Available Treatments for Hoarding Disorder

Available Treatments for Hoarding Disorder

Salina C. Sinclair

Texas A&M University-Central Texas

Abstract

There are several models of treatments for hoarding disorder, they include cognitive behavioral therapy (CBT), skills training, and medication. Which treatment will be the most effective for an individual depends on several factors. The individual’s willingness to change, the length of treatments, and the support available for the individual.

Keywords:  hoarding disorder, treatment, cognitive behavioral therapy, motivational interviewing,

Available Treatments for Hoarding Disorder

There are several possible treatments available for an individual with hoarding disorder. The treatment ranges from cognitive behavioral therapy (CBT) to medication and can be adapted into a blended therapy. Determining the most appropriate treatment for an individual with hoarding disorder is dependent on whether they are ready to follow through with the treatments and how much support is available for the individual. Support can be anything from after care support, counselor support, or it can come from social connections the individual has within their community.

Treatments

Cognitive behavioral therapy helps clients to examine the way in which they behave and think while helping the change the way they think to change their problematic behaviors. Harm reduction training aids the families of individuals with hoarding who refuse treatment in skills to help them reduce the dangers associated with hoarding. The family-as-motivators (FAM) training is for family members to learn how to apply motivational interviewing techniques and coping strategies. The FAM training is aimed at increasing the individual’s readiness to seek treatment and increase the well-being of family members. Medication can aid in problems associated with a drastic life change such as anxiety over having to get rid of items.

Cognitive Behavioral Therapy

Cognitive behavioral therapy has been shown to be highly effective in several clinical trials with varying modifications such as blended and contingency management. A newer form of CBT treatment for hoarding involves the use of online counseling. Blended therapy and via webcam have both been researched and found to do as well as traditional forms of CBT (Fitzpatrick, Nedeljkovic, Abbott, Kyrios, & Moulding, 2018; Muroff & Steketee, 2018). In Blended treatment program for hoarding disorder (HoPE) the clients go through a series of face-to-face group sessions followed by online therapists assisted therapy for several weeks (Fitzpatrick, Abbott, Kyrios, & Moulding, 2018). The researchers found that the HoPE treatment was as effective as other models of CBT which include aftercare treatment modalities. Research suggests that treatments with a longer time of aftercare can account for the improved reduction in clutter even after CBT training has ended (Fitzpatrick, Abbott, Kyrios, & Moulding, 2018; Muroff & Steketee, 2018; Worden, Bowe, & Tolin, 2017).

Cognitive behavioral therapy-web (CBT-W) is a home-based treatment for a hoarding disorder which can reduce barriers to accessibility to treatment because of disabilities or financial issues (Muroff & Steketee, 2018). Another benefit from CBT-W is that clients can have several sessions within one week, as opposed to most weekly treatment therapies. More sessions have several possible benefits for an individual with hoarding disorder. For instance, there may be an aspect of more accountability because the individual will not be as tempted to wait till right before the following session to follow through on their assignments. Muroff and Steketee (2018) found that the therapy worked as well as other forms of CBT and that longer therapy increases the positive outcome of CBT-W. Therapists and client relationship is an important factor for any therapy. Clients in the CBT-W study believed they were able to form a positive alliance with their therapists over the web which may explain some of the success of CBT-W.

Worden, Bowe, and Tolin (2017) found that CBT with contingency management for hoarding disorder was a viable and promising modification of CBT. In CBT with contingency management the token or reward system is used to aid in changing the behaviors of individuals with hoarding disorder. Every four weeks an evaluator would complete a home visit and perform a clutter image rating scale (CIR). The client would then receive a reward for every point in the reduction of the clutter plus a contingency for every point from the previous visit. The outcome was positive and cost effective even with the monetary award the clients had received. The researchers note that even though people may argue that rewarding an individual will decrease their motivation, they do not believe it will occur in different populations. Worden, Bowe, and Tolin (2017) point to studies where contingency management has been successful, such as substance use disorders and argues it may be different for adults than for a child.

Family Programs

Family training programs are useful to help reduce the harms associated with hoarding, such as falls and rodents which are not only harmful for the individual but their family as well (Chasson, Carpenter, Ewing, Gibby, & Lee, 2014; Tompkins, 2011). Family involvement is helpful in many therapy situations and can be a valid motivation for changing, disruptive or harmful behaviors when used appropriately. A harm reduction approach is a successful treatment which was originally used to reduce risk in intravenous drug use (Tompkins, 2011). Individuals with hoarding may become angered when confronted by family members over their hoarding and may increase the hoarding behaviors (Tompkins, 2011). Furthermore, many times families only exacerbate the problem by trying to seek help for the individual without them knowing (Chasson, Carpentar, Gibby, & Lee, 2014; Tompkins, 2011). Family members may make the problem worse by rejecting the individual which may in part be because of the families exaggerated severity of the hoarding (Chasson, Carpentar, Gibby, & Lee, 2014).

The first step in harm reduction is to involve the individual in the approach which is generally accomplished through motivational interviewing (Tompkins, 2011). The harm reduction team must then be gathered and should include anyone who has a stake in the well-being of the individual, such as friends or social worker. An assessment of the potential harm to the individual must be made through home visits by the clinician. The final two steps in harm reduction is to develop a plan and implement it. Harm reduction does not focus on immediately removing items, instead it focuses on ways to gradually get the individual to stop the behavior (Tompkins, 2011). Family-as-motivators (FAM) involves the family in various training including psychoeducation, harm reduction, and motivational interviewing (Chasson, Carpentar, Gibby, & Lee, 2014). Psychoeducation involves the educating the family members on the various research concerning hoarding disorder. As previously mentioned harm reduction are techniques useful for removing or controlling the harm associated with hoarding. Motivational interviewing is a technique to help individual resolve any ambivalent emotions or insecurities, so they may find their own motivation for changing problem behaviors.