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.