“…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). A recent meta-analysis of HD with the CBT treatment model (Tolin, Frost, Steketee & Muroff, 2015) found large effect sizes for symptom severity reductions, rates of clinically significant change were lower (24-43%).…”