A Comparison of Cognitive Restructuring and Thought Listing for Excessive Acquiring in Hoarding Disorder

Patients with Invisible Pain: How Might We See This Pain and Help These Patients More?

AbstractIn this piece I discuss two ways in which providers may become able to treat patients better. The first is for them to encourage all medical parties, including medical students, to always speak up. The second is to take initiatives to learn of pain that patients feel but neither show nor spontaneously report. They may refer to this pain as invisible pain, often bitterly, in that others not seeing their pain judge them wrongly and harshly. Providers, once seeing this pain, are encouraged to then take additional measures to try to alleviate it. Clinical examples provided to illustrate the range of treatments providers may add are post-traumatic stress disorders, problems involving substance use, and hoarding disorders. Similar concerns regarding people who are deaf and hard of hearing are also addressed.

Hoarding mysteries Jack would appreciate

Hoarding disorder (HD) is a multifaceted problem that presents challenges both for understanding its dimensions and for developing effective treatments. We are grateful to have known Dr. Stanley J. Rachman and his incredibly thoughtful approach to clinical psychology and research on anxiety, obsessive-compulsive disorders (OCD) and their treatment. His work has helped set the stage for our own efforts to study this challenging condition. The discussion below reviews a range of mysteries we and others have encountered in working with people who exhibit HD symptoms. Of particular interest to us are questions about biological vulnerabilities like heritability and the high rate of concurrent health problems and whether hoarded objects might serve as safety signals that protect people from traumatic life events. We are curious about the attachment process in HD and whether attachment to objects is related to early parental experiences that affect self-concept. We raise questions about the several information processing problems often seen in people with HD - attention focusing, memory, and associative responses to objects and information. Raising many questions are observations about strong emotional attachments to objects and multiple reasons given for saving them, as well as what sometimes appears to be remarkable aesthetic appreciation and creative interest in objects. Emotions in HD seem to range more widely than in some psychological disorders as both positive and negative reactions appear to reinforce excessive acquisition and difficulty discarding. Clutter blindness may be an effort to avoid confrontation with overwhelming clutter in the home. Finally, we comment on difficulty achieving more positive outcomes following a carefully designed cognitive and behavioral treatment for HD and encourage the next generation of researchers to follow in Jack Rachman's footsteps as they try to unravel these mysteries.

A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes?

Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive-compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive-compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities.

Examining subjective sleep quality in adults with hoarding disorder

Hoarding disorder (HD), characterized by difficulty parting with possessions and functionally impairing clutter, affects 2-6% of the population. Originally considered part of Obsessive-Compulsive Disorder (OCD), HD became a distinct diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. While sleep impacts OCD, little is known about sleep in HD. As HD patients often report poor sleep in clinical settings, understanding global subjective sleep quality and disturbances may lead to novel therapeutic targets. To address this gap, the authors used a sample of convenience: an existing data set designed to screen research study eligibility and explore the psychopathology and phenomenology of OCD and HD. The data set included information collected from individuals with HD (n = 38), OCD (n = 26), and healthy participants (n = 22) about insomnia, sleep quality, and mood using interviews and structured instruments including the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scales (DASS). In this data set, HD and OCD groups reported significantly greater insomnia symptoms and poorer sleep quality compared with healthy controls while controlling for depression, age, and gender. A sizable minority of HD and OCD individuals met criteria for comorbid sleep disorders. OCD and HD groups differed in delayed sleep phase prevalence. To our knowledge, this is the first study examining subjective sleep quality and insomnia in HD as compared to healthy individuals and those with OCD, while controlling for relevant clinical characteristics. Given that there are evidence-based treatments for insomnia and other sleep disorders, our study raises the possibility that treatment interventions targeting sleep may improve HD outcomes.

Comparing the Efficacy of Defusion, Self-as-Context, and Distraction Strategies for Getting Rid of Possessions

Interventions for hoarding disorder need to target difficulty letting go of items to reduce clutter and improve functioning. The present studies were designed to test the efficacy of brief cognitive interventions for letting go of possessions and self-report outcomes. Participants (N = 67 in Study 1; N = 110 in Study 2) received training on defusion or distraction in Study 1 and defusion, self-as-context, or distraction in Study 2 and completed measures at pre- and postintervention. Study 1 found no differences between defusion and distraction on saving, self-rated discomfort with discarding, or perceived importance of the target belonging. In Study 2, participants provided most favorable feedback for self-as-context compared to defusion and distraction, indicating promise of this strategy. Nonetheless, findings from both studies overall provide minimal support for use of present procedures to reduce saving. Limitations include use of nonclinical samples and single-item variables to obtain participant feedback.