Danger Ideation Reduction Therapy Research Articles

Promising Treatments for Obsessive-Compulsive Disorder: A Call for Additional Research.

Many patients with OCD respond partially or not at all to standard medications and cognitive behavioral therapy approaches, making alternate treatments necessary. We review the preliminary evidence that exists in support of the use of stimulants, high-dose caffeine, opiates, memantine, ondansetron, ketamine, and transcranial magnetic stimulation in some patients with OCD. Although limited by small or modest sample sizes, open-label study designs, and brief follow-up periods, studies suggest that each of these strategies can help some patients who have inadequately responded to first-line treatments. The existing data and the unmet needs of OCD patients justify research attention to further test these treatments' safety and efficacy. Previously untested drugs also deserve attention, especially as recent research has suggested new possible contributors to OCD pathophysiology. Similarly, psychotherapeutic interventions beyond CBT should be investigated, and treatments with preliminary evidence in OCD, including Acceptance Commitment Therapy, Danger Ideation Reduction Therapy, and technology-enabled interventions like computerized CBT and Virtual Reality Exposure Therapy, should be carefully tested.

New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

Danger Ideation Reduction Therapy in the Cases with Obsessive Compulsive Disorder

Background: Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package which focuses on providing corrective information to treat obsessive–compulsive disorder. DIRT is solely directed at decreasing the threat expectancies and does not involve direct or indirect exposure. Methodology: Aim: Present study has been under taken with the aim to reduce the obsessive compulsive disorder symptoms as well as the depressive symptoms of the individuals with the help of danger ideation reduction therapy. Sample: By using purposive sampling technique a total of 10 participants were selected, further participants were divided equally into experimental and control groups. Tools: Padua Inventory and Beck Depression Inventory. Therapeutic package planned included; cognitive restructuring, filmed interview, probability of catastrophe, corrective information, attention focusing (rhythmic breathing exercise). Result and Conclusion: The study concludes that with the help of danger ideation therapy patients exhibited improvement in OCD symptoms such as improvement control over mental activities, contamination as well as urges, improvement regarding worries of loss of control over behaviors. OCD patients also showed improvements in depressive symptoms of mood related problems, sleep problems, pessimism and social withdrawal.

PILOT STUDY EXAMINING THE POTENTIAL USE OF THE PSYCHOEDUCATION COMPONENT OF DANGER IDEATION REDUCTION THERAPY (DIRT) AS AN ADJUNCT TO TREATMENT FOR CONTAMINATION FEARS IN PATIENTS WITH PROFOUND REFRACTORY OBSESSIVE COMPULSIVE DISORDER

Background The psychoeducational approach of Danger Ideation Reduction Therapy (DIRT) was developed and researched in Australia. There have been limited trials in other countries. Indeed, there are extremely few publications highlighting the use of DIRT outside Australia (Govender, Drummond and Menzies, 2006, Drummond and Kolb,). Methods All patients who had a contamination fears and who were inpatients at the time of the pilot study (5th May 2015 – 19 th May 2015) were asked to attend a series of 3 Psychoeducational Groups. The groups were weekly and covered the following topics: • Combined session of Statistics on contamination and HIV/AIDS • Immune system • Faeces and Vomitus These groups were prepared and delivered by the Ward-based junior doctor with the assistance of medical students attached to the Ward. All patients continued to receive appropriate psychopharmacological treatment as well as treatment involving Graded Exposure and self-imposed Response Prevention alongside those groups. At the end of the pilot patients were asked for their feedback. The qualitative data obtained from the patients were analyzed. Results Feedback from the participating patients revealed the following qualitative data: Provision of relevant, practical information on various health issues, relevant to people having OCD fears regarding possibility of catching various infection Provision of factual information was useful. It was an eye opener to know about the statistics and to realise how slim the chances of contamination are. Facts were provided in relation to the actual risks of acquiring various diseases rather than the risk/ fears in this regard or perceived by various OCD sufferers Understood about the digestive system, how it works, what faeces is made of (mainly water) Learnt that getting HIV off people is very rare. Acquired a good understanding about the natural defence mechanisms of the body. Discussion The study is small and is a pilot study. However it demonstrates that the Psychoeducational component of DIRT delivered in group format to a group of profound refractory OCD patients is generally well received and appreciated. Full studies need to continue to examine the efficacy of this approach. Summary The feedback of the pilot study has showed that it was well received and appreciated. Sample size being small and data being qualitative nature has been the two main limitations. A further study of a larger sample with more structured monitoring of progress in profound refractory OCD will be worth exploring.

The treatment of obsessive‐compulsive checking: A randomised trial comparing danger ideation reduction therapy with exposure and response prevention

Standard psychological treatment of obsessive‐compulsive disorder (OCD) typically involves the behavioural‐based therapy exposure and response prevention (ERP). This study compared the effectiveness of ERP with the recently developed cognitive therapy‐based treatment package, Danger Ideation Reduction Therapy for obsessive‐compulsive checkers (DIRT‐C) (Vaccaro, Jones, Menzies, and St Clare). Both treatments were delivered in 14 1‐hr individual weekly sessions. Post‐treatment intention‐to‐treat analysis revealed large statistically significant improvements for participants in both ERP (n = 22) and DIRT‐C (n = 28) conditions. However, treatment effect sizes for change in OCD symptom severity at post‐treatment were greater for DIRT‐C than for ERP (3.74 versus 2.89). In addition, at post‐treatment assessment, significantly more participants who received DIRT‐C were recovered compared with those who received ERP (43% versus 14%). Similarly, at 6‐month follow‐up, treatment effect sizes for change in OCD symptom severity were greater for DIRT‐C than for ERP (3.9 versus 2.76). This study provides further evidence of the usefulness of the DIRT‐C package for people with OCD checking subtype. Future research investigating DIRT‐C is warranted.

Danger Ideation Reduction Therapy for Obsessive–Compulsive Checking: Preliminary Findings

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.

DIRT—danger ideation reduction therapy for obsessive–compulsive washers: a comprehensive guide to treatment

AbstractDanger ideation reduction therapy (DIRT) for obsessive compulsive disorder (OCD) is a new intervention focusing on providing corrective information, and is the subject of a new comprehensive guide to treatment for compulsive washing. The components of DIRT are well presented in this manual‐based treatment and the documentation includes dialogues, filmed interviews with workers in dangerous occupations, and fact sheets to persuade the client to exchange beliefs about danger for beliefs about safety. The book is well organized and user friendly. Clinical trials have shown DIRT to be an effective treatment. Although DIRT as a stand alone therapy seems to offer some advantages over conventional CBT, it may function currently more as an adjunct to help cognitive restructuring. DIRT certainly encourages us to rethink some assumptions about the use of corrective information in treating OCD. Copyright © 2009 John Wiley & Sons, Ltd.Key Practitioner Message:• Danger ideation therapy is principally a cognitive approach.• Corrective information may help in the treatment of OCD for washing.• The application of DIRT in other types of OCD and symbolic contamination remains uncertain.

Obsessive–Compulsive Contamination Fears and Anorexia Nervosa: The Application of the New Psycho-Educational Treatment of Danger Ideation Reduction Therapy (DIRT)

AbstractThe case history of a woman with severe and enduring anorexia nervosa and obsessive–compulsive disorder (OCD) with contamination fears is presented. These contamination fears centred on her fear of contamination by fat and fatty substances as she worried about gaining weight. Previous treatment with graded exposure had shown no clinically significant benefits. She was admitted to a specialist unit for the treatment of OCD as an inpatient. Due to the previous failure of the recognised psychological treatments for OCD it was decided to use the new psychoeducational approach of danger ideation reduction therapy (DIRT). This treatment resulted in an improvement in her OCD symptoms despite the fact that the emphasis of the treatment was on the risk of bacteria and dirt. It is believed that this is the first documented case of DIRT being used for a patient with anorexia nervosa and OCD.

Danger Ideation Reduction Therapy for the Treatment of Severe, Chronic and Resistant Obsessive-Compulsive Disorder

We describe the first application of Danger Ideation Reduction Therapy (DIRT) in the UK. It is a novel approach developed in Australia, for treatment resistant obsessive compulsive disorder with contamination fears. The DIRT program was administered to an inpatient at Springfield Hospital, South London, with severe, treatment resistant obsessive compulsive disorder. Treatment consisted of weekly one hour therapy sessions for 14 weeks. A reduction in symptom severity measured on all scales undertaken was seen by the end of treatment. The Padua Inventory had shown an 85% reduction; Activity checklist an 86% reduction; Y-BOCS an overall 41% reduction and a 33% reduction on the Beck Depression Inventory. The DIRT approach has demonstrated an impressive and consistent improvement, maintained to 6 months post-treatment. More studies are needed to evaluate this treatment further.

The Superiority of Danger Ideation Reduction Therapy (DIRT) Over Exposure and Response Prevention (ERP) in Treating Compulsive Washing

AbstractThe present study involved the random allocation of 22 obsessive-compulsive (OC) washer/cleaners to one of two treatment conditions: Danger Ideation Reduction Therapy (DIRT), or Exposure and Response Prevention (ERP). Participants received 12 1-hour individual clinical sessions and were assessed at pretreatment, posttreatment and at a 6-month follow-up with a battery of 17 measures assessing core obsessive-compulsive disorder (OCD) symptomatology, depression, stress, general anxiety, disease expectancy and perceived responsibility. DIRT subjects experienced significantly greater before to after-treatment reductions in symptomatology on six outcome measures. On 10 of the remaining 11 measures, posttreatment mean scores were lower in the DIRT condition than in the ERP condition, though differences between groups failed to reach significance. Of note, on 3 of the 17 measures, DIRT subjects experienced significantly greater posttreatment to follow-up symptom reduction. Finally, and most importantly, symptom change (regardless of treatment condition) was shown to significantly correlate with change in threat or disease expectancy across the trial. No relationships were found between improvements in perceived responsibility and any of the dependent variables. The findings suggest that DIRT and ERP may be working by reducing specific beliefs in threat; the former treatment being more effective in producing such change than the latter.

Danger Ideation Reduction Therapy (DIRT) for Atypical Obsessive—Compulsive Disorder: A Case Study

AbstractThis paper describes the application of danger ideation reduction therapy (DIRT) to a case of atypical obsessive—compulsive disorder (OCD) with prominent magical ideation. Treatment consisted of eight weekly sessions. It was cognitive in nature, did not include any exposure or response prevention, and was aimed solely at reducing threat expectancy. The treatment components were adapted from the original DIRT package for compulsive washing, and comprised attentional focusing, corrective information, cognitive restructuring and the probability of catastrophe estimation task. At posttreatment, the subject demonstrated normal functioning on all assessment measures, and met Jacobson and Truax's criteria for ‘recovery’ on the MOCI, OCI-R, DASS depression scale and DASS stress scale. The findings provide preliminary support for the effectiveness of DIRT in individuals with atypical OCD symptoms characterised by magical ideation. Implications of these findings are discussed.

Danger Ideation Reduction Therapy (DIRT) for Intractable, Adolescent Compulsive Washing: A Case Study

AbstractThis paper describes the first trial of danger ideation reduction therapy (DIRT) in an adolescent patient with severe, treatment resistant obsessive-compulsive disorder (OCD). This case study also represents the first published data on DIRT for any individual outside the Anxiety Disorders Clinic at the University of Sydney, where the treatment package was originally developed. KP was a 16-year-old girl with a 4-year history of obsessive-compulsive disorder. She was primarily concerned with contamination and presented with associated washing and avoidance behaviour. KP met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994) criteria for OCD, oppositional defiant disorder and major depressive disorder. She had also had previous diagnoses of attention-deficit/hyperactivity disorder and motor tics. KP had received considerable treatment for OCD prior to the current trial, including 12 months of outpatient treatment at the local community health centre, a 4-week inpatient admission to a private hospital in Sydney and a 16 week inpatient admission to Rivendell Adolescent Unit in Sydney. All previous treatments involved a combination of pharmacotherapy (clomipramine [up to 125mg[, sertraline [up to the 200mg], fluvoxamine [up to 200 mg], risperidone [up to 2.5 mg] and chlorpromazine [25-50 mg prn]), and attempts to administer exposure-based treatment. KP had failed to benefit from all previous treatment attempts. However, following 16 sessions of DIRT, KP experienced substantial improvement, approximating symptom-free status on all measures. Importantly, these improvements were maintained at 12-month follow-up. The DIRT package was also effective in reducing depression and anxiety scores on self-report measures over the follow-up period. There were no substantial differences between posttreatment and 12-month follow-up scores on any of the measures given.

Treating obsessive compulsive disorder: a new role for infectious diseases physicians?

Background: Patients with psychiatric disorders are often seen by infectious disease physicians. Sometimes the psychiatric condition is the primary disorder, and the physician's main task is the early identification of the disorder and referral to specialist psychiatric services. On other occasions, the psychiatric condition will need to be addressed in addition to the infectious disease, and the physician aims to treat in conjunction with a psychiatrist. It is rare for referrals to be made from psychiatry to infectious diseases physicians. Method: A single case study is used to describe a modification of Danger Ideation Reduction Therapy (DIRT), a novel intervention for obsessive compulsive disorder (OCD). In our modification the infectious diseases physician plays a key, collaborative role in the psychological treatment of the patient. Results: Although an uncontrolled trial, results from the modified DIRT protocol are encouraging and warrant replication in a randomised controlled trial. Conclusions: A collaborative approach by the infectious diseases physician, the microbiology laboratory and the psychologist can provide a valuable means of retaining patients with OCD in treatment and in the management of this common, disabling condition.

Danger Ideation Reduction Therapy (DIRT) for treatment-resistant compulsive washing

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.

Danger ideation reduction therapy (DIRT) for obsessive–compulsive washers. A controlled trial

Twenty-one OCD sufferers with washing/contamination concerns took part in a controlled treatment trial at the Anxiety Disorders Clinic, University of Sydney. Eleven of the subjects received danger ideation reduction therapy (DIRT) over eight, 1 h weekly group sessions conducted by the second author. Ten subjects were placed on a wait list and did not receive DIRT or any other treatment. DIRT procedures were solely directed at decreasing danger-related expectancies concerning contamination and did not include exposure, response prevention or behavioural experiments. Components of DIRT include attentional focusing, filmed interviews, corrective information, cognitive restructuring, expert testimony, microbiological experiments and a probability of catastrophe assessment task. All subjects were assessed at pre-treatment, post-treatment and three-month follow-up using the Maudsley Obsessional–Compulsive Inventory, Leyton Obsessionality Inventory, Beck Depression Inventory and a Self Rating of Severity Scale. Changes from pre-treatment to after treatment (post-treatment and follow-up scores averaged) were significantly greater in the DIRT condition than in the control condition for all measures. No significant differences were obtained between groups on post-treatment to follow-up change on any measure. The implications of these findings for theoretical models of OCD and its management are discussed.

Danger Ideation Reduction Therapy (DIRT): preliminary findings with three obsessive-compulsive washers

Three obsessive-compulsive patients received Danger Ideation Reduction Therapy (DIRT) in an initial treatment trial. All three subjects presented with contamination/washing concerns but refused to participate in exposure and response prevention. DIRT is solely directed at decreasing danger-related expectancies concerning contamination. DIRT procedures do not attempt to address inflated personal responsibility. In addition, DIRT does not involve direct or filmed exposure to contamination-related stimuli, or behavioural experiments. Components of DIRT include corrective information cognitive restructuring, filmed interviews, microbiological experiments, attentional focusing and Hoekstra's (1989) probability of catastrophe estimation task. Treatment consisted of between six and ten 1-hr weekly sessions. At post-treatment, substantial reductions in scores on the Padua Inventory, Maudsley Obsessional-Compulsive Inventory and two global rating scales were apparent for all subjects. These improvements were maintained at a 3-month follow-up. The theoretical and clinical implications of these preliminary findings are discussed.