Hoarding Research Team

This project directed by Dr. Gail Steketee at Boston University was also a collaborative study with Dr. Randy Frost at Smith College and Dr. David Tolin at Hartford Hospital. The study is now completed, and findings are being analyzed under the direction of Dr. Timothy Brown at Boston University. The project developed and tested a multi-component treatment that was based on the features of hoarding we had observed and on our theoretical model of this complex syndrome. During the course of this three-year study, we developed a therapy that includes motivational interventions, training in organizing and decision-making skills, cognitive therapy, and exposure to removing unwanted items to reduce clutter.

In our first test of this therapy in 10 clients with compulsive hoarding, we achieved good results—approximately 50% of clients who received 26 sessions of treatment over a period of 9–12 months were considered much or very much improved after treatment (Tolin, Frost & Steketee, 2007). We then revised the manual, which is available as a therapist guide and client workbook and published by Oxford University Press.

We tested the treatment in a second study compared to a wait list control condition. Eighteen clients were placed on a wait list for 12 weeks (no treatment) while another 18 clients received active treatment. The clients in the active therapy condition improved significantly more than those on the wait list, even after the relatively short period of 12 weeks. After everyone in both groups had received the full 26 sessions of hoarding treatment we examined how well they did—this time 70% were considered much or very much improved. We are writing these results for publication and will soon be examining factors that predict whether clients benefit from this therapy.

Prior to this project, there were no studies examining Internet-based self-help groups for compulsive hoarding. This research study tested the effectiveness of online cognitive behavioral therapy (CBT) group interventions by studying a pre-existing Internet group of individuals with compulsive hoarding.  The group intervention was designed to help individuals better manage their hoarding symptoms.

The Internet group participating in the study had well-established procedures, including: an application process; a requirement that participants actively take steps to reduce compulsive hoarding within two months of membership; and a willingness to post behavioral goals and progress on the website at least once per month. The group format was based on CBT methods, and members had access to mental health information, educational resources, tips on how to dehoard/declutter and organize, thought records, cognitive strategies, lists of professional contacts, and a real-time chat room.

Compulsive hoarding is a disabling and distressing problem that can be difficult to manage and overcome. This research provided additional information about the effectiveness of hoarding-specific CBT methods.

Internet-based self-help for compulsive hoarding may be helpful in relieving symptoms, building motivation, and reducing loneliness. Additionally, such resources may extend access to mental health care, complement existing evidence-based practices, reduce treatment costs, and appeal to individuals concerned about the stigma surrounding mental health treatments. Evaluating the benefits of web-based self-help and peer intervention groups is critical, given the growing popularity of and demand for web interventions.

This is a collaborative project by Dr. Gail Steketee at Boston University, Dr. Randy Frost at Smith College, and Dr. David Tolin at Hartford Hospital. Funded by the National Institute of Mental Health, the project recruited people with hoarding problems, people with obsessive compulsive disorder (OCD), and people from the community. Participants were recruited at Boston University and at Hartford Hospital for three studies.

The first study was an interview to help us learn more about hoarding problems, including personal and family histories and the relationship of hoarding to other psychological disorders like OCD, and to explore possible etiological features. This study also helped us refine our measures of hoarding symptoms and severity. The second aim was to investigate behavioral, emotional, and cognitive features of hoarding when people engage in actual discarding at home and in acquiring tasks in places that trigger their urges to acquire. We anticipate that analysis of our findings will improve the understanding of hoarding symptoms and the relationship of hoarding to OCD and other disorders, and will also provide a sound basis for refining treatment strategies.

Group treatment may be an especially useful strategy to help people with compulsive hoarding. A group therapy structure can not only decrease social isolation but also increase motivation; both are substantial obstacles for many individuals with compulsive hoarding. This research study examines the effectiveness of specialized group cognitive behavioral therapy (CBT) for treating individuals with compulsive hoarding.

With this structure, group members meet for two hours each week over a period of 16 to 20 weeks. In addition, there are three 90-minute individual home sessions for each participant. Participants complete self-report assessments at the beginning, middle, and end of treatment. These assessments deal with their hoarding behavior and any related symptoms (for example, depression).

Group treatment may be especially useful because it increases access to trained clinicians for compulsive hoarding, it is highly cost effective for both individuals seeking therapy as well as clinics providing treatment, and it can help reduce the social isolation and stigma linked with compulsive hoarding.