This study will compare two behavioral interventions for hoarding disorder in older adults.
Hoarding disorder is a psychological condition with a unique constellation of consequences for older adults, including increased risk of fire and dying in a fire, insect infestation, and medical problems. Dangers related to cluttered living spaces are exacerbated by reduced executive functioning, attention, and concentration. Hoarding psychopathology results from maladaptive cognitions (e.g., desire to keep items others would discard) and maladaptive behavioral patterns (e.g., avoidance of sorting/discarding items). Extant treatments for hoarding have targeted fear reduction as the mechanism of change, either through cognitive-behavioral therapy focusing on cognitive restructuring or behavior therapy focusing on exposure therapy. Older adults have a lackluster response to cognitive restructuring for hoarding, and, although exposure therapy increases treatment response, both approaches require a lengthy six-month dose. Our preliminary work suggests that fear reduction may not be a universally relevant target mechanism for older adults, and that to be responsive to the specific needs of older adults, other mechanisms need to be identified. Motivational interviewing is a technique that is already typically incorporated into hoarding treatment and has been demonstrated to increase motivation for behavioral change across a range of health conditions for older adults, including physical activity, diet, and disease management. Because sorting/discarding is at its core a health behavior that hoarding patients lack the motivation to engage in, motivational interviewing is likely to decrease hoarding severity by eliciting increased levels of sorting/discarding. The proposed project will use a mechanistic clinical trials approach to determine if a four-month intervention combining motivational interviewing with sorting practice can engage the proposed target, motivation for behavioral change, when compared to a four-month dose of sorting practice alone in a sample of rural-dwelling older adults with hoarding disorder.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
48
Participants will receive 16 weekly 1-hour treatment sessions in their home delivered by Masters-level clinicians with the assistance of undergraduate researchers. Each treatment session will involve a combination of motivational interviewing (MI) and sorting practice. The rationale behind the sorting practice is to develop the skill of sorting and the formation of a daily sorting routine. The MI portion of the initial session will involve an evaluation of client strengths and individual biopsychosocial goals. The initial and subsequent sessions will include a variety of MI techniques, including decisional balancing, developing discrepancy, personalized feedback, and reinforcement of responsibility of sense of self-efficacy.
Participants will receive 16 weekly 1-hour treatment sessions in their home delivered by Masters-level clinicians with the assistance of undergraduate researchers. Clinicians will encourage participants to sort objects during each session while refraining from use of any specific cognitive or motivational therapeutic techniques. Participants will be asked to record the frequency and duration of any sorting/ discarding they did during the previous week.
Mississippi State University
Starkville, Mississippi, United States
Frequency of Sorting/Discarding Behavior
As a behavioral indicator of motivation to engage in sorting/discarding behavior, participants will be asked to report at their weekly treatment sessions the frequency of sorting/discarding items in the previous week. Data were analyzed as percentage of days sorted between sessions (assessed at sessions 2-16). Mixed effects models were used to analyze data such that participants with at least one timepoint were included in the analyses.
Time frame: Four months
University of Rhode Island Change Assessment Questionnaire
The University of Rhode Island Change Assessment Questionnaire (URICA) is a 32-item Likert scale that assesses readiness for change. Scores for readiness for change are calculated by subtracting pre contemplation items from the other summed items. Scores range from -2 to 14, with higher scores indicating greater readiness for change.
Time frame: Four months
Apathy Evaluation Scale
The Apathy Evaluation Scale is an 18-item measure of an individual's deficits in goal-directed thoughts and behavior. Scores range from 18-72, with higher scores reflecting more apathy.
Time frame: Four months
Treatment Acceptability/ Adherence Scale
The Treatment Acceptability/ Adherence Scale is a 10-item self-report measure of a patient's perception of the acceptability of a treatment as well as their anticipated adherence to the protocol. Scores range from 10-70, with higher scores indicating greater acceptability and perceived adherence.
Time frame: Immediately after session 1
Saving Inventory-Revised
The Saving Inventory-Revised is a 23-item measure of the three core hoarding symptoms (urges to save, difficulty discarding, and excessive clutter). Scores range from 0 to 92, with higher scores indicating greater symptom severity.
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Time frame: Four months