This project will utilize a novel behavioral intervention for hoarding disorder that takes
into account age and neurocognitive factors. The goal of this project is to gain knowledge on
how treatment components may or may not work for Veterans with hoarding disorder. Further,
the investigators hope to increase understanding of functional and long term outcomes in
response to hoarding treatment.
Objective: The investigators propose to conduct a randomized controlled trial comparing six
months (26 sessions) of Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST)
treatment to a robust comparator, six months of Exposure Therapy alone, in 136 participants
Research Design: Assessments will be administered at baseline, during treatment (sessions 7,
13, 21), post-treatment, and 3- and 6-month follow-up, thus, all participants will be
enrolled for one year.
Methodology: The primary objective is to evaluate whether CREST significantly reduces
hoarding symptoms and improves functional capacity and quality of life when compared to
exposure therapy alone. The investigators will also examine the impact of treatment
mediators; treatment adherence, changes in executive functioning, avoidance, symptom severity
on outcomes. Age and executive functioning will also be explored as potential moderators.
Finally, by repeatedly measuring treatment targets, the investigators will examine time to
maximum treatment effect in an effort to understand mechanisms of change.
Clinical Relationships: By providing a treatment for many Veterans with HD, the investigators
can alter the course of their symptom trajectory and negative consequences, resulting in both
healthcare costs savings and improved quality of life for Veterans.
- Veterans age 18-85
- Hoarding Disorder diagnosis outlined by the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5)6 as measured by the Structured Interview for
Hoarding Disorder (SIHD)67
- HD as a primary diagnosis
- Stable on medications for at least 12 weeks, with no pharmacologic changes expected or
made during the 12-month study
- Voluntary consent to participate
- Diagnosis of:
- psychotic disorder
- substance abuse disorder as measured by the Mini-International Neuropsychiatric
- Current or history of any neurodegenerative disease
- Active suicidal ideation
- Concurrent participation in psychotherapy or ET for HD, or prior history of CREST for
Catherine R Ayers, PhD
VA San Diego Healthcare System, San Diego, CA
Catherine R Ayers, PhD
Phone: (858) 642-2976