Friday, January 13, 2012: 8:00 AM
Independence B (Grand Hyatt Washington)
* noted as presenting author
Hoarding is a serious mental health problem that poses a profound public health risk and carries significant health and functioning problems. Hoarding is characterized by difficulty discarding, excessive acquiring, and substantial clutter that is impairing and costly to the individual, the family, and the community. Recent research suggests that hoarding may be a syndrome distinct from OCD that is more often associated with major depression, generalized anxiety, and social phobia. To address poor outcomes following medication and behavioral treatments developed for OCD, a recent waitlist controlled trial tested a specialized office-based cognitive behavioral treatment (CBT) with home visits for hoarding. This CBT model of hoarding posits deficits in information processing, maladaptive beliefs about and attachments to possessions that provoke distress and avoidance, as well as positive emotional responses to saving and acquiring that reinforce these behaviors. The 26-session individual CBT included in-home and office assessments, motivational enhancement, collaborative model-building, training in organizing and problem solving skills, non-acquisition and sorting exposures, cognitive therapy, and relapse prevention. After 12 sessions CBT led to significantly more improvement in hoarding than did waitlist. Those who completed 26 sessions showed significant reductions in hoarding symptoms and large effect sizes. The purpose of this study is to present the follow-up outcome data and predictors of durable gains.
Of 37 clients treated with CBT for hoarding, 25 completed 12-month follow-up assessments. The follow-up sample was similar to the completer sample: 80% female, 88% White, 40% married or living with partner, 44% unemployed, disabled or retired; the average age was 50. Scores on standardized measures (Saving Inventory – Revised, SI-R; Hoarding Rating Scale – Interview, HRS-I) were analyzed using General Linear Model Repeated Measures design examining time (pretreatment, post-treatment, follow-up). There was a significant main effect for time on the SI-R total (F (2, 17) = 14.034, p=.001, partial eta squared=.438) and on the HRS -I (F (2,23) = 32.857, p=.001, partial eta square=.578), indicating large effects. Pairwise comparisons showed that significant improvements between pretest and post-test were sustained at follow-up. At follow-up, therapists rated 58% of patients “much” or “very much” improved on clinical global improvement ratings while 76% of patients rated themselves in these categories. Predictors of follow-up outcomes will be presented.
CBT with specialized components appears to be a promising intervention for hoarding, a condition traditionally thought to be resistant to treatment. Results suggest the durability of significant reductions in hoarding symptoms following this 26-session CBT treatment. Greater understanding of predictors of outcomes has the potential to direct efforts to improve CBT methods for hoarding. Ongoing research is examining hoarding intervention enhancements that may extend access to treatment, reduce costs, and enhance outcomes for this underserved population.