130 Participants Needed

Cognitive Rehabilitation for Hoarding Disorder

(CREST Trial)

PA
CR
Overseen ByCatherine R Ayers, PhD
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: VA Office of Research and Development
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Approved in 1 JurisdictionThis treatment is already approved in other countries

Trial Summary

What is the purpose of this trial?

Hoarding Disorder (HD) is serious and disabling in Veterans. Present in up to 7% of Veterans and even higher symptom rates in older Veterans; HD contributes to functional impairment and poor quality of life. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) has shown promising functional improvement and symptom reduction. To reduce burdens and barriers to implementation of CREST, the proposed project will individualize CREST based on cognitive testing and participant preferences, provide all care in the participant's home through telemedicine and home visits, and shorten the timeframe of treatment. A randomized controlled trial comparing 24 sessions of Personalized-CREST to case management for 130 adult Veterans with HD is proposed. Multifaceted functional and recovery outcomes including quality of life, HD severity, and sustained recovery outcomes will be examined throughout treatment and follow-up. By advancing the knowledge of the rehabilitative care of HD, we can interrupt the trajectory of this chronic and debilitating condition.

Will I have to stop taking my current medications?

The trial requires that participants be stable on their medications for at least 6 weeks, so you will not need to stop taking your current medications.

What data supports the effectiveness of this treatment for hoarding disorder?

Research shows that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) can be effective for hoarding disorder, especially in older adults, by improving organization and reducing clutter. Additionally, group cognitive-behavioral therapy (CBT) has been shown to help reduce hoarding symptoms and improve related issues like anxiety and depression.12345

Is Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) safe for humans?

The research on Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for hoarding disorder in older adults does not report any safety concerns, suggesting it is generally safe for humans.13456

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

Personalized-CREST is unique because it combines cognitive rehabilitation, which helps improve thinking skills, with exposure and sorting therapy, which involves practicing decision-making about keeping or discarding items. This approach specifically targets the cognitive and decision-making difficulties associated with hoarding disorder, unlike standard cognitive-behavioral therapy (CBT) that primarily focuses on changing thought patterns and behaviors.13456

Research Team

CR

Catherine R Ayers, PhD

Principal Investigator

VA San Diego Healthcare System, San Diego, CA

Eligibility Criteria

This trial is for adult Veterans diagnosed with Hoarding Disorder (HD) as their primary condition. Participants must be stable on medications for at least six weeks, voluntarily consent to join, and not have any neurodegenerative diseases or current psychosis. They should also not be undergoing any exposure-based psychotherapy.

Inclusion Criteria

DSM-5 diagnosis of HD as measured by the Structured Interview for Hoarding Disorder
My primary diagnosis is Huntington's disease and I've been stable on my medications for at least 6 weeks.
I have agreed to participate in this study willingly.

Exclusion Criteria

current psychosis or mania as measured by the Mini-International Neuropsychiatric Interview
suicide ideation will be monitored by the clinicians during sessions and VA standard suicide measure will be completed at all assessment points
You are currently undergoing any type of exposure-based psychotherapy.
See 1 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Personalized-CREST or case management for 12 weeks, with 24 sessions delivered twice a week in the home

12 weeks
24 visits (12 in-person, 12 virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months
3 visits (in-person)

Treatment Details

Interventions

  • Case Management
  • Personalized-CREST
Trial Overview The study tests a personalized Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), delivered via telemedicine and home visits over 24 sessions, against standard case management. The aim is to improve function and quality of life in Veterans with HD.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: CRESTExperimental Treatment1 Intervention
Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) provides training in compensatory cognitive strategies to address the executive dysfunction typical of individuals with HD, then helps reduce the distress associated with discarding items via exposure therapy.
Group II: Case ManagementActive Control1 Intervention
Case Management (CM). CM is the most widely available and utilized intervention for HD and is considered standard of care. This form of treatment involves managing the functional, housing, and legal ramifications of HD. Additionally, CM often involves assistance with economic, health, and social resources while providing support for the client.

Personalized-CREST is already approved in United States for the following indications:

🇺🇸
Approved in United States as Personalized-CREST for:
  • Hoarding Disorder

Find a Clinic Near You

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials
1,691
Recruited
3,759,000+

San Diego Veterans Healthcare System

Collaborator

Trials
38
Recruited
5,500+

Findings from Research

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.
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]
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.
Neuropsychological functioning in hoarding disorder.Tolin, DF., Villavicencio, A., Umbach, A., 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.
Implementation and evaluation of a community-based treatment for late-life hoarding.Pittman, JOE., Davidson, EJ., Dozier, ME., et al.[2022]

References

Group cognitive-behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: An open trial. [2019]
Neuropsychological functioning in hoarding disorder. [2021]
Implementation and evaluation of a community-based treatment for late-life hoarding. [2022]
Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial. [2021]
Comparison of a peer facilitated support group to cognitive behavior therapy: Study protocol for a randomized controlled trial for hoarding disorder. [2022]
Cognitive Rehabilitation and Exposure/Sorting Therapy for Late-Life Hoarding: Effects on Neuropsychological Performance. [2021]
Unbiased ResultsWe believe in providing patients with all the options.
Your Data Stays Your DataWe only share your information with the clinical trials you're trying to access.
Verified Trials OnlyAll of our trials are run by licensed doctors, researchers, and healthcare companies.
Back to top
Terms of Service·Privacy Policy·Cookies·Security