Hoarding is associated with problems engaging in social activities, lower social support, increased isolation and poses substantial challenges to family functioning. The aim of this investigation was to explore the relationship between hoarding severity and family and social functioning variables in 60 treatment-seeking adults with hoarding disorder (HD). Participants completed a battery of self-report measures during a baseline assessment completed prior to treatment. Forty-seven percent of participants reported they live alone. Forty-eight percent of participants reported that family and friends never visit them in their home, and 33% indicated they never had visitors to their home, not even service workers or repair people. Twelve percent of participants indicated they never visit with family or friends outside of their home; however, 55% of participants endorsed phoning family or friends more than 9 times each month. Increased clutter and hoarding severity was associated with a lower frequency of family and friends visiting in the home. Family competence and conflict were both positively associated with hoarding severity. Our results shed light on family and social impairment in HD and their relationship with symptom severity; however, additional research should examine social dysfunction among non-treatment-seeking individuals who may be more impaired or isolated.
Objectives: The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). Design: This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science. Setting: Program activities took place in San Diego County, mainly within clients’ homes or community, with some activities in-office. Participants: Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD. Intervention: A manualized, mobile protocol that incorporated CREST was utilized. Measurements: The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation. Results: Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. Conclusion: Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.
Although efficacious treatments exist for anxiety disorders, issues remain regarding how best to conceptualize and measure purported change processes in clinical research. In the current study, we examined the relationship between treatment-specific (exposure therapy, attention bias modification [ABM]) as well as more general change processes with symptoms within a transdiagnostic sample using mixed models. Results indicated that slope of self-efficacy across treatment and between-session habituation across identical exposures was associated with slope of symptom change. Although slope of anxiety ratings within session was not associated with slope of symptom change, it did interact with other candidate exposure processes to predict symptoms. Purported ABM change processes were not associated with outcome. Our use of mixed models exemplifies an emerging trend in this research aimed at minimizing loss of data through aggregation, and our results highlight the utility of integrating treatment-specific as well as more general change processes in mechanistic research.
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