT feeds into
pathological intolerance for uncertainty.
- The rote learning of restructured cognitions. One
other technique that we have found to be unique to the DIRT package
is that we request our clients to rote learn their restructured cognitions.
In our experience, the high danger expectancies held by OCD washers
can be difficult to shift, by virtue of the fact that they have been
present for an extended period of time and are habitual. We have
also noticed that for most clients, particular thoughts recur frequently.
We have found rote learning to be helpful in gradually decreasing
the client’s
belief in their maladaptive thoughts, and in preparing them to be able
to challenge their thoughts at times of high anxiety. In the early stages
of cognitive restructuring, clients often complain that they are unable
to restructure their thoughts when they are in anxiogenic situations.
We have found that overlearning of restructured thoughts generated during
times of comparatively low anxiety can greatly assist in enabling clients
to restructure cognitions when they are anxious. We encourage clients
to overlearn their restructured cognitions by both writing them and saying
them.
www.australianacademicpress.com.au |


|