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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores new methods to assist individuals with hoarding disorder, a condition that makes discarding items difficult and can lead to significant life challenges. It evaluates two treatments: Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), which teaches skills to enhance memory and problem-solving, and Case Management, which helps manage the stress of discarding items. Adults aged 50 and older with hoarding disorder who have been stable on their medications for at least eight weeks may be suitable candidates. The trial aims to determine the effectiveness of these treatments in reducing symptoms and improving daily life. As an unphased trial, it provides a unique opportunity to investigate innovative treatments that could greatly enhance quality of life.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) has been tested for its effects on hoarding disorder. One study demonstrated a significant reduction in hoarding symptoms, indicating substantial improvement for participants. Another study found that individuals using CREST improved by 36% in hoarding-related issues, compared to a 13% improvement in those receiving standard care.

Overall, CREST appears to be safe and effective. These studies reported no serious side effects, suggesting that CREST might be a safe option for reducing hoarding symptoms. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about CREST, or Cognitive Rehabilitation and Exposure/Sorting Therapy, because it combines cognitive training with exposure therapy to tackle hoarding disorder in a novel way. Unlike traditional treatments that might focus solely on behavioral interventions, CREST addresses cognitive impairments like memory and problem-solving skills, which are common in people with hoarding disorder. Furthermore, the exposure therapy component directly targets the distress associated with discarding and acquiring items by using real-life, in-home exercises. This dual approach not only aims to reduce clutter but also enhances cognitive flexibility, making it a promising alternative to existing options.

What evidence suggests that this trial's treatments could be effective for hoarding disorder?

Research shows that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), one of the treatments in this trial, significantly reduces hoarding disorder symptoms. In a study with older adults, participants experienced a substantial drop in hoarding severity after receiving this treatment. CREST also improved performance in tasks requiring focus-switching, outperforming other methods. This trial will compare CREST with Case Management (CM), another treatment option. Studies have found CREST more effective than CM for older adults, although both treatments offer benefits. Overall, CREST effectively reduces hoarding behaviors and enhances related cognitive skills. ^{1 3 4 6 7}

Who Is on the Research Team?

Catherine Ayers, PhD

Principal Investigator

University of California, San Diego

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

Citations

1.

pmc.ncbi.nlm.nih.gov

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

Cognitive Rehabilitation and Exposure/Sorting Therapy ...

An open trial of CREST in older adults with HD showed significant improvement in hoarding severity from baseline to posttreatment, with large effect sizes (d = ...

2.

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.

3.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/28541646/

Cognitive Rehabilitation and Exposure/Sorting Therapy ...

CREST appears to be an efficacious treatment compared to CM for older adults, but CM also showed meaningful benefits.

4.

ajgponline.org

ajgponline.org/article/S1064-7481(24)00143-X/fulltext

Outcomes of Exposure Based Treatment for Hoarding ...

Exposure based treatment is highly effective for HD. Both CREST and ET groups demonstrated significant reductions in HD symptoms as well as improvements on ...

5.

biologicalpsychiatryjournal.com

biologicalpsychiatryjournal.com/article/S0006-3223(24)00259-2/fulltext

Outcomes of Exposure Based Treatment for Hoarding ...

Neuropsychological tests scores improved for both groups, but with CREST demonstrated greater improvement in visual task-switching at baseline (b=0.803, p=0.036) ...

6.

sciencedirect.com

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

Self-reported helpfulness of Cognitive Rehabilitation and ...

Those in CREST averaged a 36% improvement in hoarding-related functional impairments versus a 13% reduction for the CM group. Those in the CREST group ...

7.

withpower.com

withpower.com/trial/phase-2-disease-2-2022-2f223

Cognitive Rehabilitation and Exposure Therapy for ...

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