Treating hoarding disorder with compassion‐focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects

Abstract

Objectives. Hoarding disorder (HD) was recognized as a psychiatric disorder in 2013. Existing literature suggests room for improvement in its treatment. The current pilot study aimed to provide an initial evaluation on the potential of compassion-focused therapy (CFT) as an intervention for HD, with the primary aim being assessing its feasibility and acceptability, and the secondary being evaluating its effects.Design. Both CFT and a second round of the current standard of treatment and cognitive behavioural therapy (CBT) were investigated in the current study as follow-up treatment options for individuals who had completed CBT but were still significantly symptomatic.Methods. Forty eligible individuals were enrolled (20 in each treatment). Treatment feasibility and acceptability were assessed by quantitative and qualitative measures. To explore treatment effects, HD symptom severity, HD-related dysfunctions, and their underlying mechanisms were assessed pre-treatment and post-treatment.Results. Retention rates were 72% for CFT and 37% for CBT. All participants and 79% of the participants rated CFT and CBT, respectively, as good or excellent. After receiving CFT as a follow-up treatment, HD symptom severity dropped below the cut-off point for clinically significant HD for 77% of the treatment completers, and 62% achieved clinically significant reduction in symptom severity. In contrast, after completing a second course of CBT, 23% had HD symptom severity dropped below the cut-off threshold, and 29% achieved clinically significant symptom reduction.

Evidence to guide ethical decision‐making in the management of older people living in squalor: a narrative review

“…Alternatively, compassion‐focussed therapy (CFT), which emphasises emotion regulation through mindfulness and compassion imagery, treats individuals by physiologically activating the parasympathetic nervous system to achieve settling and soothing states during de‐cluttering efforts 53 . In a small CFT study ( N = 18) without a control group, 62% of older hoarders achieved a clinically significant reduction in hoarding severity 53 .…”

“…Alternatively, compassion‐focussed therapy (CFT), which emphasises emotion regulation through mindfulness and compassion imagery, treats individuals by physiologically activating the parasympathetic nervous system to achieve settling and soothing states during de‐cluttering efforts 53 . In a small CFT study ( N = 18) without a control group, 62% of older hoarders achieved a clinically significant reduction in hoarding severity 53 . Other interventions such as cognitive remediation which use computerised programmes to target cognitive function can improve attention; however, it does not reduce hoarding severity or improve executive function 54 .…”

“…53 In a small CFT study (N = 18) without a control group, 62% of older hoarders achieved a clinically significant reduction in hoarding severity. 53 Other interventions such as cognitive remediation which use computerised programmes to target cognitive function can improve attention; however, it does not reduce hoarding severity or improve executive function. 54 Interventions that require further evaluation include the use of occupational therapists for training in planning and organisational skills, 55 and the use of volunteers, who compared with clinicians, can be less resource intensive, more flexible and able to promote relationships that lead to improvements in other aspects of life.…”

A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes?

“…Compassion‐focused therapy aimed to help individuals increase their emotional awareness and develop self‐compassion in order to regulate their emotions. At post‐treatment, the average SI‐R score for individuals who received compassion‐focused therapy was above the clinical cut‐off ( M = 41.1; SD = 12.7), but it was lower than the average score for individuals who received a second round of CBT for HD ( M = 47.3, SD = 10.9; Chou et al, 2020). Compassion‐focused therapy was associated with improvements in emotion regulation, whereas CBT for HD was not.…”

“…Unfortunately, the authors did not report if their treatment led to an improvement in emotion regulation. In a non‐randomized controlled trial, Chou et al (2020) compared compassion‐focused therapy to CBT for HD among individuals who had previously received CBT for HD. Compassion‐focused therapy aimed to help individuals increase their emotional awareness and develop self‐compassion in order to regulate their emotions.…”