In-home Decluttering Augmentation of Group CBT for HD

Cognitive behavioral therapy (CBT) is the current evidence-based treatment for HD but the majority of sufferers remain symptomatic after CBT with impairing levels of clutter in their homes. Home visits, with a focus on in-home decluttering, have in previous research been shown to be a promising intervention when combined with CBT. However, augmenting CBT with subsequent home visits has not yet been tested in a randomized controlled trial (RCT). In response to this, in this trial, we aim to investigate the efficacy of a coordinated intervention, consisting of CBT and in-home decluttering for HD, in an RCT. In this trial, 90 participants with HD will initially receive 12 sessions of CBT through a psychiatric outpatient service. After CBT, participants will be randomized to receive either 10 home visits in 10 weeks, or to a wait list condition. Our hypothesis is that augmenting CBT with home visits will lead to a reduction in hoarding symptoms and clutter and improved daily functioning compared to wait list. We will also investigate the cost-economical aspects of the intervention. Results from this trial have the potential to reveal whether in-home decluttering should be added to CBT in order to reduce symptoms of hoarding and improve function in indviduals with HD.

Inclusion criteria

• Age 18 years or older.
• Hoarding disorder as primary psychiatric condition.
• Willing and able to understand and complete consent and study procedures.
• Living in the Stockholm county (Sweden) and within a 1-hour commute by public transport from the social services office.

Exclusion criteria

• Concurrent CBT or having received CBT for HD during the last two years, for a minimum of 8 sessions including active strategies for reducing acquisition and practice of discarding with a qualified therapist or 8 previous in-home decluttering sessions with a qualified social worker.
• Unable or unwilling to allow study staff into home for home assessment.
• Animal hoarding or squalid (i.e. extremely unhygienic) home conditions that are deemed to put the personnel at risk during the in-home decluttering.
• A diagnosis of organic brain disorder, intellectual disability, psychosis, bipolar disorder without stable medication or with symptoms within the last 6 months, anorexia nervosa or alcohol/substance dependence or abuse.
• Major medical or neurological conditions that increase the risk of participation or that would prevent completing assigned behavioral practice tasks.
• Immediate risk to self or others, requiring urgent medical attention, such as high suicidality risk.
• Participant not able to read and communicate in Swedish.
• Currently at high risk for eviction (for instance having received a "rättelseanmaning" by the housing company or Swedish court).
• Potential participant lives in the same household as an already included participant.