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 Sydney

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.

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.    

You might also be interested in: