Hoarding Disorder
Conditions
Keywords
hoarding disorder, intolerance of uncertainty, experiential avoidance, imaginal exposure, clutter, attachment
Brief summary
The present study will test a potential new treatment strategy, imaginal exposure, for hoarding disorder. Although cognitive behavioral therapy often reduces hoarding, some people do not want to start, or cannot handle, that option. To help such individuals, the present study will provide imaginal exposure therapy to people with hoarding disorder, wherein they imagine discarding possessions as a way of becoming acclimated to the idea. We predict that imaginal exposure will improve hoarding symptoms as well as two psychological experiences linked to the condition: intolerance of uncertainty and emotional avoidance.
Detailed description
Hoarding disorder is a common mental illness characterized by difficulty parting with possessions and by clutter that makes living spaces unusable. Cognitive behavioral therapy (CBT) is an effective treatment for hoarding disorder, but new approaches are needed to engage those who are reluctant to start or cannot tolerate CBT. Both intolerance of uncertainty and emotional avoidance are linked to hoarding disorder and may interfere with treatment engagement. Imaginal exposure, a therapeutic technique which involves repeatedly imagining feared scenarios and experiencing the evoked emotions, effectively targets both intolerance of uncertainty and emotional avoidance. The present study is the first to test whether imagining discarding possessions can improve hoarding symptoms more than does a control exercise. We hypothesize that compared to a control exercise, imaginal exposure will improve hoarding symptoms, intolerance of uncertainty and emotional avoidance.
Interventions
BEHAVIORALImaginal Exposure Writing
Imaginal exposure is a psychotherapy strategy that has been studied and shown to be helpful in the improvement of symptoms (e.g., anxiety, worry) for other psychiatric conditions, including excessive worry and obsessive-compulsive disorder symptoms.
OTHERNeutral Writing
Used in prior research as a control condition for imaginal exposure. Neutral writing will involve writing about what one would do on a day off work or school.
Sponsors
Brain & Behavior Research Foundation
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
SINGLE (Subject)
Masking description
Participants will be randomly assigned to imaginal exposure writing intervention or neutral control writing.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age 18 and older 2. Any gender and all ethno-racial categories 3. Hoarding Disorder primary condition 4. Willing and able to understand and complete consent and study procedures 5. English speaking
Exclusion criteria
1. Severe depression 2. Clinically at risk of suicide with Columbia Suicide Severity Rating Scale (C-SSRS) Suicidal Ideation Subscale of 4 or higher (i.e. suicidal intent without specific plan) 3. Currently receiving Cognitive Behavioral Therapy (CBT)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011) | Baseline (Pre Writing) and Follow Up (week 1) | Gold-standard 23-item self-report measure of hoarding disorder symptoms. Scale scores range from 0 to 92, with higher scores indicating more severe hoarding symptoms. More severe hoarding symptoms are considered a worse outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Compulsive Acquisitions Scale (Frost et al. 2002) | Baseline (Pre Writing) and Follow Up (week 1) | Self-report 18-item measure of behaviors associated with hoarding disorder (i.e., acquiring).Scale scores range from 18 to 126, with higher scores indicating more severe hoarding behaviors. More severe hoarding behaviors are considered a worse outcome. |
| Intolerance of Uncertainty Scale (Buhr & Dugas, 2002) | Baseline (Pre Writing) and Follow Up (week 1) | Self-report 27-item measure of a cognitive process related to hoarding called intolerance of uncertainty. Scale scores range from 27 to 135 (some items are reverse scored), with higher scores indicating more severe intolerance of uncertainty. More severe intolerance of uncertainty is considered a worse outcome. |
| Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006) | Baseline (Pre Writing) and Follow Up (week 1) | Self-report 7-item measure of a cognitive process related to hoarding called experiential avoidance. Scale scores range from 7 to 49, with higher scores indicating more severe experiential avoidance. More severe hoarding behaviors are considered a worse outcome. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Imaginal Exposure Writing People with hoarding disorder will write for 20 minutes on each of 3 consecutive days about their worst-case scenario regarding discarding a possession (i.e., imaginal exposure).
Imaginal Exposure Writing: Imaginal exposure is a psychotherapy strategy that has been studied and shown to be helpful in the improvement of symptoms (e.g., anxiety, worry) for other psychiatric conditions, including excessive worry and obsessive-compulsive disorder symptoms. | 17 |
| Neutral Writing People with hoarding disorder will write for 20 minutes on each of 3 consecutive days about what they would do if they had a day off work or school.
Neutral Writing: Used in prior research as a control condition for imaginal exposure. Neutral writing will involve writing about what one would do on a day off work or school. | 15 |
| Total | 32 |
Baseline characteristics
| Characteristic | Imaginal Exposure Writing | Neutral Writing | Total |
|---|---|---|---|
| Age, Continuous | 56.94 years STANDARD_DEVIATION 10.74 | 48.33 years STANDARD_DEVIATION 15.71 | 52.91 years STANDARD_DEVIATION 13.79 |
| Employment Status Employed (full or part-time) | 9 Participants | 9 Participants | 18 Participants |
| Employment Status Not working (including student) | 5 Participants | 2 Participants | 7 Participants |
| Employment Status Retired | 3 Participants | 4 Participants | 7 Participants |
| Race/Ethnicity, Customized Black | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized East Asian | 4 Participants | 4 Participants | 8 Participants |
| Race/Ethnicity, Customized Latin American | 3 Participants | 0 Participants | 3 Participants |
| Race/Ethnicity, Customized Mixed Race | 2 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Other ethnicity | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Southeast Asian | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 8 Participants | 10 Participants | 18 Participants |
| Sex: Female, Male Female | 14 Participants | 14 Participants | 28 Participants |
| Sex: Female, Male Male | 3 Participants | 1 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 17 | 0 / 15 |
| other Total, other adverse events | 0 / 17 | 0 / 15 |
| serious Total, serious adverse events | 0 / 17 | 0 / 15 |
Outcome results
Primary
Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011)
Gold-standard 23-item self-report measure of hoarding disorder symptoms. Scale scores range from 0 to 92, with higher scores indicating more severe hoarding symptoms. More severe hoarding symptoms are considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Imaginal Exposure Writing | Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011) | Pre Writing | 62.41 score on a scale | Standard Deviation 13.22 |
| Imaginal Exposure Writing | Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011) | Follow Up | 53.41 score on a scale | Standard Deviation 16.87 |
| Neutral Writing | Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011) | Pre Writing | 62.60 score on a scale | Standard Deviation 11.97 |
| Neutral Writing | Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011) | Follow Up | 52.00 score on a scale | Standard Deviation 14.05 |
Secondary
Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006)
Self-report 7-item measure of a cognitive process related to hoarding called experiential avoidance. Scale scores range from 7 to 49, with higher scores indicating more severe experiential avoidance. More severe hoarding behaviors are considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Imaginal Exposure Writing | Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006) | Pre Writing | 24.94 score on a scale | Standard Deviation 12.4 |
| Imaginal Exposure Writing | Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006) | Follow Up | 22.06 score on a scale | Standard Deviation 12.47 |
| Neutral Writing | Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006) | Pre Writing | 28.33 score on a scale | Standard Deviation 10.93 |
| Neutral Writing | Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006) | Follow Up | 22.13 score on a scale | Standard Deviation 11.87 |
Secondary
Compulsive Acquisitions Scale (Frost et al. 2002)
Self-report 18-item measure of behaviors associated with hoarding disorder (i.e., acquiring).Scale scores range from 18 to 126, with higher scores indicating more severe hoarding behaviors. More severe hoarding behaviors are considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Imaginal Exposure Writing | Compulsive Acquisitions Scale (Frost et al. 2002) | Pre Writing | 62.88 score on a scale | Standard Deviation 29.59 |
| Imaginal Exposure Writing | Compulsive Acquisitions Scale (Frost et al. 2002) | Follow Up | 56.76 score on a scale | Standard Deviation 30.47 |
| Neutral Writing | Compulsive Acquisitions Scale (Frost et al. 2002) | Pre Writing | 57.93 score on a scale | Standard Deviation 27.68 |
| Neutral Writing | Compulsive Acquisitions Scale (Frost et al. 2002) | Follow Up | 47.47 score on a scale | Standard Deviation 23.52 |
Secondary
Intolerance of Uncertainty Scale (Buhr & Dugas, 2002)
Self-report 27-item measure of a cognitive process related to hoarding called intolerance of uncertainty. Scale scores range from 27 to 135 (some items are reverse scored), with higher scores indicating more severe intolerance of uncertainty. More severe intolerance of uncertainty is considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Imaginal Exposure Writing | Intolerance of Uncertainty Scale (Buhr & Dugas, 2002) | Pre Writing | 68.47 score on a scale | Standard Deviation 31.63 |
| Imaginal Exposure Writing | Intolerance of Uncertainty Scale (Buhr & Dugas, 2002) | Follow Up | 65.06 score on a scale | Standard Deviation 33.27 |
| Neutral Writing | Intolerance of Uncertainty Scale (Buhr & Dugas, 2002) | Pre Writing | 72.27 score on a scale | Standard Deviation 28.86 |
| Neutral Writing | Intolerance of Uncertainty Scale (Buhr & Dugas, 2002) | Follow Up | 65.47 score on a scale | Standard Deviation 30.21 |