Treatment for Hoarding Behaviors: A Review of the Evidence

Abstract

This article reviews the empirical literature on treating clients with hoarding behaviors, including psychosocial treatments, mainly cognitive behavioral, and pharmacotherapy. Standard treatments used for obsessive compulsive disorder (OCD) such as medication and/or behavior therapy have been associated with poor treatment response for those with hoarding. Recent prospective pharmacotherapy research suggests that serotonergic medication may be helpful to OCD patients with or without hoarding. A multi-component cognitive behavioral treatment (CBT) designed specifically for hoarding has shown promising results especially in trials of individual therapy with periodic home visits. Social work researchers have played a prominent role in the development and testing of this CBT intervention and development of instruments to assess hoarding treatment outcomes. This CBT intervention has demonstrated modest success when delivered individually in an open trial and a waitlist-controlled trial, and in quasi-experimental studies of group treatment modalities, including in-person and web-based groups as well as bibliotherapy-based support groups. Overall, evidence supports the use of specialized CBT methods to improve hoarding symptoms. Future testing may include controlled trials with more diverse samples.

An intensive time-series evaluation of the effectiveness of cognitive behaviour therapy for hoarding disorder: A 2-year prospective study

“…Whilst domiciliary visits have been proposed to enhance treatment adherence and ability to discard (Nesiroglu et al, 2004;Steketee & Frost, 2007;Tolin et al, 2007), the current study challenges these opinions. There was no evidence that DVs facilitated increased discard, suggesting that DVs may not be an essential component of hoarding treatment (Muroff et al, 2011). There was a reliable reduction in compulsive acquisition over treatment and this was an early treatment target in the attempt to reduce the 'inflow' of objects into the home, before concentrating on increasing 'outflow' via improved discard.…”

“…Compulsive hoarding is viewed as difficult to address with risk of dropout, poor outcome and behavioural relapse (Muroff et al, 2011 …”

“…To achieve a reliable change on the primary outcome measure of the SI-R, a patient needs to drop 14 points between measurement points and for this change to be clinically significant then the final score needs to be >50 (Muroff et al, 2011). Reliable and clinically significant change therefore occurs when there is both a positive RCI and the termination score places the patient within a community norm -this is being increasingly taken as evidence of recovery and classifies 'treatment responders' (Barkham, Stiles, Connell & Mellor-Clark, 2011).…”

“…The testing completed of the CBT model undoubtedly shows clinical promise (Muroff et al, 2011), but there remains major room for improvement regarding increasing the acceptability, efficacy and durability of outcomes and identifying the optimal means of service delivery. The outcome literature has also been criticized for failing to investigate the inter-relationship and responsivity of cognitive, affective and behavioural factors during treatment .…”

“…Such visits enable clinicians to treat hoarders in their home environment and therefore enable the in vivo assessment of the effectiveness of change methods (Nesiroglu, Bubrick & Yaryura-Tobias, 2004;Steketee & Frost, 2007). However, Muroff et al, (2011) labeled domiciliary visits as time consuming, costly and not always feasible.…”