Cognitive Rehabilitation for Hoarding Disorder

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Miami

Must not be taking: Psychotropics

Disqualifiers: Under 18, Over 85, Dementia, Psychosis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 20 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a 20-week group course that combines cognitive rehabilitation (learning new thinking skills) and exposure therapy (gradually facing fears about items) to help reduce compulsive hoarding behaviors. The goal is to determine if these methods can decrease the distress and difficulty in making decisions about keeping or discarding possessions. It suits English-speaking individuals with noticeable hoarding issues who are not dealing with severe cognitive or substance-related problems. Participants should not currently be in other therapy or have recently changed their mental health medications. As an unphased trial, this study offers a unique opportunity to explore innovative treatments for hoarding behaviors.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you may be excluded if you have changed your psychotropic medications (medications affecting the mind) within three months of starting the trial.

What prior data suggests that this protocol is safe for participants?

Research has shown that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for hoarding disorder is generally safe. Studies have not identified any specific safety issues with this treatment. Participants in earlier studies found it helpful in reducing hoarding symptoms and improving thinking and decision-making skills. This suggests that the treatment is well-tolerated by those who have tried it. The available data reports no major side effects, which is reassuring for those considering joining a trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Cognitive Rehabilitation and Exposure-based Class for Compulsive Hoarding because it combines cognitive training with exposure therapy, offering a unique dual approach. Unlike standard treatments like cognitive-behavioral therapy alone, this method starts with cognitive training to enhance decision-making skills, helping participants learn new strategies to manage their hoarding behaviors. The exposure therapy component gradually introduces participants to the anxiety-provoking process of discarding, aiming to reduce distress and improve their ability to make choices about possessions over time. This innovative combination targets both cognitive processes and emotional responses, potentially providing more comprehensive relief for those with hoarding disorder.

What evidence suggests that this protocol is effective for hoarding disorder?

Research has shown that Cognitive Rehabilitation and Exposure Therapy (CREST), which participants in this trial will receive, helps reduce hoarding symptoms. One study found that CREST was more effective than standard care for older adults in reducing these symptoms. Specifically, 77% of those who completed the treatment had much lower hoarding severity scores, indicating significantly less severe symptoms. Additionally, 62% of participants showed significant improvement. These results suggest that this combined approach can help individuals make better decisions about their belongings and feel less stressed when organizing or discarding items. ^{2 4 6 7 8}

Who Is on the Research Team?

Kiara R Timpano, PhD

Principal Investigator

University of Miami

Are You a Good Fit for This Trial?

This trial is for adults with hoarding disorder, as confirmed by specific interviews and questionnaires. They can have other mood or anxiety disorders and be pregnant. Exclusions include recent medication changes, other psychotherapies, primary diagnoses other than hoarding, cognitive impairments like dementia, substance abuse issues, prisoners, and those under 18 or over 85.

Inclusion Criteria

Individuals who exhibit subclinical and clinical levels of hoarding disorder, as determined by the SCID interview conducted at the screening assessment, will be eligible to participate in the study. Individuals may also display clinically relevant symptoms of hoarding as indicated by scores on the Hoarding Rating Scale Interview (HRS-I) and/or on the Saving Inventory-Revised (SIR)

English-speaking

Pregnant women

Exclusion Criteria

I am over 85 years old.

Participants may be excluded if hoarding is not their primary diagnosis

Prisoners

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a 20-week group cognitive rehabilitation and exposure therapy course for compulsive hoarding

20 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Cognitive Rehabilitation and Exposure-based Class for Compulsive Hoarding

Trial Overview The study tests a structured 20-week group class combining cognitive rehabilitation (CR) and exposure therapy (ET) to reduce symptoms of compulsive hoarding. The goal is to see if this course helps people manage their hoarding behavior better than before.

How Is the Trial Designed?

Group I: Cognitive Rehabilitation and Exposure-based Class for Compulsi Experimental Treatment 1 Intervention

Cognitive training is to improve thinking by learning new skills and strategies. The class begins with cognitive training to increase ability to carry out the skills learned later in treatment. Exposure therapy for discarding and acquiring helps to improve ability to make choices about possessions and learn to tolerate anxiety. Participants will face making difficult choices about items and potentially letting them go. Through repeated exposure to decisions about discarding and acquiring, distress about letting go or making choices about items will decrease over time.

Who Is Running the Clinical Trial?

University of Miami

Lead Sponsor

Trials

976

Recruited

423,000+

Published Research Related to This Trial

A non-inferiority trial is being conducted to compare the effectiveness of group cognitive-behavioral therapy (CBT) and a structured support group called Buried in Treasures (BiT) for treating hoarding disorder, involving 300 participants over 16 weeks.

The primary goal of the study is to assess whether BiT can effectively reduce hoarding symptoms to a level comparable to that of traditional CBT, potentially increasing treatment accessibility for individuals with hoarding disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of a peer facilitated support group to cognitive behavior therapy: Study protocol for a randomized controlled trial for hoarding disorder. Uhm, SY., Tsoh, JY., Mackin, RS., et al.[2022]

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) was found to be more effective than geriatric case management (CM) in reducing hoarding symptoms among older adults, with a 38% decrease in symptoms for CREST participants compared to a 25% decrease for CM participants.

Both treatments showed lasting benefits, as improvements were maintained at a 6-month follow-up, indicating that while CREST is more efficacious, CM also provides meaningful support for individuals with hoarding disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial. Ayers, CR., Dozier, ME., Twamley, EW., et al.[2021]

Hoarding disorder (HD) patients demonstrated significant difficulties in sustaining attention and using adaptive memory strategies compared to healthy controls, indicating neurocognitive challenges associated with the disorder.

While HD and obsessive-compulsive disorder (OCD) patients did not show significant differences in neuropsychological performance, a higher percentage of HD patients (67%) scored in the impaired range on at least one test, suggesting a distinct cognitive profile for HD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuropsychological functioning in hoarding disorder. Tolin, DF., Villavicencio, A., Umbach, A., et al.[2021]

A randomized controlled trial showed that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) effectively reduced hoarding symptoms in older adults with hoarding disorder (HD).

Participants receiving CREST also demonstrated significant improvements in cognitive flexibility and inhibition, suggesting that this therapy may enhance executive functioning in addition to alleviating hoarding symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Rehabilitation and Exposure/Sorting Therapy for Late-Life Hoarding: Effects on Neuropsychological Performance. Ayers, CR., Davidson, EJ., Dozier, ME., et al.[2021]

In a pilot study involving 16 participants with hoarding disorder, group cognitive-behavioral therapy (G-CBT) demonstrated very large to large effect sizes in reducing hoarding severity immediately after treatment and maintained improvements at a 6-month follow-up.

The inclusion of targeted reasoning and self-identity components in G-CBT further enhanced its efficacy, indicating that these elements may be beneficial in treating hoarding disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group cognitive-behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: An open trial. O'Connor, K., Bodryzlova, Y., Audet, JS., et al.[2019]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05254015

Cognitive Rehabilitation and Exposure Therapy for ... Data collected from this project includes self-report, observational, paradigm and physiology de-identified data from participants with hoarding disorder.

2. withpower.com withpower.com/trial/cognitive-rehabilitation-for-hoarding-disorder-045f2

Cognitive Rehabilitation for Hoarding Disorder Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) was found to be more effective than geriatric case management (CM) in reducing hoarding symptoms ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9063579/

Hoarding Disorder: Development in Conceptualization ... Of the participants who completed the treatment, 77% had severity scores below the cutoff for clinically significant hoarding, and 62% of participants achieved ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S0022395624007313

Psychological interventions for hoarding disorder Online group for HD, members must post to show they are actively taking steps to reduce hoarding. Group, 49.73, 92.7, 87.50%, 0, US, Self-identified. Hoarders

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4048717/

Cognitive-behavioral therapy for geriatric compulsive ... In an open trial of standard CBT in a sample of 10 hoarders, Tolin, Frost, and Steketee (2007) found significant improvements on self-reported hoarding severity ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7295125/

Cognitive Rehabilitation and Exposure/Sorting Therapy ... Hoarding disorder (HD) is a chronic and progressive psychiatric condition that leads to far-reaching community consequences, particularly in later life.

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2211364921000026

Self-reported helpfulness of Cognitive Rehabilitation and ... A randomized controlled trial of CREST found it to be favorable to case management for reducing hoarding symptoms and improving executive functioning. The ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7483985/

Implementation and evaluation of a community-based ... The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive ...