Group Treatment for Hoarding: A Community-Based Pilot
Hoarding disorder includes difficulty discarding ordinary items, substantial clutter that impairs daily functioning, and excessive acquiring that contributes to clutter (Frost & Hartl, 1996; Saxena, 2008). Hoarding is a serious psychiatric problem with individual, family and community stakeholders. It poses a profound public health challenge (Tolin, Frost, Steketee, Gray, & Fitch, 2008) and can be life-threatening to the individual and the neighboring community (Frost, Steketee, Williams, 2000). Hoarding is a highly prevalent mental health problem, occurring in 4-5% of the community (Iervolini et al., 2009; Samuels et al., 2008). Recent pilot studies and waitlist controlled trials for individual cognitive behavioral therapy (CBT) designed specifically for hoarding have shown promising results; however, motivation problems, treatment length, and access to trained providers remain a barrier (Steketee, Frost, Tolin, Rasmussen, & Brown, 2010; Tolin, Frost, & Steketee, 2007). Group CBT for hoarding has also shown good effects (Muroff et al., 2009; in press). Treatment trials to this point have only been tested in controlled research settings. The purpose of this study was to disseminate and evaluate the effectiveness of group treatment for hoarding being delivered in a community mental health setting.
Inclusion criteria were hoarding as a major problem; other comorbid mental health problems were permitted. The adult sample was predominantly female, middle-aged, white, unmarried, and unemployed. Two social work clinicians led 20-week groups at an outpatient community mental health clinic. Groups convened once weekly for 1.5 hours plus 2 home visits with one of the group co-therapists. The adapted group CBT intervention included motivational enhancement, psycho-education, training in sorting and decision-making, non-acquisition exposure exercises, and home based support. Groups included 8-9 participants. Pre-post analyses were conducted using the self-reported Saving Inventory-Revised (SI-R) and Hoarding Rating Scale (HRS–SR), Clinical Global Improvement scale, and the Beck Depression Inventory (BDI-II).
Mixed model analyses with time as the repeated measure were conducted. Participants showed statistically significant reductions in hoarding symptoms from pre- to post-test on the HRS (28.5%, F1,6=9.158, p=.023, partial eta squared=.604). Participants also reported improvement on the SI-R though it did not reach statistical significance (18%; F1,7=2.653, p=.147). About 50% of participants rated themselves as “much” or “very much” improved at post-test. Participants also showed significant reductions (28.5%) in depression symptoms (moderate depression to mild mood disturbance; F1,7=5.734, p=.048, partial eta squared=.450).
Conclusions and Implications:
Delivery of GCBT for hoarding by social workers in a community setting appears feasible and associated with moderate improvement. Findings from this study help clarify the effectiveness of group hoarding treatment in the community and whether manuals and trainings may need to be modified for delivery in this setting. The benefits and challenges of conducting research on community-based GCBT interventions for hoarding will be discussed.