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

Five intractable cases of obsessive-compulsive disorder were treated with t he Danger Ideation Reduction Therapy (DIRT) program. All five cases: (1) ha d 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 wi th serotonergic agents; (3) failed to respond to at least 15 sessions of ex posure and response prevention at the beginning of the present trial, and; (4) satisfied the DSM-IV criteria for OCD with Poor Insight. DIRT was condu cted in 14, weekly, individual sessions or until, in the judgement of the t reating clinician: (1) clinically significant gains were apparent with mini mal symptomatology remaining, and (2) clients displayed a sound grasp of th e cognitive model underpinning DIRT procedures. At post-treatment, substant ial 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 imp rovements 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 MO CI and the PI by this assessment stage. While one subject remained non-resp onsive, the present findings suggest that DIRT may be a viable option for t reatment-resistant cases of compulsive washing. The theoretical implication s of the findings are discussed. 2001 Elsevier Science Ltd. (C) All rights reserved.