Does CBT Work for Hoarding?
Hoarding, which is often arguably a component of obsessive compulsive disorder, has been notoriously difficult to treat effectively. Although SSRI drugs have successfully helped people to control their other OCD tendencies, they do not seem to help a hoarder. Researchers have recently begun to develop CBT techniques for OCD hoarding that help to change the way that people with hoarding tendencies think about their possessions.
There are four main issues that CBT techniques for OCD hoarding focus on: discarding possessions, organizing items, limiting incoming possessions, and using alternative behaviors.
Discarding and Organizing Possessions
OCD hoarders often struggle to discard even the most disposable possessions. In order to conquer this difficulty, CBT therapists talk with the hoarder to help discover the reasons behind this. Some hoarders feel that their own identities are tied up with their possessions, others are scared of throwing out something they may need later, and still others do not like making decisions. The CBT therapist will work to eliminate these faulty rationales.
To do this, they will instruct the hoarder to take one item at a time from a room to decide whether to discard it, keep it, or recycle it. The hoarder is encouraged to discard as many objects as possible. If the hoarder wants to keep an object, the therapist asks many questions, such as the following:
- If you throw out this object, what is the worst possible thing that will happen in the future?
- If you throw this object away, is there a way you could get the information found in it (e.g., newspaper, old mail) if you needed it in the future?
- What do you think other people do with objects like these?
These questions help hoarders rethink their attitude towards their possessions. It also gives them practice in making decisions to discard objects, which can minimize their anxiety levels in the future (an example of Exposure and Response Prevention, or ERP). If the hoarder does decide to keep an object, it must have a specified place where it belongs. This helps hoarders learn to organize their possessions, even those that they truly should keep.
Limiting Incoming Clutter
Being able to discard items is only minimally beneficial if the hoarder then continues to buy armloads of items, beyond what is normal. Therefore, the hoarder is encouraged to keep a log of all the items that come into the home. In addition, for hoarders who find it difficult to walk in and out of a store without buying anything, therapists may design an ERP session in which the hoarder needs to walk into and out of several stores without buying anything. (See this article for more information about how ERP, a major component of CBT, works).
Using Alternative Behaviors
People who have been defined by their hoarding habits will need to introduce plenty of structure into their lives. CBT techniques for OCD hoarding include making a schedule to structure each day, and each week. The schedule should include many of the chores and activities that hoarders tend to push off, such as folding laundry, sorting through junk mail, and taking out the garbage. Therapists also encourage former hoarders to develop interests and hobbies, as well as taking on a part-time job or volunteer position. This can help former hoarders feel successful and can help them avoid their hoarding tendencies.