Treating Hoarding Disorder in a real-world setting: Results from the Mental Health Association of San Francisco

Abstract

Hoarding Disorder (HD) is associated with substantial distress, impairment, and individual and societal costs. Cognitive-behavioral therapy (CBT) tailored to HD is the best-studied form of treatment and can be led by mental health professionals or by non-professionals (peers) with specific training. No previous study has directly compared outcomes for therapist-led and peer-led groups, and none have examined the effectiveness of these groups in a real-world setting. We used retrospective data to compare psychologist-led CBT groups (G-CBT) to groups led by peer facilitators using the Buried in Treasures workbooks (G-BiT) in individuals who sought treatment for HD from the Mental Health Association of San Francisco. The primary outcome was change in Hoarding Severity Scale scores. Approximate costs per participant were also examined. Both G-CBT and G-BiT showed improvement consistent with previous reports (22% improvement overall). After controlling for baseline group characteristics, there were no significant differences in outcomes between G-CBT and G-BiT. For G-CBT, where additional outcome data were available, functional impairment and severity of hoarding symptoms improved to a similar degree as compared to previous G-CBT studies, while hoarding-related cognition improved to a lesser degree (also consistent with previous studies). G-BiT cost approximately $100 less per participant than did G-CBT.

Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis

“…Mathews et al. () administrated Muroff protocol with shortened time of at‐home sessions (30–45 min instead of 90 min); Moulding, Nedeljkovic, Kyrios, Osborne, and Mogan () administrated the original Steketee and Frost protocol, adapted for 12 sessions, with the addition of addressing self‐blame and hopelessness.…”

“…Number/percentage of participants having previously received CBT for HD was reported in Mathews et al. () and Moulding et al. ().…”

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“…Some variations of CBT have been also developed, including CBT with bibliotherapy [29], CBT with cognitive rehabilitation [30] CBT with motivational interviewing [31], CBT with internet supported group [32] and isolated bibliotherapy [33][34][35]. In conclusion, these studies reveal that there are a percentage of hoarders who do not benefit the current CBT approaches.…”

“…Vancouver Obsessional Compulsive Inventory is a 55-item self-reported questionnaire with very good internal consistency of >0.9 and good test-retest reliability of 0.8 in OCD setting. Internal consistency of the Hoarding Subscale (items 10,22,26,35,42,45,51) ranges between 0.8 in nonclinical adults and 0.92 in participants with OCD.…”

Group cognitive–behavioural treatment with long‐term follow‐up and targeting self‐identity for hoarding disorder: An open trial

“…Worden, Bowe, and Tolin () used the G‐CBT protocol found in the study of Gilliam et al () with payment for decreasing in cluttering coded by an independent evaluator (30$ for each point reduction on clutter image rating scale). Mathews and collaborators (Mathews et al, ) administered Muroff's and collaborators protocol with shortened time of at‐home sessions (30–45 min instead of 90 min); Moulding, Nedeljkovic, Kyrios, Osborne, and Mogan () administered the original Steketee and Frost () protocol, adapted for a 12‐week treatment, with the addition of a session for reducing self‐blame and hopelessness. A recent meta‐analysis of the efficacy of G‐CBT for HD by Bodryzlova, Audet, Bergeron, Koszegi, and O'Connor (, in press) found a large effect size (g = 0.96, 95% CI [0.79, 1.13], z = 10.80, p < 0.001) with no effect on treatment outcome for the number of sessions, presence/absence of at‐home visits, and session duration of G‐CBT.…”