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

Abstract

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.

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

“…Further, they reported a stable and improved outcome for the DIRT group compared with the ERP group in which a slight increase in OC symptoms for the ERP group was observed in the post‐treatment to follow‐up period. The current findings also confirm the preliminary results from the first three DIRT‐C cases of the present trial (Vaccaro et al., 2010b) that demonstrated DIRT‐C to be an effective treatment for obsessive compulsive checking.…”

“…A preliminary investigation of this treatment was conducted with three adult OCD checkers receiving 12–14 individual sessions. Substantial and clinically significant reductions in OCD symptom severity were apparent for all three participants at the end of the treatment period, and further clinical improvements were identified at the 4‐month follow‐up assessment (Vaccaro et al., 2010b). These preliminary findings suggest that DIRT for Obsessive‐Compulsive Checkers (DIRT‐C) may be an important addition to the OCD treatment landscape.…”

“…The first three participants randomised to DIRT‐C were described, and their outcomes were analysed in the preliminary study conducted by Vaccaro et al. (2010b). The study protocols and treatments were unchanged after this early examination; thus, their data were included in the final sample.…”

“…The most frequently used treatments for OCD are serotonin reuptake inhibitors (SRIs), and exposure and response prevention (ERP). However, limitations have been recognised for both these approaches (Vaccaro, Jones, Menzies, & Wootton, 2010b). As noted by Dougherty, Rauch, and Jenike (), OCD symptom reductions identified for SRIs are usually between 25% and 50%.…”

“…Based on the previous findings by Vaccaro et al. (2010b), it is hypothesised that participants in both the DIRT‐C condition and ERP conditions will experience significant reductions in their OCD symptoms from pretreatment to post‐treatment and pretreatment to follow‐up. However, given that treatments developed specifically for different forms of OCD presentation have been found to be useful (Freeston et al., ; Jones & Menzies, , ; Krochmalik et al., ; Wilhelm et al., ), we predict that the efficacy (effect size (ES)) for DIRT‐C will be significantly greater than the efficacy (ES) for ERP.…”