Comparing Peer-Led Support Groups with Therapist-Led Support Groups for Treating Hoarding Disorder

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What was the research about?

People with hoarding disorder are unable to give or throw things away. They also often buy or collect items to excess. Clutter caused by hoarding can lead to unsafe living conditions and make it hard to function in daily life. Group cognitive behavioral therapy, or CBT, is one type of treatment for hoarding disorder. Patients meet in groups with others who have hoarding disorder and learn to change their patterns of thinking and behavior.

Some communities only have a few therapists trained in CBT. This lack of therapists can make it hard for people with hoarding disorder to get treatment. Peer-led group therapy is a type of treatment led by people who have or have had hoarding disorder and received training to help others. It gives people more opportunities to get treatment.

The research team wanted to see if peer-led group therapy worked as well as therapist-led CBT to treat hoarding disorder.

What were the results?

The study found that peer-led group therapy helped as many patients with hoarding disorder as therapist-led CBT did. One month after treatment ended, patients in both groups had fewer symptoms of hoarding disorder. They were also better able to do daily activities, such as preparing food or taking showers. Within one to two years after treatment, patients in both groups still had fewer symptoms of hoarding disorder but they did not maintain the improvements in daily activities.

Who was in the study?

The study included 323 patients with hoarding disorder in San Francisco, California. Of these patients, 75 percent were female. Sixty percent of patients were white, 11 percent were Asian, 8 percent were African American, and 20 percent were other or more than one race; 9 percent were Hispanic. The average age was 59.

What did the research team do?

The research team assigned patients by chance to one of two groups. One group took part in CBT led by therapists using a hoarding disorder therapy workbook as a guide. This group had 16 two-hour group sessions over 20 weeks. Patients in this group learned about hoarding symptoms. They also learned how to set goals and how to change their behavior and thinking.

The other group took part in peer-led therapy. Patients in this group had 15 two-hour sessions over 20 weeks. The group leaders had current or past hoarding disorder and received training to help others with hoarding disorder. They used a workbook that had similar activities to those of the CBT group.

The research team surveyed each patient about his or her hoarding disorder symptoms and daily activities. The team collected this information at the beginning of the study and within one month after the end of treatment. One to two years after treatment ended, the team followed up with patients in the study again.

What were the limits of the study?

About 30 percent of patients in the study didn’t finish treatment. The results may have been different if everyone completed the treatment. The findings from the study may not apply to patients with hoarding disorder who don’t want treatment or who are not aware of their hoarding disorder.

Future studies could look into improving both types of treatment and examine ways to encourage patients to complete the treatments.

How can people use the results?

It can be hard to find trained therapists to help with hoarding disorder. Peer-led group therapy was as effective as group CBT and may be a good option for making treatment available to more people.

Objective

To compare the effectiveness of group peer-facilitated therapy (PFT) with group therapist-led cognitive behavioral therapy (CBT) in reducing the severity of hoarding disorder symptoms

Study Design

This randomized controlled trial compared the effectiveness of therapist-led group CBT with peer-facilitated group PFT for reducing the severity of hoarding disorder symptoms. PFT may be more accessible in communities that lack access to therapists trained in CBT.

The study included 323 participants living with hoarding disorder in San Francisco, California. Of these participants, 75% were female, 60% were white, 11% were Asian, 8% were African American, and 20% reported either other or more than one race. In addition, 9% were Hispanic. The mean age was 59.

The research team randomly assigned participants to either the CBT or PFT treatment groups. The CBT group attended 16 two-hour group sessions over 20 weeks led by one or two psychology postdoctoral fellows using a CBT workbook. Sessions included information about hoarding symptoms, goal setting, behavior modification, cognitive restructuring, motivational enhancement, executive functioning skills training, and relapse prevention.

The PFT group included 15 two-hour group sessions over 20 weeks led by one to two trained peers with current or past hoarding disorder. This group used a treatment workbook that covered topics similar to those of the CBT group.

The research team assessed each patient’s hoarding symptom severity and daily functioning using surveys taken at baseline, within one month after treatment ended, and again within one to two years after the patients finished treatment. On average, the last assessment occurred about 14.4 months after treatment ended.

People who screened positive for hoarding disorder and professionals who treat the disorder contributed to the development and design of the study. The Mental Health Association of San Francisco helped identify these contributors.

Results

At the end of treatment, the study found no significant difference between groups in the reduction in hoarding symptom severity. Patients in the CBT group had a 28% reduction in symptom severity, while patients in the PFT group had a 26% reduction. The team also found no significant difference in the reduction in impairment in daily function between the CBT group (11% reduction) and the PFT group (12% reduction). Within one to two years after treatment, patients in both groups maintained reductions in hoarding symptom severity, but not in daily functioning.

At baseline, patients with higher symptom severity were more likely to reduce symptom severity with treatment than patients with lower symptom severity. Those who attended more sessions and completed homework from the sessions also showed more reduction in symptom severity than those who attended less sessions or did not complete homework. Also, patients who had higher levels of anxiety and depression along with their hoarding symptoms had less improvement in daily functioning than those with lower levels of anxiety and depression.

Limitations

About 30% of patients dropped out of treatment before completion. Results may have been different if all patients had completed treatment. Because patients voluntarily sought hoarding treatment, they may have had a higher awareness and understanding of their disorder than patients who did not seek treatment. Results may not be the same for people who do not recognize their disorder or do not see it as problematic.

Conclusions and Relevance

In this study, PFT performed as well as CBT in reducing the severity of hoarding symptoms. Having the option to use PFT may increase access to treatment in communities with a limited pool of therapists trained in CBT.

Future Research Needs

Future research could continue to examine how to improve treatment outcomes for both CBT and PFT.