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The Efficacy of Danger Ideation Reduction Therapy for an 86-Year Old Man with a 63-Year History of Obsessive-Compulsive Disorder: A Case Study
Abstract:While OCD is one of the most commonly occurring psychiatric conditions experienced by older adults, there is a paucity of research conducted into the treatment of older adults with OCD. This case study represents the first published investigation of a cognitive treatment for geriatric OCD. It describes the successful treatment of an 86-year old man with a 63-year history of OCD using Danger Ideation Reduction Therapy (DIRT). The client received 14 individual, 50-minute treatment sessions of DIRT over 13 weeks. Clinician-based Y-BOCS scores reduced 84% from 25 (severe) at pre-treatment, to 4 (subclinical) at 6-month post-treatment follow-up interview, demonstrating the efficacy of DIRT for this client. DIRT may have particular advantages over ERP and pharmacological approaches, however further research is required in older adults with OCD.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1061380Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1575
 Australian Bureau of Statistics, Australian Social Trends: Future population growth and ageing, Cat. no. 4102.0. Canberra: Author, 2009.
 C. Mathers, T. Vos, and C. Stevenson, The burden of disease and injury in Australia. Canberra: Australian Institute of Health and Welfare, 1999.
 J. L. Eisen, M. A. Mancebo, A. Pinto, M. E. Coles, M. E. Pagano, R. Stout, et al., "Impact of obsessive-compulsive disorder on quality of life," Comprehensive Psychiatry, vol. 47, no. 4, pp. 270-275, 2006.
 K. C. Burke, J. D. Burke, D. A. Regier, and D. S. Rae, "Age at onset of selected mental disorders in five community populations," Arch. Gen. Psychiatry, vol. 47, pp. 511-518, 1990.
 S. A. Rasmussen and J. L. Eisen, "The epidemiology and clinical features of obsessive-compulsive disorder," Psychiatric Clin. North Am., vol. 15, pp. 743-759, 1992.
 A. P. Weiss and M. A. Jenike, "Late-onset obsessive-compulsive disorder: A case series," J. Neuropsych. Clin. Neurosci., vol. 12, no. 2, pp. 265-268, 2000.
 J. E. Calamari and K. L. Cassiday, "Treating obsessive-compulsive disorder in older adults: A review of strategies", in Handbook of counseling and psychotherapy with older adults, M. Duffy, Ed. New York: Wiley, 1999, pp. 526-538.
 M. A. Jenike, "Geriatric obsessive-compulsive disorder," Geriatr. Psychiatry Neuro., vol. 4, pp. 34-39, 1991.
 S. Grenier, M. Préville, R. Boyer, and K. O-Conner, "Prevalence and correlates of obsessive compulsive disorder among older adults living in the community," J. Anxiety Disord., vol. 23, pp. 858-865, 2009.
 M. A. Jenike, "Obsessive-compulsive disorders in the elderly," in Geriatric psychiatry and Psychopharmacology: A clinical approach, M. A. Jenike, Ed. Chicago: Year Book Medical Publishing, 1989, pp. 339-362.
 M. C. Price and N. L. Salsman, "Exposure and response prevention for the treatment of late-onset obsessive-compulsive disorder in an 82-yearold man," Clin. Case Studies, vol. 9, no. 6, pp. 426-441, 2010.
 A. J. Flint, "Epidemiology and comorbidity of anxiety disorders in the elderly," Am. J. Psychiatry, vol. 151, pp. 640-649, 1994.
 R. Crino, T. Slade, and G. Andrews, "The changing prevalence and severity of obsessive compulsive criteria from DSM-III to DSM-IV," Am. J. Psychiatry, vol. 162, no. 5, pp. 876-882, 2005.
 H. J. Watson and C. S. Rees, "Meta-analysis of randomized, controlled treatment trials for pediatric obsessive-compulsive disorder," J.Child Psychol.Psychiatry Allied Disciplines, 49(5), 489-498. 2008
 I. Gava, C. Barbui, E. Aguglia, D. Carlino, R. Churchill, M. De Vanna, and H. F. McGuire, "Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)," Cochrane Database of Syst. Rev., Issue 2, Art. No.: CD005333, April 2007, DOI: 10.1002/14651858.CD005333.pub2.
 J. Cottraux, I. Note, S. N. Yao, S. Lafont, B. Note, E. Mollard, et al., "A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder," Psychother. Psychosom., vol. 70, no. 6, pp. 288-297, 2001.
 E. Nakatani, A. Nakagawa, T. Nakao, C. Yoshizato, M. Nabeyama, A. Kudo, et al., "A randomized controlled trial of Japanese patients with obsessive-compulsive disorder - Effectiveness of behavior therapy and fluvoxamine," Psychother. Psychosom., vol. 74, no. 5, pp. 269-276, 2005.
 M. L. Whittal, D. S. Thordarson, P. D. McLean, "Treatment of obsessive-compulsive disorder: Cognitive behaviour therapy vs. exposure and response prevention," Behav. Res. Ther., vol, 43, pp. 1559-1576, 2005.
 C. R. Ayers, J. T. Sorrell, S. R. Thorp, and J. L. Wetherell, "Evidencebased psychological treatments for late-life anxiety," Psychol. Aging, vol. 22, pp. 8-17, 2007.
 C. N. Carmin and P. S. Wiegartz, "Successful and unsuccessful treatment of obsessive-compulsive disorder in older adults," J. Contemporary Psychother., vol. 30, no. 2, pp. 181-193, 2000.
 J.E. Calamari, N.K. Pontarelli, K.M. Armstrong, and S.A. Salstrom, "Obsessive-Compulsive Disorder in Late Life," Cogn. Behav. Practice, to be published, doi:10.1016/j.cbpra.2010.10.004
 C. Krasucki, R. Howard, and A. Mann, "Anxiety and its treatment in the elderly," Int. Psychogeriatrics, vol. 11, no. 1, pp. 25-45, 1999.
 C. N. Carmin, C. A. Pollard, and R. L. Ownby, "Obsessive Compulsive Disorder: Cognitive behavioral treatment of older versus younger adults," Clin. Gerontologist, vol. 19, no. 2, pp. 77-81, 1998.
 L. Velayudhan and A. W. Katz, Late-onset obsessive-compulsive disorder: the role of stressful life events. Int. Psychogeriatrics, vol. 18, pp. 341-344, 2006.
 M. K. Keeley, E.A. Storch, L.J. Merlo, and G.R. Geffken, "Clinical predictors of response to cognitive-behavioural therapy for obsessive- compulsive disorder," Clin. Psychol. Rev., vol. 28, pp. 118-130, 2008.
 M. E. Franklin, J. S. Abramowitz, M. J. Kozak, J. T. Levitt, and E. B. Foa, "Effectiveness of exposure and ritual prevention for obsessive- compulsive disorder: Randomized compared with nonrandomized samples," J. Consult. Clin. Psychol., vol. 68, pp. 594−602, 2000.
 A. Hirsch, K. O-Brien, G. R. Geffken, J. Adkins, W. K. Goodman, and E. A. Storch, "Cognitive-behavioral treatment for obsessive-compulsive disorder in an elderly male with concurrent medical complaints," Am.J. Geriatr. Psychiatry, vol. 14, no. 4, pp. 380-381, 2006.
 E. B. Foa, M. L. Liebowitz, M. J. Kozak, S. Davies, R. Campeas, M. E. Franklin, et al., "Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder," Am. J. Psychiatry, vol. 162, pp. 151-161, 2005.
 G. P. J. Keijsers, C. A. L. Hoogduin, and C. P. D. R. Schaap, "Predictors of treatment outcome in the behavioural treatment of obsessive-compulsive disorder," Br. J. Psychiatry, vol. 152, pp. 781- 786, 1994.
 M. K. Jones and R. G. Menzies, "Danger Ideation Reduction Therapy (DIRT): preliminary findings with three obsessive-compulsive washers," Behav. Res. Ther., vol, 35, pp. 955-960, 1997.
 T. St Clare, R. G. Menzies, and M. K. Jones, Danger Ideation Reduction (DIRT) for obsessive-compulsive washers: A comprehensive guide to treatment. Bowen Hills QLD: Australian Academic Press, 2008.
 M. K. Jones and R. G. Menzies, "Danger Ideation Reduction Therapy (DIRT) for obsessive-compulsive washers. A controlled trial," Behav. Res. Ther., vol, 36, pp. 959-970, 1998.
 A. Krochmalik, M. K. Jones, R. G. Menzies, and K. Kirkby, "The Superiority of Danger Ideation Reduction Therapy (DIRT) over Exposure and Response Prevention (ERP) in Treating Compulsive Washing," Behav. Change, vol. 21, pp. 251-268, 2004.
 A. Krochmalik, M. K. Jones, and R. G. Menzies, "Danger Ideation Reduction Therapy (DIRT) for treatment-resistant compulsive washing," Behav. Res. Ther., vol, 39, pp. 897-912, 2001.
 L. M. Drummond, A. Pillay, P. Kolb, and S. Rani, "Specialised inpatient treatment for severe, chronic, resistant obsessive-compulsive disorder," Psychiatric Bulletin, vol. 31, pp. 49-52, 2007.
 L. M. Drummond and P. Kolb, "Obsessive-compulsive contamination fears and Anorexia Nervosa: the application of the new psychoeducational treatment of Danger Ideation Reduction Therapy (DIRT)," Behav. Change, vol. 25, pp. 44-50, 2008.
 S. Govender, L. M. Drummond and R. G. Menzies, "Danger Ideation Reduction Therapy for the treatment of severe, chronic and resistant Obsessive-Compulsive Disorder," Behav. Cogn. Psychother., vol. 34, pp. 477-480, 2006.
 J. Hambridge and M. Loewenthal, "Treating Obsessive Compulsive Disorder: a new role for infectious diseases physicians?" Int. J. Infectious Diseases, vol. 7, pp. 152-155, 2003.
 M. O-Brien, M. K. Jones and R. G. Menzies, "Danger Ideation Reduction Therapy (DIRT) for intractable, adolescent compulsive washing: a case study," Behav. Change, vol. 21, pp. 57-65, 2004.
 T. St Clare, "Danger Ideation Reduction Therapy (DIRT) for atypical Obsessive-Compulsive Disorder: a case study," Behaviour Change, vol. 21, pp. 186-196, 2004.
 L. D. Vaccaro, M. K. Jones, R. G. Menzies, and T. St. Clare, Danger Ideation Reduction Therapy for Obsessive- Compulsive Checkers: A Comprehensive Guide to Treatment, Bowen Hills, QLD: Australian Academic Press, 2010.
 L. D. Vaccaro, M. K. Jones, R. G. Menzies, and B.M. Wootton, "Danger Ideation Reduction Therapy for obsessive-compulsive checking: preliminary findings," Cogn. Behav.Therapy, vol. 39, no. 4, pp. 293-301, 2010.
 American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 4th ed., text revised, Washington, DC: Author, 2000.
 World Health Organisation, Composite International Diagnostic Inventory, Core, Version 2.1, Geneva: Author, 1997.
 W. K. Goodman, L. H. Price, S. A. Rasmussen, C. Mazure, R. L. Fleischmann, C. L. Hill, et al., "The Yale-Brown obsessive-compulsive scale: Part 1 development, use and reliability," Arch. Gen. Psychiatry, vol. 46, pp. 1006-1011, 1989.
 W. K. Goodman, L. H. Price, S. A. Rasmussen, C. Mazure, P. Delgado, G. R. Heninger, et al., "The Yale-Brown obsessive-compulsive scale: Part 2. Validity," Arch. Gen. Psychiatry, vol. 46, pp. 1012-1016, 1989.
 S. Pallanti, E. Hollander, C. Bienstock, L. Koran, J. F. Leckman, D. Marazziti, et al., "Treatment non-response in OCD: methodological issues and operational definitions," Int. J. Neuropsychopharmacol., vol. 5, pp. 181-191, 2002.
 E. B. Foa, J. D. Huppert, S. Leiberg, R. Langner, R. Kichic, G. Hajcak, et al., "The obsessive-compulsive inventory: development and validation of a short version," Psychological Assessment, vol. 14, pp. 485-495, 2002.
 E. B. Foa, M. J. Kozak, P. M. Salkovskis, M. E. Coles, and N. Amir, "The validation of a new obsessive-compulsive disorder scale: The Obsessive Compulsive Inventory," Psychological Assessment, vol. 10, pp. 206-214, 1998.
 A. T. Beck, R. A. Steer, and G. K. Brown, Beck Depression Inventory - Second Edition manual, San Antonio, TX: The Psychological Corporation, 1996.
 A. T. Beck, R. A. Steer, R. Ball, and W. F. Ranieri, "Comparison of the Beck Depression Inventories-IA and -II in psychiatric outpatients," J. Personality Assessment, vol. 67, pp. 588-797, 1996.
 M. A. Whisman, J. E. Perez, and W. Ramel, "Factor Structure of the Beck Depression Inventory - Second Edition (BDI-II) in a Student Sample," J. Clin. Psychology, vol. 56, pp. 545-551, 2000.
 J. C. Clarke and W. Wardman, Agoraphobia. A personal and clinical account, Pergamon: Sydney, 1985.
 M. R. Goldfried and A. P. Goldfried, "Cognitive change methods," in Helping people to change, 2nd ed., F. H. Kanfer and A. P. Goldfried Eds. New York: Pergamon, 1980.
 A. Ellis, Reason and emotion psychotherapy, New York: Stuart, 1962.
 R. P. Mattick, L. Peters and J. C. Clarke, "Exposure and cognitive restructuring for social phobia: A controlled study," Behav. Ther., vol. 20, pp. 3-23, 1989.
 R. G. Menzies and J. C. Clarke, "Individual response patterns, treatment matching and the effects of behavioural and cognitive interventions for acrophobia," Anxiety Stress Coping, vol. 8, pp. 141-160. 1995.
 A. S. Radomsky, P. T. Gilchrist and D. Dussault, "Repeated checking really does cause memory distrust," Behav. Res. Ther, vol. 44, pp. 305- 316, 2006.
 M. Van den Hout and M. Kindt, "Repeated checking causes memory distrust," Behav. Res. Ther, vol. 41, pp. 301-316, 2003.
 R. Hoekstra, "Treatment of obsessive-compulsive disorder with rationalemotive therapy," paper presented at the First World Congress of Cognitive Therapy, Oxford, 28 June-2 July, 1989. G. R. Faulhaber, "Design of service systems with priority reservation," in Conf. Rec. 1995 IEEE Int. Conf. Communications, pp. 3-8.