Danger Ideation Reduction Therapy (DIRT) for Obsessive Compulsive Checkers: A Comprehensive Guide To Treatment

DIRT for Checkers is a unique evidence-based treatment program designed to specifically reduce expectancies of danger or threat in those with Obsessive Compulsive Disorder (OCD) with predominant checking concerns. 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 that harmful events such as the fear of fire, damage, theft, harm to others and other physical losses will follow any failure to check 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. The treatment includes attentional focusing, cognitive restructuring, double-checking experiments, corrective information, filmed interviews, 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.

Table of Contents

• Chapter 1 - Introduction To DIRT
• Chapter 2 - Treatment Rationale
• Chapter 3 - Attentional Focusing
• Chapter 4 - Cognitive Restructuring
• Chapter 5 - The Double Checking Experiments
• Chapter 6 - Corrective Information
• Chapter 7 - Filmed Interviews
• Chapter 8 - Probability Of Catastrophe Task
• Chapter 9 - Ending Therapy: The Final Session

"Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive-compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive-compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers."
- Lisa D Vaccaro, Research Project Officer at the Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney  read the full review