New Herts research challenges reliance on CBT to treat hoarding disorder

The practise of offering cognitive behavioural therapy (CBT) as the main treatment for hoarding disorder needs to be reviewed, a new University of Hertfordshire study has suggested.

Experts have found offering patients a choice of different psychological interventions, including CBT - a type of talking therapy, could be more effective in significantly reducing symptoms of the debilitating condition which affects around four million people in the UK.

The largest-ever review of its kind analysed over 40 studies, which revealed therapies including online sessions and group programmes are just as effective as face-to-face or home-based treatments.

This raises hope that the condition, which can not only impact a person’s quality of life but also increase the risk of falls and fire hazards, can be treated cost-effectively by a range of psychological approaches, Herts researchers said.

Hoarding is a mental health condition where a person acquires an excessive number of items and stores them, resulting in unmanageable amounts of clutter. This differs from collecting, which is typically characterised by deliberately acquiring items that bring joy or have value to the owner.

NICE (National Institute for Heath and Care Excellence) has not issued specific guidance for the treatment of hoarding disorder in the UK, but it is considered in the treatment guidance for Obsessive Compulsive Disorder (OCD) and so, CBT is offered by the NHS as the main treatment for hoarding disorders.

Senior author Keith Laws, Professor of Cognitive Neuropsychology at the University of Hertfordshire, said: “This study challenges the prevailing reliance on CBT as the gold-standard for hoarding disorder treatment and underscores the need for a multifaceted approach perhaps involving more patient choice.

“Surprisingly, our research shows that all current forms of psychological intervention, however they are delivered (be it group versus individual, home visits or not, online or face-to-face), help reduce hoarding symptoms.

“The findings offer hope to those living with hoarding disorder and provide a fresh perspective on managing this debilitating condition, paving the way for more inclusive and effective therapeutic options and potentially, more choice over the mode and style of psychological intervention.”

The research, published in the Journal of Psychiatric Research, is based on a systematic review (a structured analysis of all relevant research) and meta-analysis (statistical method combining data from multiple studies) of 41 studies involving 1,343 people, with an average age of 55.

A total of 10 different types of interventions were examined, which also included acceptance and commitment therapy (ACT), cognitive rehabilitation and exposure/sorting therapy (CREST), compassion focused therapy (CFT) and Buried in Treasures (BiT) - a group programme specifically designed to help those struggling with hoarding disorder.

All interventions showed a significant reduction in hoarding symptoms, the researchers said.

Prof Laws said: “We also found that 75% of the people in the hoarding disorder trials were women, which does not reflect the true picture of the condition as men are just as likely to be hoarders as women.

“Our research calls for more rigorous randomised controlled trials and innovative approaches to address limitations in such as gender imbalances in hoarding disorder research participation.”

First author Emily O’Brien, who received her master’s degree in research in clinical psychology from the University of Hertfordshire and works in a mental health team for older adults for Herts Partnership Foundation Trust, said: “Hoarding disorder is difficult to treat for many reasons and requires a multi-service approach with mental health services working alongside social and environmental services due to potential health and eviction issues.

“In the paper, we found no single psychological intervention showed superiority over the others, but that these interventions may need to be refined to successfully treat hoarding disorder.“

Commenting on the study, Jo Cooke, director of Hoarding Disorders UK, said: “We welcome any research around exploring therapeutic input for hoarding disorder.

“Hoarding is a complex condition that impacts at least 6% of the UK population, making it more prevalent than OCD or schizophrenia, and there is not one therapy, intervention or treatment that fits all.

“More research is needed to quantify the benefits of other therapies such as ACT and CFT to be accessible on the NHS rather than just CBT.  A buffet of different interventions is key to supporting those with hoarding behaviours.

“We are hoping that the NICE can consider revisiting their guidelines to reflect these findings.”