Toward a biopsychosocial model of hoarding disorder

Tolin, David F.

doi:10.1016/j.jocrd.2022.100775

Cited by 5 publications

(3 citation statements)

References 176 publications

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“…We have suggested that the blunted general dACC activity seen in HD may help to explain the decreased insight and failure to correct maladaptive behavior frequently seen in these patients, whereas the relatively increased dACC activity during decision-making may help to explain the difficulty patients experience making decisions about the relative importance of possessions (Tolin, 2023). As such, the present study aims to examine the degree to which CBT alters activity in this and other brain ROIs.…”

Section: Discussionmentioning

confidence: 99%

Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder.

Tolin¹,

Levy²,

Hallion³

et al. 2023

Journal of Consulting and Clinical Psychology

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Objective: Cognitive behavioral therapy (CBT) is efficacious for hoarding disorder (HD), though results are modest. HD patients show an increase in activity in the dorsal anterior cingulate cortex (dACC) when making decisions. The aim of this study is to determine whether CBT’s benefits follow improvements in dACC dysfunction or abnormalities previously identified in other brain regions. Method: In this randomized clinical trial of 64 treatment-seeking HD patients, patients received group CBT, delivered weekly for 16 weeks, versus wait list. Functional magnetic resonance imaging was used to examine neural activity during simulated decisions about whether to acquire and discard objects. Results: During acquiring decisions, activity decreased in several regions, including right dorsolateral prefrontal, right anterior intraparietal area, both right and left medial intraparietal areas, left and right amygdala, and left accumbens. During discarding decisions, activity decreased in right and left dorsolateral prefrontal, right and left rostral cingulate, left anterior ventral insular cortex, and right medial intraparietal areas. None of the a priori brain parcels of interest significantly mediated symptom reduction. Moderation effects were found for left rostral cingulate, right and left caudal cingulate, and left medial intraparietal parcels. Conclusions: Therapeutic benefits of CBT for HD do not appear to be mediated by changes in dACC activation. However, pretreatment dACC activation predicts outcome. Findings suggest the need to re-evaluate emerging neurobiological models of HD and our understanding of how CBT affects the brain in HD, and perhaps shift focuses to new neural target discovery and target engagement trials.

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Section: Discussionmentioning

confidence: 99%

Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder.

Tolin¹,

Levy²,

Hallion³

et al. 2023

Journal of Consulting and Clinical Psychology

Self Cite

View full text Add to dashboard Cite

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“…As an example, a recent study in undergraduate students found that a single-session cognitive-behavioral intervention focused on reducing error sensitivity decreased the ERN, particularly for those with the highest baseline ERN (Meyer et al, 2020). It will also be important to further test the proposed neurobiological model of HD (Tolin, 2023). One particular area that remains to be studied pertains to the hypoactivity observed at rest (Saxena et al, 2004) and in neutral (non-discarding) tasks (Mathews et al, 2016;Sunol et al, 2019) among individuals with HD.…”

Section: Discussionmentioning

confidence: 99%

“…To address this problem, research has focused on identifying neurobiological mechanisms of HD that may inform novel treatment development. A proposed biphasic neurobiological model of HD (Tolin, 2023) posits that HD is characterized by blunted central nervous system (CNS) and peripheral nervous system (PNS) activity at rest or during neutral (non-discarding) tasks, and exaggerated CNS and PNS activity during decision-making about discarding personal possessions. Some evidence points to a baseline under-engagement of CNS processes in individuals with HD.…”

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confidence: 99%

Central and Peripheral Physiological Responses to Decision Making in Hoarding Disorder

Levy,

Naples,

Collett

et al. 2023

Preprint

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Individuals with hoarding disorder (HD) have difficulty parting with personal possessions, which leads to the accumulation of excessive clutter. According to a proposed biphasic neurobiological model, HD is characterized by blunted central and peripheral nervous system activity at rest and during neutral (non-discarding) decisions, and exaggerated activity during decision-making about discarding personal possessions. Here, we compared the error-related negativity (ERN) and psychophysiological responses (skin conductance, heart rate and heart rate variability, and end tidal CO2) during neutral and discarding-related decisions in 26 individuals with HD, 37 control participants with anxiety disorders, and 28 healthy control participants without psychiatric diagnoses. We also compared alpha asymmetry between the HD and control groups during a baseline resting phase. Participants completed a series of Go/No Go decision-making tasks, one involving choosing certain shapes (neutral task) and the other involving choosing images of newspapers to imaginally “discard” (discarding task). Contrary to hypotheses, there were no group differences in the ERN or any psychophysiological measures. Alpha asymmetry at rest did not differ between groups. The findings suggest that the ERN and psychophysiological responses may not differ in individuals with HD during simulated discarding decisions relative to control participants, although the null results may be explained by methodological challenges in using Go/No Go tasks as discarding tasks. Future replication and extension of these results will be needed using ecologically valid discarding tasks.

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Clinician Sentiments Related to Implementation of Evidence-Based Treatment for Hoarding in Older Adults

Nix,

Dozier,

Porter

et al. 2024

J Psychopathol Behav Assess

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Toward a biopsychosocial model of hoarding disorder

Cited by 5 publications

References 176 publications

Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder.

Changes in neural activity following a randomized trial of cognitive behavioral therapy for hoarding disorder.

Central and Peripheral Physiological Responses to Decision Making in Hoarding Disorder

Clinician Sentiments Related to Implementation of Evidence-Based Treatment for Hoarding in Older Adults

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