Randomised clinical trial of community-based peer-led and psychologist-led group treatment for hoarding disorder.

BACKGROUND: Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas. AIMS: We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive-behavioural therapy (G-CBT). METHOD: We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3-25). Predictors of treatment response were examined. RESULTS: G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = -1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004). CONCLUSIONS: Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals. DECLARATION OF INTEREST: C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers' honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.

The synergistic effect of growing older with hoarding behaviors.

Clinically significant hoarding behaviors (HB) have been defined as acquisition of, and failure to discard, large numbers of items, which limits the use of one's home and causes functional impairment or distress. HB disproportionally affect adults aged 55 and older, and although research on HB has accelerated in the past decade, few studies focus on older adults. This qualitative study, based on grounded theory methodology, utilized interview data from 22 older adults with HB to understand the dynamic interaction between HB and the aging process. Participants described the specific ways that their chronic HB were complicated by changes in their health status, social context, and home setting, resulting in greater functional impairment and distress. By identifying these changes that commonly occur with age and their synergistic relationship with HB, nurses and other health professionals can develop targeted interventions to improve home safety and support the independence of these older adults.