A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes?

Abstract

Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive-compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive-compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities.

Are hoarding disorder and buying-shopping disorder behavioural addictions? A conceptual review.

“…The purpose of the present article is to summarize the theoretical and empirical evidence for conceptualizing hoarding disorder (HD) and compulsive buying-shopping disorder (BSD) as behavioral addictions. The impetus for this evaluation is to provide avenues for treatment advances because current BSD and HD treatments help fewer than one-third of individuals achieve clinically meaningful change (David, Crone, et al, 2021; Mueller et al, 2008). Thus, we conclude this review by providing recommendations for treatment.…”

Preliminary investigation of objective and subjective experiences of relatives of individuals with hoarding behaviors

“…Individuals with relatives with HD may be more motivated to focus on immediate harm reduction than helping the relative receive long‐term psychological treatment. Evidence‐based treatment for hoarding is lengthy and does not always result in clinically meaningful reductions in symptoms (David et al, 2022). Thus, more acute solutions, such as clean‐outs, may be more immediately appealing to individuals who are worried about a relative with HD.…”

‘A more human approach … I haven’t found that really’: experiences of hoarding difficulties and seeking help

“…Miller and Rollnick (2012) suggest strategies such as 'agenda mapping' (similar to agenda-setting in CBT) to manage this. David et al (2022) proposed incorporating concepts from approaches such as emotional regulation, mentalisation and attachment within CBT and these ideas seem likely to help given the current participants' experiences of interventions. Participants all spoke of the value of nonjudgemental relationships, therefore professionals should strive to create a compassionate bond, which focuses on understanding the problem.…”