Research That Matters (January 17 - 20, 2008)

Individuals suffering from compulsive hoarding experience distress and interference not only from the manifestation of the disorder itself (i.e., excessive clutter, excessive acquisition, and difficulty discarding), but also from co-morbid disorders, social isolation, and shame and embarrassment about the condition of the home. This complex disorder has been shown to respond moderately well to a specialized cognitive behavioral individual treatment protocol developed by Steketee and Frost (2007). This protocol has recently been adapted for use in group treatment that includes psychoeducation, model-building, skill development, cognitive therapy, exposure to discarding and not acquiring, and addressing attention and motivation deficits. Existing research suggests that relatively brief group cognitive behavioral treatment (CBT) for compulsive hoarding and related disorders, such as OCD, is associated with improvement in symptoms (Anderson & Rees, 2006; Steketee et al., 2000; Van Noppen et al., 1997). Group treatment has also been shown to be effective for disorders that are often co-morbid with compulsive hoarding, such as depression and social anxiety (e.g., Herbert et al., 2002; Morrison, 2001). This study characterizes group processes and evaluates outcomes from this specialized group CBT protocol.

Four treatment groups for compulsive hoarding were conducted that included a total of 22 members. Group members volunteered for an unrelated study on the nature of compulsive hoarding and requested treatment. All group members had a diagnosis of compulsive hoarding at a clinical level. The average age of participants was 53, 73% were female, and 91% identified as Caucasian. The groups were led by two therapists and met once weekly for 2 hours over 12 weeks (1 group), 16 weeks (2 groups), and 20 weeks (1 group). In addition, each group member had three 2-hour sessions in the home with one of the group co-leaders.

Group processes identified in all four groups examined in this study included universality insofar as stigma and shame about compulsive hoarding is reduced in encountering others with this disorder, and socialization insofar as attending a weekly group reduced social isolation and provided behavioral activation that may reduce depression. In addition, peer pressure and support served as motivational factors for goal attainment. A fourth process included mutual aid as group members offered a different perspective and challenged beliefs, as well as instilling hope and possibly reducing depression.

To measure outcome, group members completed self-report assessments at baseline, mid-treatment, and post-treatment about hoarding and related symptoms (e.g., depression). Group treatment resulted in a modest reduction in hoarding symptoms across all groups as measured by individual ratings of clinical global severity. Modest reduction in depression measured by the Beck Depression Inventory were also evident. Longer treatment was associated with greater therapeutic gains. While limited by small sample size and variable dosage of CBT, the current results suggest that group CBT for compulsive hoarding is effective. Group treatment may be especially useful because of its cost-effectiveness, greater access to trained clinicians, and potential for positively impacting co-morbid symptoms.