How Effective is Cognitive Behavioral Therapy for Hoarding Disorder?

What you need to know

• Cognitive behavioral therapy (CBT) is effective for treating hoarding disorder, with large improvements in hoarding symptoms after treatment
• CBT for hoarding disorder also leads to small improvements in depressive symptoms
• Treatment was equally effective whether delivered individually or in a group format
• More research is needed on the long-term effects of CBT for hoarding disorder

What is hoarding disorder?

Hoarding disorder is a mental health condition characterized by difficulty discarding or parting with possessions, regardless of their actual value. People with hoarding disorder experience distress at the thought of getting rid of items and may excessively acquire new possessions. The clutter that accumulates can make living spaces unusable and create health and safety hazards.

Hoarding disorder affects approximately 2.5% of people. It often has a significant negative impact on a person’s daily functioning and relationships. Many people with hoarding disorder also experience other mental health conditions, particularly depression.

How is hoarding disorder treated?

Cognitive behavioral therapy (CBT) is considered the gold standard psychological treatment for hoarding disorder. CBT for hoarding typically includes:

• Practicing sorting and discarding items
• Exposure exercises to resist acquiring new items
• Challenging unhelpful thoughts and beliefs related to possessions
• Skills training to improve organization, decision-making, and problem-solving
• Motivational enhancement techniques

CBT for hoarding disorder often involves 20 or more therapy sessions. Some treatment programs also incorporate home visits where the therapist assists with decluttering and organizing in the person’s home environment.

What did this study examine?

This study was a meta-analysis, which means it combined and analyzed the results of multiple previous studies on CBT for hoarding disorder. The researchers aimed to update previous meta-analyses by including newer studies and examining additional factors.

Specifically, they looked at:

1. How effective is CBT at reducing hoarding symptoms?
2. How long do improvements in hoarding symptoms last after treatment ends?
3. How effective is CBT at reducing depressive symptoms in people with hoarding disorder?
4. What factors influence how effective the treatment is?

The analysis included 16 studies with a total of 505 participants who received CBT for hoarding disorder.

How effective is CBT for hoarding disorder?

The meta-analysis found that CBT leads to large improvements in hoarding symptoms from before to after treatment. The average effect size was 1.11, which is considered large. This means that on average, people’s hoarding symptoms decreased substantially after completing CBT.

Only a few studies examined long-term effects, but the available data showed that improvements were maintained 3-6 months after treatment ended. The effect size for pre-treatment to follow-up was 1.25, indicating that gains were not only maintained but potentially increased slightly over time.

These results suggest that CBT is an effective treatment for reducing hoarding symptoms, with benefits that persist for at least several months after treatment. However, more research is needed on long-term outcomes beyond 6 months.

Does CBT for hoarding disorder improve depression?

Many people with hoarding disorder also experience depression. The researchers found that CBT for hoarding led to small improvements in depressive symptoms, with an effect size of 0.45. This indicates that while the treatment’s primary focus is on hoarding, it may have some positive effects on mood as well.

However, the improvements in depression were much smaller than the improvements in hoarding symptoms. This suggests that people with significant depression may benefit from additional treatment specifically targeting their mood symptoms.

What factors influence treatment effectiveness?

The researchers examined several factors to see if they affected how well CBT worked for hoarding disorder:

• Individual vs. group treatment: Both individual and group CBT were equally effective.
• Therapist training: Licensed therapists and therapists-in-training achieved similar outcomes.
• Home visits: Including home visits as part of treatment did not significantly improve outcomes compared to office-based treatment alone.
• Treatment length: The number of weeks of treatment did not affect outcomes.
• Participant age: The average age of participants did not influence treatment effectiveness.
• Gender: Studies with a higher percentage of female participants showed slightly better outcomes.

Overall, CBT for hoarding disorder appears to be effective across different treatment formats and for different types of patients. The finding that group treatment is as effective as individual treatment is particularly encouraging, as group therapy can be a more cost-effective option.

Limitations and future directions

While this meta-analysis provides valuable insights into the effectiveness of CBT for hoarding disorder, there are some important limitations to keep in mind:

• Most studies did not include a control group, making it difficult to definitively attribute improvements to the treatment itself rather than other factors.
• Only a few studies examined long-term outcomes beyond the end of treatment.
• The analysis could not examine factors like specific CBT techniques or patient characteristics that may influence outcomes.

Future research should address these limitations through:

• More randomized controlled trials comparing CBT to other treatments or wait-list control groups
• Longer-term follow-up assessments (e.g. 1-2 years after treatment)
• Examining how specific components of CBT contribute to improvement
• Identifying patient characteristics that predict better or worse treatment outcomes

Additionally, given the modest effects on depression, more research is needed on how to effectively address mood symptoms in people with hoarding disorder. This may involve combining hoarding-focused CBT with depression-specific interventions.

Conclusions

• CBT is an effective treatment for hoarding disorder, leading to large improvements in hoarding symptoms that are maintained for at least several months.
• CBT for hoarding also produces small improvements in depressive symptoms, though additional interventions may be needed for patients with significant depression.
• Both individual and group CBT appear to be equally effective treatment formats.
• More research is needed on long-term outcomes and factors that influence treatment effectiveness.

For individuals struggling with hoarding disorder, these results offer hope that effective treatment is available. CBT can lead to meaningful reductions in hoarding symptoms and may also provide some mood benefits. The effectiveness of group treatment also means that more people may be able to access care.

While questions remain about optimizing and personalizing treatment, CBT represents an evidence-based option for those seeking help with hoarding. Individuals interested in treatment should consult with a mental health professional to determine the best approach for their specific situation.