DIRT [Danger Ideation Reduction Therapy] for Obsessive Compulsive Washers: A Comprehensive Guide to Treatment
Tamsen St Clare, Ross G. Menzies, Mairwen K. JonesSydney West Health Service and University of Sydney
DIRT has been shown to be a highly successful treatment package for OCD, able to shift even the most intractable of cases. Randomised control studies have established that DIRT represents a viable alternative to the standard behavioural approach. In addition, DIRT appears to have several potential advantages over behavioural and pharmacological treatments:
- Unlike in an Exposure and Response Prevention (ERP) program, clients who undergo the DIRT regime are not asked to confront anxiety-provoking (feared) stimuli. This is particularly important since many sufferers either refuse exposure treatment or drop out before completion because of its anxiety-provoking effects.
- Unlike medication used in the treatment of OCD, DIRT achieves its success without the complication of physical side effects.
- DIRT is a highly structured treatment package involving films, information sheets and worksheets which are relatively inexpensive to package and administer.
- DIRT appears to require relatively few sessions for its therapeutic effect. Substantial reductions in OCD symptomatology have been achieved in as few as six clinical hours.
- DIRT may prove beneficial for intractable patients who have failed with standard treatments, and for those who exhibit poor insight.
Some DIRT research references:
Drummond, L.M. & Kolb, P. (2008). Obsessive-compulsive contamination fears and anorexia nervosa: The application of the new psycho-educational treatment of Danger Ideation Reduction Therapy (DIRT), Behaviour Change, 25, 44-50.
Govender, S., Drummond, L. M., Menzies, R. G.(2006) Danger Ideation Reduction Therapy for the Treatment of Severe, Chronic and Resistant Obsessive-Compulsive Disorder. Behavioural and Cognitive Psychotherapy. 34(4), 477-480.
Hambridge, J. & Loewenthal, M. (2003). Treating Obsessive Compulsive Disorder: A New Role for Infectious Diseases Physicians? International Journal of Infectious Diseases, 7, 152-155.
Jones, M. K., & Menzies, R. G. (1997a). Danger Ideation Reduction Therapy (DIRT): preliminary findings with three obsessive-compulsive washers. Behaviour Research and Therapy, 35, 955-960.
Jones, M. K., & Menzies, R. G. (1997b). The cognitive mediation of obsessive-compulsive handwashing. Behaviour Research and Therapy, 35, 843-850.
Jones, M. K., & Menzies, R. G. (1998a). Danger Ideation Reduction Therapy (DIRT) for obsessive-compulsive washers. A controlled trial. Behaviour Research and Therapy, 36, 959-970.
Jones, M. K., & Menzies, R. G. (1998b). The role of perceived danger in the mediation of obsessive-compulsive washing. Depression and Anxiety, 8, 121-125.
Krochmalik, A., Jones, M. K., & Menzies, R. G. (2001). Danger Ideation Reduction Therapy (DIRT) for treatment-resistant compulsive washing. Behaviour Research and Therapy, 39, 897- 912.
Krochmalik, A., Jones, M. K., Menzies, R. G., & Kirkby, K. (2004). The Superiority of Danger Ideation Reduction Therapy (DIRT) over Exposure and Response Prevention (ERP) in Treating Compulsive Washing. Behaviour Change, 21, 251-268.
O’Brien, M., Jones M.K, & Menzies, R.G. (2004). Danger Ideation Reduction Therapy (DIRT) for Intractable, Adolescent Compulsive Washing: A Case Study. Behaviour Change, 21, 57–65.
St Clare, T. (2004). Danger Ideation Reduction Therapy (DIRT) for Atypical Obsessive-Compulsive Disorder: A Case Study. Behaviour Change, 21, 186-196.