Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T06:48:56.908Z Has data issue: false hasContentIssue false

17 - Cognitive Behavioral Therapy for Hoarding Disorder

from Part Three - Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Associated Disorders

Published online by Cambridge University Press:  06 January 2022

By
Caitlin A. Stamatis ,
McKenzie K. Roddy  and
Kiara R. Timpano
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
Get access

Summary

Patients with hoarding disorder (HD) experience difficulties discarding that result in excess clutter in the home. HD causes distress and impairment for patients and family members and represents a significant public health burden, highlighting a need for treatment research. In this chapter, we provide an overview of cognitive behavioral therapy (CBT) for hoarding, a promising avenue to treat core HD features in a collaborative and time-limited manner. We begin by discussing etiological factors for HD, including familial features, information-processing deficits, and core beliefs about the self and possessions. Next, we describe HD assessment, including standardized measures and case conceptualization considerations. After discussing the research evidence for individual and group CBT for HD, we provide an overview of treatment components, including psychoeducation, motivational enhancement, skills training, behavioral exposures, cognitive techniques, and relapse prevention. Barriers to treatment are also considered. We end with a case vignette illustrating the successful application of CBT for HD in an individual outpatient setting.

Keywords

hoarding disordercognitive behavioral therapydifficulty discardingclutteracquiringexposurecognitive therapyskills trainingtreatment barriers
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 341 - 364
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71(6), 1049.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.Google Scholar
American Psychological Association. (2014). Guidelines for psychological practice with older adults. The American Psychologist, 69(1), 34.CrossRefGoogle Scholar
Ayers, C. R., Saxena, S., Espejo, E., Twamley, E. W., Granholm, E., & Wetherell, J. L. (2014). Novel treatment for geriatric hoarding disorder: An open trial of cognitive rehabilitation paired with behavior therapy. The American Journal of Geriatric Psychiatry, 22(3), 248–252.CrossRefGoogle ScholarPubMed
Ayers, C. R., Wetherell, J. L., Golshan, S., & Saxena, S. (2011). Cognitive-behavioral therapy for geriatric compulsive hoarding. Behaviour Research and Therapy, 49(10), 689–694.CrossRefGoogle ScholarPubMed
Bloch, M. H., Bartley, C. A., Zipperer, L., Jakubovski, E., Landeros-Weisenberger, A., Pittenger, C., & Leckman, J. F. (2014). Meta-analysis: Hoarding symptoms associated with poor treatment outcome in obsessive-compulsive disorder. Molecular Psychiatry, 19(9), 1025.CrossRefGoogle ScholarPubMed
Brakoulias, V., Eslick, G. D., & Starcevic, V. (2015). A meta-analysis of the response of pathological hoarding to pharmacotherapy. Psychiatry Research, 229(1–2), 272–276.CrossRefGoogle ScholarPubMed
Bratiotis, C. (2013). Community hoarding task forces: A comparative case study of five task forces in the United States. Health & Social Care in the Community, 21(3), 245–253.Google Scholar
Bratiotis, C., Sorrentino Schmalisch, C., & Steketee, G. (2011). The hoarding handbook: A Guide for human service professionals. Oxford University Press.Google Scholar
Bratiotis, C., & Woody, S. (2014). Community interventions. In Frost, R. O. & Steketee, G. (Eds.), The Oxford handbook of hoarding and acquiring (p. 316). Oxford University Press.Google Scholar
Chasson, G. S., Carpenter, A., Ewing, J., Gibby, B., & Lee, N. (2014). Empowering families to help a loved one with hoarding disorder: Pilot study of family-as-motivators training. Behaviour Research and Therapy, 63, 9–16.Google Scholar
Cromer, K. R., Schmidt, N. B., & Murphy, D. L. (2007). Do traumatic events influence the clinical expression of compulsive hoarding? Behaviour Research and Therapy, 45(11), 2581–2592.Google Scholar
First, M. B., & Williams, J. B. (2016). SCID-5-CV: Structured clinical interview for DSM-5 disorders: Clinician version: American Psychiatric Association Publishing.Google Scholar
Frost, R., Kim, H.-J., Morris, C., Bloss, C., Murray-Close, M., & Steketee, G. (1998). Hoarding, compulsive buying and reasons for saving. Behaviour Research and Therapy, 36(7–8), 657–664.Google Scholar
Frost, R., Rosenfield, E., Steketee, G., & Tolin, D. (2013). An examination of excessive acquisition in hoarding disorder. Journal of Obsessive-Compulsive and Related Disorders, 2(3), 338–345.CrossRefGoogle Scholar
Frost, R., Ruby, D., & Shuer, L. (2012). The buried in treasures workshop: Waitlist control trial of facilitated support groups for hoarding. Behaviour Research and Therapy, 50(11), 661–667.Google Scholar
Frost, R., & Steketee, G. (1998). Hoarding: Clinical aspects and treatment strategies. In Jenike, M., Baer, L., & Minichiello, W. E. (Eds.), Obsessive compulsive disorders: Practical management (3rd ed., pp. 533–554). Mosby.Google Scholar
Frost, R., Steketee, G., & Williams, L. (2000). Hoarding: A community health problem. Health & Social Care in the Community, 8(4), 229–234.Google Scholar
Frost, R., Steketee, G., & Williams, L. (2002). Compulsive buying, compulsive hoarding, and obsessive-compulsive disorder. Behavior Therapy, 33(2), 201–214.Google Scholar
Frost, R., Tolin, D. F., & Maltby, N. (2010). Insight-related challenges in the treatment of hoarding. Cognitive and Behavioral Practice, 17(4), 404–413.Google Scholar
Frost, R., Tolin, D. F., Steketee, G., Fitch, K. E., & Selbo-Bruns, A. (2009). Excessive acquisition in hoarding. Journal of Anxiety Disorders, 23(5), 632–639.Google Scholar
Frost, R. O., & Hartl, T. L. (1996). A cognitive-behavioral model of compulsive hoarding. Behaviour Research and Therapy, 34(4), 341–350.CrossRefGoogle ScholarPubMed
Frost, R. O., Hartl, T. L., Christian, R., & Williams, N. (1995). The value of possessions in compulsive hoarding: Patterns of use and attachment. Behaviour Research and Therapy, 33(8), 897–902.CrossRefGoogle ScholarPubMed
Frost, R. O., & Hristova, V. (2011). Assessment of hoarding. Journal of Clinical Psychology, 67(5), 456–466.CrossRefGoogle ScholarPubMed
Frost, R. O., Steketee, G., & Grisham, J. (2004). Measurement of compulsive hoarding: Saving inventory – Revised. Behaviour Research and Therapy, 42(10), 1163–1182.Google Scholar
Frost, R. O., Steketee, G., & Tolin, D. F. (2011). Comorbidity in hoarding disorder. Depression and Anxiety, 28(10), 876–884.CrossRefGoogle ScholarPubMed
Frost, R. O., Steketee, G., Tolin, D. F., & Renaud, S. (2008). Development and validation of the clutter image rating. Journal of Psychopathology and Behavioral Assessment, 30(3), 193–203. https://doi.org/10.1007/s10862-007-9068-7Google Scholar
Gilliam, C. M., Norberg, M. M., Villavicencio, A., Morrison, S., Hannan, S. E., & Tolin, D. F. (2011). Group cognitive-behavioral therapy for hoarding disorder: An open trial. Behaviour Research and Therapy, 49(11), 802–807.Google Scholar
Gilliam, C. M., & Tolin, D. F. (2010). Compulsive hoarding. Bulletin of the Menninger Clinic, 74(2), 93–121.Google Scholar
Grassi, G., Micheli, L., Mannelli, L. D. C., Compagno, E., Righi, L., Ghelardini, C., & Pallanti, S. (2016). Atomoxetine for hoarding disorder: A pre-clinical and clinical investigation. Journal of Psychiatric Research, 83, 240–248.CrossRefGoogle ScholarPubMed
Grisham, J. R., Frost, R. O., Steketee, G., Kim, H.-J., & Hood, S. (2006). Age of onset of compulsive hoarding. Journal of Anxiety Disorders, 20(5), 675–686.CrossRefGoogle ScholarPubMed
Grisham, J. R., Frost, R., Steketee, G., Kim, H.-J., Tarkoff, A., & Hood, S. (2009). Formation of attachment to possessions in compulsive hoarding. Journal of Anxiety Disorders, 23(3), 357–361.CrossRefGoogle ScholarPubMed
Hall, B. J., Tolin, D. F., Frost, R. O., & Steketee, G. (2013). An exploration of comorbid symptoms and clinical correlates of clinically significant hoarding symptoms. Depression and Anxiety, 30(1), 67–76.Google Scholar
Hartl, T. L., Frost, R., Allen, G. J., Deckersbach, T., Steketee, G., Duffany, S. R., & Savage, C. R. (2004). Actual and perceived memory deficits in individuals with compulsive hoarding. Depression and Anxiety, 20(2), 59–69.Google Scholar
Hirschtritt, M. E., & Mathews, C. A. (2014). Genetics and family models of hoarding disorder. In Frost, R. O. & Steketee, G. (Eds.), The Oxford handbook of hoarding and acquiring (pp. 159–176). Oxford University Press.Google Scholar
Iervolino, A. C., Perroud, N., Fullana, M. A., Guipponi, M., Cherkas, L., Collier, D. A., & Mataix-Cols, D. (2009). Prevalence and heritability of compulsive hoarding: A twin study. American Journal of Psychiatry, 166(10), 1156–1161. doi:appi.ajp.2009.08121789Google Scholar
Kyrios, M., Frost, R. O., & Steketee, G. (2004). Cognitions in compulsive buying and acquisition. Cognitive Therapy and Research, 28(2), 241–258.Google Scholar
Landau, D., Iervolino, A. C., Pertusa, A., Santo, S., Singh, S., & Mataix-Cols, D. (2011). Stressful life events and material deprivation in hoarding disorder. Journal of Anxiety Disorders, 25(2), 192–202.Google Scholar
Mataix‐Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., … & Wilhelm, S. (2010). Hoarding disorder: A new diagnosis for DSM‐V? Depression and Anxiety, 27(6), 556–572.Google Scholar
Mataix-Cols, D., Wooderson, S., Lawrence, N., Brammer, M. J., Speckens, A., & Phillips, M. L. (2004). Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Archives of General Psychiatry, 61(6), 564–576.Google Scholar
Mathews, C. A., Uhm, S., Chan, J., Gause, M., Franklin, J., Plumadore, J., … & Vega, E. (2016). Treating hoarding disorder in a real-world setting: Results from the Mental Health Association of San Francisco. Psychiatry Research, 237, 331–338. doi:10.1016/j.psychres.2016.01.019Google Scholar
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change: Guilford Press.Google Scholar
Morein-Zamir, S., Papmeyer, M., Pertusa, A., Chamberlain, S. R., Fineberg, N. A., Sahakian, B. J., … & Robbins, T. W. (2014). The profile of executive function in OCD hoarders and hoarding disorder. Psychiatry Research, 215(3), 659–667.CrossRefGoogle ScholarPubMed
Moulding, R., Nedeljkovic, M., Kyrios, M., Osborne, D., & Mogan, C. (2016). Short-term cognitive-behavioural group treatment for hoarding disorder: A naturalistic treatment outcome study. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2001Google Scholar
Mueller, A., Mueller, U., Albert, P., Mertens, C., Silbermann, A., Mitchell, J. E., & De Zwaan, M. (2007). Hoarding in a compulsive buying sample. Behaviour Research and Therapy, 45(11), 2754–2763.Google Scholar
Muroff, J., Steketee, G., Bratiotis, C., & Ross, A. (2012). Group cognitive and behavioral therapy and bibliotherapy for hoarding: A pilot trial. Depression and Anxiety, 29(7), 597–604.Google Scholar
Muroff, J., Steketee, G., Frost, R. O., & Tolin, D. F. (2014). Cognitive behavior therapy for hoarding disorder: Follow‐up findings and predictors of outcome. Depression and Anxiety, 31(12), 964–971.Google Scholar
Muroff, J., Steketee, G., Himle, J., & Frost, R. (2010). Delivery of internet treatment for compulsive hoarding (DITCH). Behaviour Research and Therapy, 48(1), 79–85.CrossRefGoogle Scholar
Muroff, J., Steketee, G., Rasmussen, J., Gibson, A., Bratiotis, C., & Sorrentino, C. (2009). Group cognitive and behavioral treatment for compulsive hoarding: A preliminary trial. Depression and Anxiety, 26(7), 634–640.Google Scholar
Muroff, J., & Underwood, P. (2016). Treatment of an adult with hoarding disorder. In Clinical handbook of obsessive-compulsive and related disorders (pp. 241–258). Springer.Google Scholar
Muroff, J., Underwood, P., & Steketee, G. (2014). Group treatment for hoarding disorder: Therapist guide: Treatments That Work.CrossRefGoogle Scholar
Nordsletten, A. E., Reichenberg, A., Hatch, S. L., de la Cruz, L. F., Pertusa, A., Hotopf, M., & Mataix-Cols, D. (2013). Epidemiology of hoarding disorder. The British Journal of Psychiatry, 203(6), 445–452.Google Scholar
O’Connor, K., Bodryzlova, Y., Audet, J. S., Koszegi, N., Bergeron, K., & Guitard, A. (2018). Group cognitive-behavioural treatment with long‐term follow‐up and targeting self‐identity for hoarding disorder: An open trial. Clinical Psychology & Psychotherapy, 25(5), 701–709.CrossRefGoogle ScholarPubMed
Pertusa, A., Frost, R. O., Fullana, M. A., Samuels, J., Steketee, G., Tolin, D., … & Mataix-Cols, D. (2010). Refining the diagnostic boundaries of compulsive hoarding: A critical review. Clinical Psychology Review, 30(4), 371–386.CrossRefGoogle ScholarPubMed
Rodriguez, C. I., Bender, J. Jr., Morrison, S., Mehendru, R., Tolin, D., & Simpson, H. B. (2013). Does extended release methylphenidate help adults with hoarding disorder? A case series. Journal of Clinical Psychopharmacology, 33(3), 444.Google Scholar
Saxena, S., Brody, A. L., Maidment, K. M., Smith, E. C., Zohrabi, N., Katz, E., … & Baxter, L. R. Jr. (2004). Cerebral glucose metabolism in obsessive-compulsive hoarding. American Journal of Psychiatry, 161(6), 1038–1048.Google Scholar
Shaw, A., Timpano, K., Steketee, G., Tolin, D., & Frost, R. (2015). Hoarding and emotional reactivity: The link between negative emotional reactions and hoarding symptomatology. Journal of Psychiatric Research, 63, 84–90.Google Scholar
Slyne, K., & Tolin, D. F. (2014). The neurobiology of hoarding disorder. In Frost, R. O. & Steketee, G. (Eds.), The Oxford handbook of hoarding and acquiring (pp. 177–186). Oxford University Press.Google Scholar
Steketee, G., & Frost, R. O. (2013). Treatment for hoarding disorder: Therapist guide: Oxford University Press.Google Scholar
Steketee, G., Frost, R., & Kyrios, M. (2003). Cognitive aspects of compulsive hoarding. Cognitive Therapy and Research, 27(4), 463–479.Google Scholar
Steketee, G., Frost, R. O., Tolin, D. F., Rasmussen, J., & Brown, T. A. (2010). Waitlist‐controlled trial of cognitive behavior therapy for hoarding disorder. Depression and Anxiety, 27(5), 476–484.Google Scholar
Steketee, G., Frost, R., Wincze, J., Greene, K. A. I., & Douglass, H. (2000). Group and individual treatment of compulsive hoarding: A pilot study. Behavioural and Cognitive Psychotherapy, 28(3), 259–268.Google Scholar
Thompson, C., de la Cruz, L. F., Mataix-Cols, D., & Onwumere, J. (2017). A systematic review and quality assessment of psychological, pharmacological, and family-based interventions for hoarding disorder. Asian Journal of Psychiatry, 27, 53–66.CrossRefGoogle ScholarPubMed
Timpano, K. R., Broman-Fulks, J. J., Glaesmer, H., Exner, C., Rief, W., Olatunji, B. O., … & Wilhelm, S. (2013). A taxometric exploration of the latent structure of hoarding. Psychological Assessment, 25(1), 194.Google Scholar
Timpano, K. R., Exner, C., Glaesmer, H., Rief, W., Keshaviah, A., Brahler, E., & Wilhelm, S. (2011). The epidemiology of the proposed DSM-5 hoarding disorder: Exploration of the acquisition specifier, associated features, and distress. The Journal of Clinical Psychiatry, 72(6), 780–786.Google Scholar
Timpano, K. R., Muroff, J., & Steketee, G. (2016). A review of the diagnosis and management of hoarding disorder. Current Treatment Options in Psychiatry, 3(4), 394–410.Google Scholar
Timpano, K. R., & Schmidt, N. B. (2013). The relationship between self-control deficits and hoarding: A multimethod investigation across three samples. Journal of Abnormal Psychology, 122(1), 13–25. doi:10.1037/a0029760CrossRefGoogle ScholarPubMed
Timpano, K. R., Shaw, A. M., Cougle, J. R., & Fitch, K. E. (2014). A multifaceted assessment of emotional tolerance and intensity in hoarding. Behavior Therapy, 45(5), 690–699.Google Scholar
Tolin, D., Frost, R., & Steketee, G. (2013). Buried in treasures: Help for compulsive acquiring, saving, and hoarding: Oxford University Press.Google Scholar
Tolin, D. F., Frost, R. O., Steketee, G., & Fitch, K. E. (2008). Family burden of compulsive hoarding: Results of an internet survey. Behaviour Research and Therapy, 46(3), 334–344.Google Scholar
Tolin, D. F., Frost, R. O., Steketee, G., & Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta‐analysis. Depression and Anxiety, 32(3), 158–166.Google Scholar
Tolin, D. F., Kiehl, K. A., Worhunsky, P., Book, G. A., & Maltby, N. (2009). An exploratory study of the neural mechanisms of decision making in compulsive hoarding. Psychological Medicine, 39(2), 325–336. doi:S0033291708003371Google Scholar
Tolin, D. F., Meunier, S. A., Frost, R. O., & Steketee, G. (2010). Course of compulsive hoarding and its relationship to life events. Depression and Anxiety, 27(9), 829–838.Google Scholar
Tolin, D. F., Meunier, S. A., Frost, R. O., & Steketee, G. (2011). Hoarding among patients seeking treatment for anxiety disorders. Journal of Anxiety Disorders, 25(1), 43–48.CrossRefGoogle ScholarPubMed
Tolin, D. F., Stevens, M. C., Villavicencio, A. L., Norberg, M. M., Calhoun, V. D., Frost, R. O., … & Pearlson, G. D. (2012). Neural mechanisms of decision making in hoarding disorder. Archives of General Psychiatry, 69(8), 832–841. doi:10.1001/archgenpsychiatry.2011.1980Google Scholar
Tolin, D. F., & Villavicencio, A. (2011). Inattention, but not OCD, predicts the core features of hoarding disorder. Behaviour Research and Therapy, 49(2), 120–125.Google Scholar
Tolin, D. F., Worden, B. L., Wootton, B. M., & Gilliam, C. M. (2017). CBT for hoarding disorder: A group therapy program therapist’s guide: John Wiley & Sons.Google Scholar
Tompkins, M. A. (2015). Harm reduction process for severe hoarding. In Clinician’s guide to severe hoarding (pp. 59–88). Springer.Google Scholar
Tompkins, M. A., & Hartl, T. L. (2013). Family interventions for hoarding. In Frost, R. O. & Steketee, G. (Eds.), The Oxford handbook of hoarding and acquiring (p. 303). Oxford University Press.Google Scholar
Weintraub, M. J., Brown, C. A., & Timpano, K. R. (2018). The relationship between schizotypal traits and hoarding symptoms: An examination of symptom specificity and the role of perceived cognitive failures. Journal of Affective Disorders, 237, 10–17.CrossRefGoogle ScholarPubMed
Woody, S. R., Kellman-McFarlane, K., & Welsted, A. (2014). Review of cognitive performance in hoarding disorder. Clinical Psychology Review, 34(4), 324–336.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×