Fully Online Group Cognitive Behavioral Treatment (GCBT-W) for Hoarding Disorder in Naturalistic Community Settings

Background and Purpose: Hoarding is a mental health and public health challenge described as difficulty discarding and often excessive acquiring resulting in substantial clutter that impairs daily functioning and often causes distress. Meta-analyses show promising evidence that support the efficacy of both individual and group cognitive behavioral therapy (CBT) for hoarding disorder (HD) delivered in-person, with comparable outcomes (Bodryzlova et al., 2018; Thompson et al., 2017; Tolin et al., 2015). Technology-based distance intervention models facilitates the delivery of treatment in the client’s home for this home-based problem and may extend access to providers trained to assist with hoarding. Promising results have been demonstrated by studies applying web-based technology-assisted treatments for hoarding include combined face-to face and web-based therapist support (Ivanov et al., 2018), “blended” models (Fitzpatrick et al., 2018), and fully online videoconferencing-based CBT delivered in individual (Muroff & Steketee, 2018) and group (Muroff & Otte, 2019) formats. This study extends prior studies of group CBT and technology-supported CBT for hoarding by examining the feasibility and effectiveness of a fully online webcam-based group CBT (GCBT-W) intervention models for hoarding, delivered by community clinicians at 3 distinct community mental health agencies (in the US and Canada).

Methods: The GCBT-W intervention was conducted using a videoconferencing internet platform and webcam for 20 weekly sessions. The treatment was based on an adaptation of manualized GCBT for HD (Muroff, Underwood, & Steketee, 2014). Self-report assessments of hoarding behavior and related symptoms (e.g., the Saving Inventory-Revised) were collected at baseline and post-treatment. To date, four groups have completed the protocol. Participants were 85% white, 72% female, and an average age of 62-years old.

Results: Findings demonstrate the feasibility of 20-week GCBT-W with regular session attendance, good homework adherence, and modest (~20%) improvement in hoarding symptoms between pre- and post-test (e.g., SI-R: F (1, 21) = 16.93, p<.01). The majority of participants rated their clinical global improvement as “much improved” at post-test. Additionally, a briefer version of GCBT-W (12 sessions with between texting support) was also piloted most recently with two more groups in response to community feedback that shorter-term groups would be more feasible to implement more broadly and research support for in-person 12-week groups for hoarding (Moulding et al., 2017). This sample was 64% white, 93% female, and 56 years-old on average. Hoarding symptom improvement on the SI-R was also 20% (F(1,11)=29.9, p<0.01). Adaptations and implementation will be discussed.

Conclusions and Implications: This study illustrates the feasibility and effectiveness of GCBT-W for hoarding, delivered online by clinicians in community agencies, in longer and briefer formats. Such community collaborations and examination of implementation in community settings are crucial to the dissemination of evidence-based interventions for hoarding, a complex mental health and public health challenge.