Thinking Outside the Box: Novel Delivery Methods for Treating Hoarding

Hoarding is a serious psychiatric problem associated with a poor response to behavior treatment and medications demonstrated to be effective for obsessive-compulsive disorder (OCD). While commonly associated with OCD, hoarding patients often have higher rates of comorbid depression, generalized anxiety, and social anxiety A specialized cognitive behavioral treatment (CBT) for hoarding was developed. Trials testing this individual, manualized treatment have shown positive results; however, this protocol is limited by long treatment periods, problems with feasibility and excessive cost of home visits, and limited access to clinicians that are well-trained in CBT for hoarding. Thus, alternative methods of CBT delivery for hoarding are being developed and tested, including group, web-based, self-help, and coaching approaches. Specialized CBT for hoarding, focusing on innovative alternatives and adaptations of these methods, are reviewed. New advances addressing the home-based component may be considered within the context of stepped care.