Neziroglu Hoarding Presentation – Part 4

  1. ERP for Acquisition Compulsion
  • STEP 1: Construct an Exposure Hierarchy
  • Create hierarchy of anxiety-producing situations
  • Rate items in terms of how much anxiety you anticipate each of them will create (SUDS 1 to 100)
  • STEP 2: Begin with the Lowest SUDS Item
  • Begin with the item at the bottom of the list (lowest SUD)
  • In vivo exposure, resist all urges to acquire multiples of items
  • STEP 3: Repeat That Exposure Until the SUDS Peak is at least 50 Percent Less
  • STEP 4: Go on to the Next Item
  • Continue on with the hierarchy
  1. Sample E/RP Hierarchy
•         Going to a garage sale and not purchasing any items
•         Going to a garage sale and purchasing only one item
•         Seeing an advertisement for a garage sale and not going to it
•         Going window-shopping at the mall without purchasing anything
•         Taking no brochures from the doctor’s office
•         Taking one brochure from the doctor’s office
•         Canceling your subscription to several newspapers or magazines
•         Canceling your subscriptions to one newspaper or magazine
•         Going grocery shopping and not purchasing multiples of items
  1. Treatment Guidelines
  • Best outcomes when performed in-home
  • Therapist does not touch anything without permission
  • All decisions made by patient
  • 3 ½ Box Technique
  • Apply cognitive strategies during cleaning
  1. Treatment Sessions
  • Identify target area
  • Aim for positive visual reinforcement
  • Apply 3 ½ Box Technique
  • Maintain gains made
  • Identify new target area
  • Or complete remaining from previous area
  1. Medications
  • Antidepressants

▫          SSRIs

▫          Tricyclics

▫          MAOIs

  • Antipsychotics: gain insight
  • Anticonvulsants: mood regulation
  • Antianxiety Agents
  • Stimulants: if hoarding is related to attention deficit disorder (ADD)
  1. Effectiveness of SRIs in Treating Hoarding Disorder
  • Studies investigating Hoarding Disorder treatment response yield conflicting results
  • Case study: patient met diagnostic criteria for OCD and Hoarding Disorder

▫         Treatment: 12 weeks of venlafaxine (SRI)

▫         Patient showed over 60% decrease in the severity of her compulsive hoarding symptoms

▫         Patient showed less comorbid anxiety and OCD symptoms, and overall functioning at the end of the 12-week period
Saxena, S. (2011). Pharmacotherapy of compulsive hoarding. Journal Of Clinical Psychology, 67(5), 477-484. doi:10.1002/jclp.20792

  • 24 Patients meeting the DSM-5 criteria for hoarding disorder were treated with venlafaxine extended-release for a 12 week period
  • Severity of hoarding assessed (pre & post):
  • UCLA Hoarding Severity Scale (UHSS)
  • Saving Inventory-Revised (SI-R)
  • Venlafaxine may be effective for treatment
  • 36% decrease in UHSS scores
  • 32% decrease in SI-R scores
  • Saxena, S., & Sumner, J. (2014). Venlafaxine extended-release treatment of hoarding disorder. International Clinical Psychopharmacology, 29(5), 266-273.
  • Hoarders were treated with the SRI paroxetine (Paxil) for 12 weeks
  • Subjects were assessed using the
  • Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
  • Hamilton Depression Rating Scale (HDRS)
  • Hamilton Anxiety Scale (HAS)
  • Global Assessment Scale (GAS)
  • Clinical Global Impression/Improvement (CGI) scale
  • Paroxetine treatment yielded combined overall response rates of 50% for compulsive hoarders (“Response” rate defined as 25-35% and >35% decrease in Y-BOCS scores)
  • Saxena, S. (2011). Pharmacotherapy of compulsive hoarding. Journal Of Clinical Psychology, 67(5), 477-484. doi:10.1002/jclp.20792
  1. Mean Symptom Improvement between CBT and Pharmacotherapy
  • Symptom improvement from Pharmacotherapy has been shown to be as great as or greater than that of CBT treatment.
  • Compulsive hoarding mean symptom improvement (decline in Saving Inventory-Revised scores) :
  • Individual CBT: 27%-28%
  • Group CBT: 10%-21%
  • SRI (venlafaxine) treatment: 31%-37%
  • Saxena, S. (2011). Pharmacotherapy of compulsive hoarding. Journal Of Clinical Psychology, 67(5), 477-484. doi:10.1002/jclp.20792
  1. Getting the Family Involved
  • Family members have the right to live without clutter
  • Families may seek treatment first
  • Because hoarders are notoriously resistant to treatment, family intervention is often necessary
  • The hoarder may not think hoarding behavior is a problem or may downplay the impact of hoarding on functioning.
  1. Treatment Steps for Family Members: Psychoeducation
  • Psychoeducation on hoarding
  • Understanding the motivation behind hoarding behaviors
  • primary hoarding: Hoarding behavior is due to an emotional attachment to objects/animals and/or identity formation around hoarded items
  • secondary hoarding: Hoarding occurs as a peripheral consequence of another pathological process.Examples include: dementia, depression, ADHD and OCD.
  • – Understanding the therapeutic implications of primary vs. secondary hoarding
  • Learning how to communicate more effectively with hoarder
  • Assertive vs. Aggressive vs. Passive communication style.
  • Use of validating statements
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