Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder


  • Portions of this study were presented at the Association for Behavioral and Cognitive Therapy, Philadelphia, PA, November 16–18, 2007.

  • Drs. Steketee, Frost, and Tolin receive royalties from Oxford University Press (OUP) for publication of a self-help version of the therapy methods (Tolin, Frost and Steketee, Buried in Treasures). Drs. Steketee and Frost also receive royalties from the therapist guide and client workbook describing the methods used in this study (Steketee and Frost, Compulsive Hoarding and Acquiring), and are under contract with Harcourt Press to publish Stuff: Compulsive Hoarding and the Meaning of Things for a public audience. Dr. Tolin received funding from the following sources: Schering-Plough, Indevus Pharmaceuticals, and Eli Lilly.


Objective: This study investigated a multicomponent cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). Method: Participants with clinically significant hoarding were recruited from the community and a university-based anxiety clinic. Of the 46 patients randomly assigned to CBT or waitlist (WL), 40 completed the 12-week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to nonacquiring and discarding, and cognitive therapy. Measures included the Saving Inventory-Revised (self-report), Hoarding Rating Scale-Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre-post effects for all CBT participants combined after 26 sessions. Results: After 12 weeks, CBT participants benefited significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 71% of patients were considered improved on therapist clinical global improvement ratings and 81% of patients rated themselves improved; 41% of completers were clinically significantly improved. Conclusions: Multicomponent CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern, and further research with independent assessors is needed to establish treatment benefits and durability of gains. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.