DIRT [Danger Ideation Reduction Therapy] for Obsessive Compulsive Washers: A Comprehensive Guide to Treatment
Tamsen St Clare, Ross G. Menzies, Mairwen K. Jones
Sydney West Health Service and University of SydneyDIRT for washers is a unique evidence-based program to treat people suffering from obsessive–compulsive disorder (OCD) specifically, OCD washers whose behaviour is characterised by expectancies of danger.
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. The program 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 components may be used selectively or concurrently, as and how a therapist decides is appropriate for individual clients.
The treatment components are attentional focusing, cognitive restructuring, corrective information, microbiological experiments, filmed interviews and the probability of catastrophe task. Included in the program is a DVD of 8 filmed interviews about risk assessment. Additionally, a resource CD contains all 45 handouts and worksheets so that therapists don’t have to photocopy these resources from the book.
What makes DIRT different to other OCD treatments?
Unlike most other OCD treatment programs DIRT features:
- inclusion of attentional focusing.
- exclusive focus on threat expectancies relating to illness or disease.
- direct challenging of negative automatic thoughts that relate to illness or disease.
- use of factual information to provide assurance of the real likelihoods of various outcomes.
- rote learning of restructured cognitions.
DIRT has
been shown to be a highly successful treatment, 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.