Objective This study investigated a multi-component cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). Method Participants with clinically significant hoarding were recruited from the community and a university-based anxiety clinic. Of 46 patients randomly assigned to CBT or WL, 40 completed the 12-week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to non-acquiring and discarding, and cognitive therapy. Measures included the Saving Inventory-Revised (self-report), Hoarding Rating Scale-Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling (GLM) examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre-post effects for all CBT participants combined after 26 sessions. Results After 12 weeks, CBT participants benefitted significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 68% of patients were considered improved on therapist clinical global improvement ratings, and 76% of patients rated themselves as improved; 41% of completers were clinically significantly improved. Conclusions Multi-component CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern and further research with independent assessors is needed to establish treatment benefits and durability of gains.

This study demonstrates the feasibility and modest success of GCBT methods in improving hoarding symptoms. Group treatment may be especially valuable because of its cost-effectiveness, greater client access to trained clinicians, and reduction in social isolation and stigma linked to this problem. Further research is needed to improve the efficacy of GCBT methods for hoarding and to examine durability of change, predictors of outcomes, and processes that influence change.

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