Efficacy and mediators of a group cognitive–behavioral therapy for hoarding disorder: A randomized trial.

Abstract

Objective: Hoarding disorder (HD) is a common and potentially debilitating psychiatric disorder. Thus far, psychological treatments have yielded modest effects and/or were time-consuming and costly to deliver. The aim of the present study was to test the efficacy of a brief group cognitive-behavioral therapy (CBT) for adults with HD and to test hypothesized mediators of treatment outcome. Method: Eighty-seven adults with a primary diagnosis of HD were randomized to either immediate CBT or wait list. CBT consisted of 16 weekly, 90-min group sessions that emphasized in-session practice of discarding and refraining from acquiring, decision-making and problem-solving training, emotional distress tolerance, motivational interviewing strategies, and contingency management. Participants were assessed at pretreatment, midtreatment, and posttreatment by an independent evaluator unaware of treatment condition. Results: CBT was efficacious for the symptoms of HD compared with wait list. Saving-related cognitions, but not subjective cognitive impairment, partially mediated treatment outcomes. Conclusion: Brief Group CBT is an efficacious and feasible treatment for adults with HD, and is partially mediated by reductions in maladaptive beliefs about possessions. Superiority trials comparing CBT to active treatments, and additional research into mechanisms of treatment outcome, are warranted. What is the public health significance of this article?Hoarding disorder (HD) is a common and often severe psychiatric illness. As a new diagnosis, it has received less research attention than many other disorders. Treatment efficacy for HD also lags behind that of many other psychiatric disorders. This study suggests that a relatively brief (16session) Group CBT is efficacious for adults with HD, with 83% of patients classified as improved. These results support the consideration of Group CBT as a first-line treatment for HD.

Hoarding to the heart’s content: a case series and detailed case report of hoarding treatment in heart failure

“…Across the three cases, one patient declined treatment, while the other two experienced modest improvements in HD symptoms. This finding is consistent with the wider literature where dropout rates can range from 13% [21] to 30% [22], and even after best-practice CBT treatment many patients with HD remain symptomatic despite reducing their symptoms significantly [8]. Reflecting this, multiple new directions for research are being investigated to enhance the efficacy of CBT for HD including adding a contingency management approach to treatment [23] and between-session internet-based clinician support [24] and such strategies may enhance outcomes in patients who have HD and comorbid HF or other cardiovascular diseases.…”

Predictors of treatment outcome and attrition in adults with hoarding disorder

“…More recently, Levy et al (2017) found that changes in maladaptive saving cognitions mediated symptom improvement in CBT for HD. This finding was partially replicated in a study of mediators of treatment response in group CBT for HD (Tolin et al, 2019).…”

“…Integrating an intervention that targets increasing readiness for change, such as motivational interviewing (MI), with HD treatment might result in improved treatment response and should be explored in further research with HD. MI augmented behavior therapy has already been implemented with children and adults with OCD (Merlo et al, 2010;Simpson, Zuckoff, Page, Franklin & Foa, 2008) as well as in one trial with HD individuals (Tolin et al, 2019).…”

A clinician's quick guide to evidence‐based approaches: Hoarding disorder

“…CBT for hoarding disorder: A group therapy program therapist's guide. Wiley.—This group‐based manual was effective in a recent RCT (Tolin et al, submitted for publication).…”