Cognitive Rehabilitation and Exposure Therapy for Hoarding Disorder

(CREST Trial)

Overseen By Philip Salas, MFT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Diego

Must not be taking: Benzodiazepines

Disqualifiers: Psychosis, Mania, Neurodegenerative, Substance use, others

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

Compensation: Varies

Number of Visits: 17

Duration: 32 weeks

150 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that participants have been stable on their medications for at least 8 weeks, so you should not need to stop taking your current medications unless you are using benzodiazepines, which are not allowed.

What data supports the effectiveness of the treatment Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder?

Research shows that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) is effective in reducing hoarding symptoms in older adults, with improvements in executive functioning (mental skills used in managing tasks) and reductions in anxiety and depression. Studies also indicate that CREST leads to significant decreases in hoarding severity compared to other treatments. ^{1 2 3 4 5}

Is Cognitive Rehabilitation and Exposure Therapy safe for humans?

The studies on Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for hoarding disorder in older adults did not report any safety concerns, suggesting it is generally safe for humans. ^{1 2 3 4 6}

How is the treatment CREST different from other treatments for hoarding disorder?

CREST is unique because it combines cognitive rehabilitation, which helps improve thinking skills, with exposure and sorting therapy, which involves gradually facing and organizing clutter. This approach not only reduces hoarding symptoms but also improves executive functioning (mental skills like planning and problem-solving) in older adults, making it more effective than traditional cognitive-behavioral therapy alone. ^{1 2 3 4 7}

What is the purpose of this trial?

Hoarding disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and public consequences, particularly for older adults. This confirmatory efficacy trial will advance our knowledge of the mechanisms of action in the treatment of HD as well as reduce symptom severity, disability, and community consequences.

Research Team

Catherine Ayers, PhD

Principal Investigator

University of California, San Diego

Eligibility Criteria

This trial is for adults aged 50 or older who have been diagnosed with Hoarding Disorder (HD) as their primary condition and are stable on medications. They must understand and agree to participate voluntarily. People with current psychosis, substance use disorders, benzodiazepine use, suicidality, neurodegenerative diseases, or those already in exposure therapy cannot join.

Inclusion Criteria

HD as a primary, most severe diagnosis

Voluntary informed consent for participation

Stable on medications for at least 8 weeks

Exclusion Criteria

Substance use disorder

Suicidality

Current participation in exposure-based therapy

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with 26 weekly sessions over 32 weeks

32 weeks

13 visits (in-home), 13 visits (office)

Mid-treatment Evaluation

Evaluation of treatment outcome, including hoarding severity and functional outcomes

3 months

1 visit (in-person)

End of Treatment Evaluation

Final evaluation of treatment outcome, including hoarding severity and functional outcomes

6 months

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

2 visits (in-person)

Treatment Details

Interventions

• Case Management
• Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST)

Trial Overview The study tests Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) combined with Case Management against HD symptoms in older adults. It aims to understand how these treatments work and reduce the severity of hoarding behaviors as well as associated disability.

Participant Groups

Group I: Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) Experimental Treatment 1 Intervention

Compensatory Cognitive Training (CCT) Modules (7 sessions). Compensatory Cognitive Training is a manualized, low-tech, cognitive training intervention designed to target cognitive impairments common in people with psychiatric illnesses. The CCT modules specifically selected for CREST map onto known areas of HD neurocognitive impairments and include training in prospective memory, prioritizing, problem solving, planning, and cognitive flexibility. Exposure to Discarding and Acquiring Modules (19 sessions). Symptoms of acquiring and saving are themselves avoidance behaviors to avoid internal distress related to negative thoughts and emotions. ET utilizes in vivo exposure exercises taking place in the home to enhance generalization of their new skills. Fear hierarchies typically start with a space that has low clutter volume or there is less of an urge to save a particular type of item in that environment.

Group II: Case Management (CM) Active Control 1 Intervention

Case Management (CM). CM consists of a set of well-established strategies commonly used in community service settings to address serious and complex problems in particularly vulnerable and often marginalized populations such as those with HD.

Who Is Running the Clinical Trial?

University of California, San Diego

Lead Sponsor

Trials

1,215

Recruited

1,593,000+

Findings from Research

The community-based intervention using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) showed significant improvements in hoarding severity and clutter volume among older adults with hoarding disorder, with 15 out of 37 participants completing the treatment in the first two years.

The successful implementation of the CREST intervention in clients' homes and community settings led to funding for program expansion, indicating its effectiveness and potential for broader application in San Diego County.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation and evaluation of a community-based treatment for late-life hoarding. Pittman, JOE., Davidson, EJ., Dozier, ME., 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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Implementation and evaluation of a community-based treatment for late-life hoarding. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Cognitive Rehabilitation and Exposure/Sorting Therapy for Late-Life Hoarding: Effects on Neuropsychological Performance. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Group Cognitive Rehabilitation and Exposure/Sorting Therapy: A Pilot Program. [2022]

5. United States 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. [2022]

6. England pubmed.ncbi.nlm.nih.gov

An intensive time-series evaluation of the effectiveness of cognitive behaviour therapy for hoarding disorder: a 2-year prospective study. [2019]

7. England pubmed.ncbi.nlm.nih.gov

Therapist and patient perspectives on cognitive-behavioral therapy for older adults with hoarding disorder: a collective case study. [2021]