Danger Ideation Reduction Therapy (DIRT) for Obsessive Compulsive

[LuvSun]

Hi everyone! Have any of you heard of DIRT- Danger Ideation Reduction Therapy? I came across it recently while reading and it sounds interesting. I have suffered with OCD for over 30+ years. I know ERP is the mainstream therapy but I have had a hard time wanting to really seriously practice that. My main obsessions are with contamination and this DIRT therapy supposedly can be effective for contamination fears dealing with disgust fears. Not too much is mentioned about it so I wanted to throw it out to all my fellow OCD ers on here. I really appreciate all the great posts and responses from this group. This group has really helped me a lot with my OCD struggles- kind of a kinship if you will😊

[deValentin]

DIRT is recommended for people who find ERP too difficult. It presents factual information to the client and is meant to appeal to their common sense. It’s great to help people with OCD gain more insights, if they don’t see a problem with their condition. However, if the logical part of their mind knows that their compulsions don’t make sense, but they do them anyway because they can’t help themselves, then it’s not very helpful. DIRT is supposed to decrease your threat expectancy, but if you already know that your response is disproportionate to the actual threat, what’s the point of that type of therapy?

There is more than one way to make ERP palatable. Let’s take the example of contamination OCD. People who suffer from it depend on a zero-risk environment to have their mind at peace. They may wonder, what’s the big deal if that lowers their anxiety? It’s no big deal as long as they can take three-hour showers and spend half a day cleaning their apartment without adverse consequences. However, in the real world, this type of behavior has adverse consequences in the long-term. It interferes with normal living. You harm your skin, you may not be able to hold a regular job, you strain the relationship with others who live with you, etc. And, if shops run out of hand sanitizers, like it happened in 2020, you get in a state of panic because you’re so dependent on it for your mental well-being.

So, why not learn to rely less and less on a zero-risk environment to feel comfortable and more and more on a reasonably safe environment? You go at your own pace, so your anxiety won’t hit the roof. After a while, you realize you regain some psychological flexibility: you can give up a behavior that doesn’t make sense. That renewed freedom makes the efforts worthwhile, and motivates to keep practicing ERP. It's at least my experience, even if my OCD theme was different.

[LuvSun in reply to deValentin]

Thank you for your insightful reply. I really appreciate it.

[Sallyskins in reply to deValentin]

Absolutely agree. Little steps make a big difference. And then you're on the way to relinquishing the compulsions.

I've often made the analogy with when I had an injured shoulder. So painful, and ached from neck to wrist - I couldn't sleep. I kept it immobile for fear of injuring it further, but couldn't get a doctor's appointment for 2 weeks, then another 8 weeks for the physio. I phoned the physio and asked if there was anything I could do meanwhile. They told me to stretch it! Like ERP, extremely painful, but almost immediately after the pain was lessened, and I had more movement! And that enabled more stretching!

The freedom you get from a little ERP is worth the effort - and it enables you to do more ERP. But go at your own pace - pushing beyond what you're ready for isn't good.

[deValentin in reply to Sallyskins]

Excellent analogy!

[Natureloverpeace]

Richard Gallagher is an OCD specialist who has developed a method called the Mastery Approach to treat disgust based OCD. He has found through his own experience of working with clients and talking with other OCD specialists that people with disgust based OCD don’t respond to ERP at the rate that other people do. Fear feelings are based in the amygdala and disgust is based in the insula. The Mastery Approach borrows heavily from ACT ( Acceptance Commitment Therapy). He is quick to point out that this method is from his own conclusions and from his opinions after reviewing literature on it. He says more research is needed on this. I think he gave a presentation last year at the big annual virtual IOCDF conference last year. He’s also written a couple of articles on it.

[LuvSun in reply to Natureloverpeace]

Thank you for your response. Yes I did read Richard Gallagher’s Workbook on his Mastery Approach. I found it very interesting and it really resonated with me. In fact through his writing is where I came across the DIRT Therapy- it was mentioned in his book.

[Sallyskins in reply to Natureloverpeace]

That's interesting. I already knew the amygdala is involved in OCD, but not that other parts of the brain are.

The book by Joseph LeDoux, The Emotional Brain, is worth reading. It's based on his own research but is aimed at the general reading public, so not too technical.

[Natureloverpeace in reply to Sallyskins]

Thanks, I haven’t heard of him so now I’m curious. OCD researchers are investigating the neural circuits and networks involved in OCD. Chris Pittenger, M.D., Ph.D. has been involved in quite a few of these studies and he’s written some interesting articles on the topic as well.

[Sallyskins in reply to Natureloverpeace]

I'm making a note of his name and will follow up!