Neziroglu Hoarding Presentation – Part 3

  1. How likely is a Hoarder to Engage in Treatment
  • N=40
  • 9 entered hoarding treatment   (22.5%)
  • 10 came for 5 or less sessions and never engaged in hoarding treatment (25%)
  • 21 came for over 25 sessions but never engaged in hoarding treatment   (52.5%)
  • Number of people engaging increases when hoarding is due to OCD, ADD, Depression.  These individuals improve with treatment.
  • Data obtained at the Bio-Behavioral Institute, New York

18. Reasons for Treatment

  • Lack of functional living space
  • Unsafe living conditions
  • Fire exits blocked, staircases cluttered, possible structural damage from excessive weight
  • Unhealthy living conditions
  • High levels of fungus, molds, insect/rodent infestation, etc.
  • Allergies, respiratory problems, insomnia, etc. Financial strain
  • Ordering meals out, additional storage units/apartments
  • High family strain
  • Little, if any place to gather as family
  • Furniture used as storage
  • Resentment/anger from other family members
  • Often leads to separation of families
  1. Treatment of Hoarding
  • Goals of treatment
  • Improve quality of life
  • Increase functional living space
  • Improve decision-making skills
  • Maintain gains
  • Improve family relations
  1. Individual Therapy for Hoarders
  • Motivational Interviewing
  • CBT using exposure therapy is most effective
  • Decision-making skill building: problem solving
  • Motivational Strategies
  • List the Pros and Cons of coping with hoarding
  • Set realistic goals (i.e. weekly goals)
  • Use Premack principle (Grandma’s rule): success in completing any task comes to those who work on it first and reward themselves with a pleasurable activity later
  1. Goals of CBT
  • Increase functional living space
  • Create appropriate storage spaces for possessions
  • Correct irrational thinking
  • Maintain treatment gains (prevent relapse)
  • Improve family relations
  • Improve decision making and organizational skills
  • Improve quality of life
  1. Starting Cognitive Behavioral Therapy
  • Identify your thought patterns: consider and eliminate your negative automatic thoughts about your hoarding and avoid triggers like…

o       Focusing on clutter

o       Going to a garage sale

o       Shopping at the supermarket without someone

  • List your situation (i.e. “came home from appointment and saw clutter”), emotion (“overwhelmed,” “depressed,” “frustrated), and automatic thought (“Look at this mess, this hoarding is killing me!”)
  1. Implementation of CBT
  • Identify cognitive distortions: inaccurate or irrational automatic thoughts
  • Cognitive distortions that relate to hoarding:
    • All-or-nothing thinking
    • Overgeneralization
    • Discounting the Positive
    • Mental Filtering
    • Jumping to conclusions
    • Personalization and Blame
    • Labeling
  1. Cognitive Distortions
  • All-or-Nothing Thinking

▫         “My whole life means nothing without this possession.”

▫         “If I can’t find the perfect spot for this item, I’ll be miserable.”

  • Overgeneralization

▫         “My coupons for the supermarket expired, so I had to pay full price for the groceries.  I have terrible luck.”

▫         “I once threw out a valuable item.  Therefore, if I am not extremely cautious, I will always discard things of value.”

  • Discounting the Positive

▫         “I only cleared off my bed enough to be able to sleep on it, but other people don’t have anything on theirs.”

  • Jumping to Conclusions

▫         “I will never be able to keep the dining room table cleared off, so why bother?” (Fortune Telling)

▫         “Because the clerk counted the cans I purchased, she thought I was a freak.” (Mind Reading)

  • Magnification and Minimization

▫         “My house will never be clutter-free, and my family will always hate me for it.” (Magnification)

▫         “My house is just a little messy, and I am not the best housekeeper.” (Minimization)

  • Emotional Reasoning

▫         “I feel overwhelmed and out of control, therefore my problems are not fixable.”

▫         “I am an anxious person, and I will never be able to be calm.”

  • Should Statements

▫         “I should be able to clean up the clutter with no problems.”

▫         “I should be able to find everything I need immediately.”

  • Labeling

▫         “I’m a loser because I have clutter in my home.”

▫         “I have difficulty making decisions, so I am inadequate.”

  • Personalization and Blame

▫         “My husband spilled coffee on himself while sitting on the sofa.  There is clutter around the sofa, so I guess it was my fault. I’m not a good person to live with.”

Cognitive Behavioral Therapy Treatment (Cont’d)

  • Change the irrational thoughts
  • Develop rational responses to automatic negative thoughts
  • Test the validity of the thought
    25. CBT Treatment Studies on Hoarders
  • Tolin, Frost, Steketee (2007): 10 Hoarders, 26 sessions of CBT and very much improved
  • Turner, Steketee, Nauth (2010): 11 elderly, 6 completed the study, 35 sessions of home visits.  Treatment included CT, practice sorting discarding and not acquiring.  Moderate changes.
  • Steketee, Frost, Wincze, Greene, Douglass (2000): Out of a total of 7 hoarders, 6 received CBT (group and individual) for 20 weeks,
  • 3 of the 6 continued for 48 weeks and 1 received only individual therapy.
  • 5 of the 7 in 20 weeks showed a noticeable improvement 3 of the 4 who continued for 1 year showed even greater improvement although none felt entirely recovered
  • Muroff, Steketee, Himle, Frost (2010): Online CBT based group (N=106) intervention vs. naturalistic waitlist (N=155).  Participants post actions taken on the web and their progress at least monthly.  Educational resources are provided.
  • Compared to waitlist at 6 months hoarders showed greater improvement and less clutter
  • Muroff, Steketee, Rasmussen, et al. (2009): A group CBT format used. 32 patients and 5 groups with 5 to 8 individuals per group.  Group met one time a week for 2 hours for 16 weeks (4 groups) and one group met for 20 weeks.
  • 2 home sessions of 90 minutes (weeks 3& 12).
  • Improvement noted on Savings Inventory
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