Cognitive Behavioral Therapy for Compulsive Hoarding Delivered via Webcam

Background and Purpose: Individually-delivered CBT for hoarding has demonstrated moderately good success (Tolin et al., 2007), but there remains considerable room to improve upon the outcomes and service delivery methods. A technology-based distance treatment model may be especially useful, with the added benefit of delivering all sessions in the client's home for this home-based problem. Home-based CBT has been shown to be effective for treatment refractory OCD clients (Rosqvist et al., 2002), but is untested with hoarding clients. Studies applying internet/technology treatments to OCD and hoarding show promising results (Himle et al., 2006; Muroff et al, 2008). This pilot study examines the feasibility and effectiveness of home-based CBT treatment delivered via webcam (CBT-W) for hoarding.

Methods: To date 3 clients with clinically significant hoarding have been treated with CBT-W; 2 females, 2 Whites, 1 Asian, 2 living with a spouse/partner, 55 years old on average, and all are employed. Clients had undergone group CBT for hoarding with limited gains. Treatment adapted from Steketee and Frost's (2007) manual was delivered individually in real-time using webcam and internet technology for 26 weekly sessions. Self-report assessments of hoarding behavior and related symptoms were completed at baseline, mid- and post-treatment.

Results: Initial findings demonstrated feasibility of CBT-W, a shorter treatment period from that of individually-delivered CBT averaging 49 weeks, and modest improvement on hoarding symptoms. One client finished treatment and follow-up, completing 26 sessions in 30 weeks with minimal technical difficulty. His symptoms reduced by 10.5 points on the SI-R (57 to 46.5) and from moderate to mild clinical severity. He maintained gains at 3-month follow-up (SI-R=45.5). A second client completed CBT-W in 38 weeks, rating herself much improved although her SI-R scores improved only slightly (70 to 67).Currently in therapy, the third client reported a 19.25 point reduction on the SI-R pre- to mid-test at week 13 (69 to 49.75). Therapeutic alliance was rated high by all suggesting that webcam methods did not adversely affect the therapy relationship.

Conclusions: Despite the small sample, home-based CBT-W for hoarding shows promise. It may extend access to mental health care for this debilitating problem and help disseminate evidence-based practices. CBT-W may circumvent practical barriers to in-home treatment. Given the growing popularity of technology supported interventions, it is critical that their benefits be evaluated at the same time that social workers learn to use such resources.