title: Danger Ideation Reduction Therapy (DIRT) for treatment-resistant compulsive washing.
abstract: Five intractable cases of obsessive-compulsive disorder were treated with the Danger Ideation Reduction Therapy (DIRT) program. All five cases: (1) had displayed excessive washing/cleaning behaviour for at least 10 years; (2) had failed to respond to a minimum of two separate, 12-week drug trials with serotonergic agents; (3) failed to respond to at least 15 sessions of exposure and response prevention at the beginning of the present trial, and; (4) satisfied the DSM-IV criteria for OCD with Poor Insight. DIRT was conducted in 14, weekly, individual sessions or until, in the judgement of the treating clinician: (1) clinically significant gains were apparent with minimal symptomatology remaining, and (2) clients displayed a sound grasp of the cognitive model underpinning DIRT procedures. At post-treatment, substantial reductions in scores on the Padua Inventory (PI), Maudsley Obsessional-Compulsive Inventory (MOCI), Beck Depression Inventory-II (BDI-II) and two global rating scales were apparent for four of the five subjects. These improvements were maintained at 4-to-6 month follow-up, with four of the five cases meeting Jacobson and Truax's (1991) criteria for 'recovery' on the MOCI and the PI by this assessment stage. While one subject remained non-responsive, the present findings suggest that DIRT may be a viable option for treatment-resistant cases of compulsive washing. The theoretical implications of the findings are discussed.
authors.affiliation: School of Behavioural and Community Health Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Krochmalik
authors.forename: M K
authors.initials: MK
authors.lastname: Jones
authors.forename: R G
authors.initials: RG
authors.lastname: Menzies
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006235:Hand Disinfection; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010555:Personality Inventory; D017211:Treatment Failure