An open trial of cognitive-behavioral therapy for compulsive hoarding

Abstract

The aim of the present study was to provide preliminary data on the efficacy of a new cognitivebehavioral treatment (CBT) for compulsive hoarding. Fourteen adults with compulsive hoarding (10 treatment completers) were seen in two specialty CBT clinics. Participants were included if they met research criteria for compulsive hoarding according to a semistructured interview, were age 18 or above, considered hoarding their main psychiatric problem, and were not receiving mental health treatment. Patients received 26 individual sessions of CBT, including frequent home visits, over a 7-12 month period between December 2003-February 2005. Primary outcome measures were the Saving Inventory-Revised (SI-R), Clutter Image Rating (CIR), and Clinician's Global Impression (CGI). Significant decreases from pre-to post-treatment were noted on the SI-R and CIR, but not the CGI-severity rating. CGI-Improvement ratings indicated that at mid-treatment, 40% (n = 4) of treatment completers were rated "much improved" or "very much improved;" at post-treatment, 50% (n = 5) received this rating. Adherence to homework assignments was strongly related to symptom improvement. CBT with specialized components to address problems with motivation, organizing, acquiring and removing clutter appears to be a promising intervention for compulsive hoarding, a condition traditionally thought to be resistant to treatment.

Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder

“…In a group treatment for compulsive hoarding, Steketee and colleagues (2000) reported an attrition rate of 14.3% after 15 sessions (N = 7); 50% of the participants who completed the group treatment also completed 14 sessions of individual treatment. Tolin and colleagues (2007) (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010;Tolin, Steketee, & Frost, 2007). Although the attrition rates reported above are not higher than those seen in other geriatric treatment studies for anxiety (e.g., Stanley et al, 2009;Wetherell & Gatz, 2001) and depression (Serfaty et al, 2009), we believe that increased use of informal therapeutic techniques, such as motivational interviewing and problem solving, can increase the retention of geriatric participants in treatment studies for HD.…”

“…Treatment studies utilizing midlife samples reveal inconsistent attendance (Tolin, Steketee, & Frost, 2007), early termination (MataixCols, Marks, Greist, Kobak, & Baer, 2002), and poor compliance (Christensen & Greist, 2001) as potential factors contributing to decreased rates of treatment success. While research on the development of effective treatments is ongoing, there have been reports of several possible sources of interference with treatment completion, such as decreased motivation (Tolin, Steketee, & Frost, 2007), limited insight and resistance to change (Kim, Steketee, & Frost, 2001), and the sense that the hoarding symptoms are normal behavior (Christensen & Greist, 2001). …”

Effectiveness of cognitive-behaviour therapy for hoarding disorder in people with mild intellectual disabilities

“…Group CBT for hoarding improvement rates range from 10-21% (Muroff et al, 2010;Steketee et al, 2000), whilst individual CBT improvement rates range from 14-28% (Ayers et al, 2011;Steketee et al, 2010;Tolin et al, 2007). This calls into question why this is the case?…”

“…Therapy based upon the CBT model has been manualised . Uncontrolled (Tolin, Frost & Steketee, 2007) and controlled (Steketee, Frost, Tolin, Rasmussen & Brown, 2010) outcome studies do evidence empirical support for the model. However, when the CBT model has been tested in more varied clinical samples (such as in a geriatric hoarding), evidence indicates attenuated outcomes (Ayers et al, 2011), without necessary population specific alterations (Ayers et al, 2014).…”

“…Goals were set by the participants during the treatment-planning module and were typically based on their need to free up space in their property. The home delivery of treatment allowed for the careful monitoring and assistance of in-session change methods and homework compliance, which has previously been seen to be related to treatment outcome in hoarding (Tolin et al, 2007). Where participants could make use of key-workers as co-therapists, these were included where indicated and were involved in assisting treatment from …”