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

200 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Cognitive Rehabilitation and Exposure-based Class for Compulsive Hoarding?

Research shows that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) is effective in reducing hoarding symptoms in older adults and may also improve executive functioning (mental skills like planning and organizing). ^{1 2 3 4 5}

Is Cognitive Rehabilitation and Exposure-based Class for Compulsive Hoarding safe for humans?

The studies on Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for hoarding disorder in older adults do not report any specific safety concerns, suggesting it is generally safe for human use. ^{1 2 3 6 7}

How is the Cognitive Rehabilitation and Exposure-based Class for Compulsive Hoarding treatment different from other treatments for hoarding disorder?

This treatment is unique because it combines cognitive rehabilitation, which helps improve thinking skills, with exposure therapy, which involves gradually facing fears related to discarding items. It has shown effectiveness in reducing hoarding symptoms and improving executive functioning (mental skills used in managing tasks) in older adults, unlike traditional cognitive-behavioral therapy that may not fully address these cognitive deficits. ^{1 3 8 9 10}

What is the purpose of this trial?

The purpose of this protocol is to investigate the effectiveness of a manualized, 20-week group cognitive rehabilitation (CR) and exposure therapy (ET) course for compulsive hoarding. The overarching aim is to understand whether this course will decrease the core symptoms of hoarding and associated features.

Research Team

Kiara R Timpano, PhD

Principal Investigator

University of Miami

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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]

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]

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]

References

1. 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]

2. 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]

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

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

4. Ireland pubmed.ncbi.nlm.nih.gov

Neuropsychological functioning in hoarding disorder. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral therapy for geriatric compulsive hoarding. [2021]

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

Group cognitive-behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: An open trial. [2019]

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

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

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

Cognitive behavior therapy for hoarding disorder: follow-up findings and predictors of outcome. [2022]

10. Germany pubmed.ncbi.nlm.nih.gov

[Hoarding as a Disorder of the Obsessive-Compulsive Spectrum]. [2018]