Research That Matters (January 17 - 20, 2008)

Recently, a specialized form of cognitive-behavioral therapy (CBT) for compulsive-hoarding has proved moderately effective (Steketee & Frost, 2006; Tolin, Frost, & Steketee, 2007). However, access to CBT therapists trained in treating hoarding is extremely limited. Accordingly, many people seek health information and intervention strategies from the web (Taylor, 1999). Web-based CBT interventions may be especially helpful for people who hoard because the problem is home-based and many are embarrassed to seek treatment. To our knowledge there have not been any studies examining internet based self-help groups for compulsive hoarding. This research study aims to test the effectiveness of an existing private unpublished stable ongoing online CBT-based group intervention designed to help people with compulsive hoarding better manage their symptoms. Web group participants are hypothesized to show more improvement in hoarding symptoms over time compared to waitlist controls.

This web-based self-help group (N=100 members; N=100 waitlist) has well-delineated procedures including: an application process; a requirement that participants actively take steps to reduce compulsive hoarding within 2 months of membership; and willingness to post behavioral goals and progress at least once per month. The group format is based in CBT methods and members have access to mental health information and educational resources on hoarding (posted by several hoarding experts and group members), tips on how to dehoard/ declutter and organize, thought records, cognitive strategies, lists of professional contacts, and a real-time chat-room. The leader of the online hoarding group contacted potential research participants via an email message containing a unique link to a voluntary anonymous web-based survey designed for this study. To date, research participants have been surveyed at two time points (3 months apart) about their hoarding behaviors, social supports, readiness to change, impairment, clinical improvement.

The sample (N=73) is 92% female, 93% White, 45% married, on average 51.6 years-old, highly educated, and 56% employed. Members were older (t=2.53, p<.02) and more likely to have received previous treatment (OR=5.4, p<.05) and marginally less likely to use wireless internet service (OR=2.79, p<.08). Paired t-tests for members show statistically significant reductions in hoarding symptoms (SIR: t=3.0, p<.01; CIR: t=2.7, p<.02), marginal reductions in loneliness (UCLA: t=1.7, p<.09) and marginal clinical global improvement (CGI: t=1.9, p<.07). Median split analyses for group membership (15 months) demonstrate that being in the group longer is associated with fewer hoarding symptoms, suggesting improvement over time. Being married or cohabitating with a partner was associated with lower CIR ratings (β=-.94, SE=.29, p<.01).

Compulsive hoarding is a disabling and distressing problem that can be difficult to manage and overcome. This research provides additional information about the efficacy and effectiveness of hoarding specific CBT-methods. Internet based self help for compulsive hoarding may be helpful in relieving symptoms, building motivation, and reducing loneliness. Additionally, such resources may extend access to mental health care, complement existing evidence-based practices, reduce treatment costs, and appeal to persons with stigma concerns. Evaluating the benefits of web-based self-help and peer intervention groups is critical given growing popularity of and demand for web interventions.