Pilot Trial of Cognitive and Behavioral Treatment of Compulsive Hoarding Compared to Wait List Control

Pilot Trial of Cognitive and Behavioral Treatment of Compulsive Hoarding Compared to Wait List Control

This study developed and tested a specialized cognitive and behavioral treatment for the symptoms of hoarding disorder, including excessive acquiring, difficulty discarding items, and extensive clutter in the home.

Compulsive hoarding is characterized by excessive acquisition of possessions, difficulty discarding possessions, and excessive clutter. This condition is resistant to standard pharmacological and psychotherapeutic interventions that have proven effective in treating other obsessive compulsive spectrum disorders. This study aimed to determine the effectiveness of a specialized cognitive behavioral therapy (CBT) designed for treating hoarding symptoms. This study consists of three phases. In Phase 1, pilot data from previous studies were examined to develop an intervention suitable for use in a waitlist trial. In Phase 2, pilot study information were used to develop and test a treatment manual for compulsive hoarding. During this phase, treatment was applied flexibly to allow for variations in treatment duration and choice of techniques. During Phase 3, participants were randomly assigned to 26 weekly sessions of CBT or to a 12-week wait-list control, followed by active treatment for a fixed duration of 26 sessions. Therapist adherence and competence were assessed through audiotaped therapy sessions.

Cognitive behavior therapy included 26 sessions of motivational enhancements; skills training for sorting, organizing and problem solving; direct practice not acquiring new items and discarding possessions to remove clutter and organize possessions; cognitive therapy to evaluate beliefs about possessions; and relapse prevention skills.

Self-report questionnaire of hoarding severity; total score range = 0 to 92; higher values indicate more symptoms

Interviewer measure with 5 questions to assess hoarding severity; total score range = 0 to 40; higher values indicate more symptoms

Inclusion criteria: Display at least moderately severe hoarding symptoms Must live within 45 minutes of Boston, MA or Hartford, CT Exclusion criteria: Ten or more sessions of cognitive behavior therapy for hoarding Concurrent psychotherapy or medications Suicidal, psychotic, or other psychiatric symptoms requiring hospitalization Compulsive buying symptoms that are part of a manic phase of bipolar disorder Mental retardation, dementia, brain damage, or other cognitive dysfunction that would interfere with the study

De-identified data have been shared with investigators working on hoarding relevant projects such as assessment of hoarding and meta-analyses of treatment outcome for hoarding disorder. Sharing of de-identified data will be considered upon request.