This study will compare two behavioral interventions for hoarding disorder in older adults.
Aged 60+
Live within a 60-minute driving radius of Starkville, MS
Have a primary psychiatric diagnosis of hoarding disorder
Major cognitive impairment
Active psychosis, drug use, or acute suicidal ideation
Concurrent psychotherapy focused on hoarding
Changed psychotropic medications within the past three months
Parallel
RECLAIM: Reducing Clutter and Increasing Meaning
BehavioralParticipants 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.
Sorting Practice
BehavioralParticipants 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.
Change in frequency of sorting/discarding behavior
As a behavioral indicator of motivation to engage in sorting/discarding behavior, participants will be asked to report at baseline and at their weekly treatment sessions the frequency of sorting/discarding items in the previous week.
Change in duration of sorting/discarding behavior
As a behavioral indicator of motivation to engage in sorting/discarding behavior, participants will be asked to report at baseline and at their weekly treatment sessions the duration of sorting/discarding items in the previous week.
Change in score on the University of Rhode Island Change Assessment Questionnaire McConnaughy et al., 1983)
The URICA is a 32-item Likert scale that assesses readiness for change and includes four subscales that individually assess stage of change (Precontemplation, Contemplation, Action, and Maintenance). Previous investigations have found adequate internal reliability for the URICA in treatment-seeking samples (Dozois et al., 2004), including in older hoarding samples specifically (Ayers et al., 2019).
Change in score on the Apathy Evaluation Scale (AES-S; Marin, 1991)
The AES is an 18-item measure of an individual's deficits in goal-directed thoughts and behavior. The AES was developed specifically to assess apathy in adults aged 55+ and is predictive of motivation for behavioral change (Resnick et al., 2012).
Rating on the Treatment Acceptability/ Adherence Scale (TAAS; Milsevic et al., 2015)
The TAAS 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.
Change in score on the Saving Inventory-Revised (SI-R; Frost et al., 2004)
The SI-R is a 23-item measure of the three core hoarding symptoms (urges to save, difficulty discarding, and excessive clutter).
Change in score on the Clutter Image Rating (CIR; Frost et al., 2008)
The CIR is a three-item pictorial rating scale of clutter level in the bedroom, kitchen, and living room. Assessor ratings of the CIR will be used for the proposed project.
Change in scores on the Behavioral Approach Task for sorting/discarding(BAT; Dozier & Ayers, 2017; Dozier et al., 2020)
The BAT involves the participant sorting items in a cluttered part of their home for 15 minutes. The speed of sorting and percentage of items discarded will be used as behavioral indicators of hoarding severity.
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Mississippi State University
Lead sponsor
National Institute of Mental Health (NIMH)
Collaborator
