Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder

Abstract

Objective This study investigated a multi-component cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). Method Participants with clinically significant hoarding were recruited from the community and a university-based anxiety clinic. Of 46 patients randomly assigned to CBT or WL, 40 completed the 12-week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to non-acquiring and discarding, and cognitive therapy. Measures included the Saving Inventory-Revised (self-report), Hoarding Rating Scale-Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling (GLM) examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre-post effects for all CBT participants combined after 26 sessions. Results After 12 weeks, CBT participants benefitted significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 68% of patients were considered improved on therapist clinical global improvement ratings, and 76% of patients rated themselves as improved; 41% of completers were clinically significantly improved. Conclusions Multi-component CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern and further research with independent assessors is needed to establish treatment benefits and durability of gains.

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

“…In five trials [33][34][35][36][37], a reliable change index [38] was used to identify whether a proportion of participants had deteriorated. Six trials [39][40][41][42][43][44] used the clinical global impression of improvement (CGI-I) [45], which is a clinician-administered scale ranging from 1 (very much improved) to 7 (very much worse). However, only three of these reports included information about the proportion of participants that deteriorated [39,40,44].…”

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.…”

“…Unfortunately, attrition rates for many treatment outcome studies are not available (e.g., Saxena, Brody, Maidment, & Baxter, 2007;Muroff et al, 2009). Reasons for early termination reported in these studies included poor homework compliance (Steketee, Frost, Wincze, Greene, & Douglass, 2000;Tolin, Steketee, & Frost, 2007), frequent cancellations and scheduling conflicts (Tolin, Steketee, & Frost, 2007;Steketee, Frost, Tolin, Rasmussen, & Brown, 2010), transportation difficulties (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010), and dissatisfaction with progress or treatment (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.…”

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).…”