How to Facilitate Effective Interventions for Hoarding

At Hoarding Help Central, we understand that in order to facilitate effective interventions for hoarding, you have to have all of the information needed to form appropriate goals and strategies. Today, Hoarding Help Central will be explaining what an effective intervention for hoarding looks like, what you need to know in order to facilitate effective intervention for hoarding, and what the obstacles to effective treatment strategies for hoarding are. With that, let’s get started!

What is Hoarding?

According to the Mayo Clinic, hoarding disorder is defined as “a persistent difficulty discarding or parting with possessions because of a perceived need to save them. A person with hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs”.

Oftentimes, hoarding results in such cramped living conditions that a home may be filled to capacity with clutter. This means that navigating your way through the home is nearly impossible as there are typically only narrow passageways winding through stacks of clutter. Virtually all surfaces, including stairways, countertops, stoves, and sinks are piled up with items. It is also common for the clutter to end up spreading to garages, vehicles, and other on-site storage facilities when the clutter can no longer be placed on the inside of the home.

Cases of hoarding range from mild to more severe. In some cases of hoarding, there may be an observable impact on the individual’s ability to go about day to day life while milder cases of hoarding may not have as much of an impact. At the same time, hoarders may not see their behavior as a problem, which can make treatment especially challenging for those attempting to intervene. When effective treatment strategies are applied, however, there is hope that the individual can receive help for their hoarding behavior.

What You Need to Know About Treating Compulsive Hoarding Disorder

There are various things you need to know about the act of treating compulsive hoarding disorder in order to implement the appropriate strategies. For one, there is little current research that exists surrounding the efficacy of interventions that are specifically designed to treat compulsive hoarding disorder. However, a number of approaches have demonstrated successful outcomes. Secondly, it should be noted that various jurisdictions have formed community hoarding task forces which are made up of professionals from a wide range of fields and disciplines. These particular community hoarding task forces are showing promising results in regard to facilitating effective interventions for hoarding.

It should also be noted that a particular form of cognitive behavioral therapy that was specifically designed to treat compulsive hoarding disorder has proven effective in facilitating treatment in some cases. Currently, adapted versions of this form of therapy are being tested in order to be used with specific demographics, in groups, within homes, and via online therapy, among various other forms of treatment.

In order for compulsive hoarding intervention to be effective, the approaches used must take into account that a large number of individuals who display hoarding behavior are resistant to both assessment and treatment of their behavior. Lastly, the complex nature of compulsive hoarding disorder makes dynamic treatment approaches especially valuable with the individual services required being best determined on a case-by-case basis.

What is the Problem?

It should be noted that compulsive hoarding disorder is far from a new phenomenon in our society. That being said, however, compulsive hoarding disorder has only recently been distinctly classified as its own mental disorder. While compulsive disorder is now defined as its own distinct mental disorder in the current version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, compulsive hoarding was previously viewed as a symptom of other underlying mental disorders rather than a distinct mental disorder. Current statistics estimate that 2 to 5 percent of the nation’s adult population engage in some form of compulsive hoarding behavior and this can create especially dangerous and hazardous living conditions for not only individuals that hoard but also their friends, family, pets, and community.

With the awareness of compulsive hoarding disorder currently on the rise, the prevalence of self-reporting and referrals from various service providers has also increased. This has resulted in both researchers and health practitioners focusing their efforts on developing effective treatment strategies in order to facilitate successful intervention of hoarding behavior. Unfortunately, due to the little research available about compulsive hoarding disorder as a distinct mental disorder, attempts to treat these individuals have produced varying results.

It should be noted that it can be very challenging to determine which intervention strategies are the most effective in treating compulsive hoarding disorder. For this reason, it is important that we address what the small amount of research available says about what is the most effective intervention strategy for treating compulsive hoarding disorder. In this article, we will be observing what has proven to be the most effective intervention strategies in terms of community-based intervention and clinical intervention. It is our hope that this information will assist you in making more informed decisions when facilitating an intervention yourself.

Effective Community-Based Interventions

So what do effective community-based interventions look like in regards to treating compulsive hoarding disorder? In order to answer this question, we can look at research and one particular example of a successful treatment plan.

While it has been proven that the complexity of compulsive hoarding disorder requires dynamic interventions, the research available has made it especially clear what successful intervention doesn’t look like. For example, evidence shows that one-time forced removal of clutter within a hoarder’s home, also known as “clean sweeps”, may not only exacerbate hoarding behavior but also perpetuate hoarding behavior. This is due to the fact that these forms of interventionary approaches do not address the underlying causes of the disorder in most cases. Regardless, home clean-out remains the most commonly used form of intervention, especially in terms of more mild cases of hoarding.

Although mental health treatments such as cognitive behavioral therapy are highly recommended, such services are used in fewer than 20 percent of cases. Ultimately, this means that the best evidence-based approach to intervention involves using a collaborative, multi-disciplinary, community hoarding task force. This community hoarding task force should be made up of mental health support. Evidence also suggests that this appears to be true for all demographics, including the elderly and individuals who consistently resist treatment.

How an Effective Hoarding Task Force Works

The current research available regarding effective hoarding task forces suggests that there are several key steps that should be taken in order for this approach to result in successful treatment of compulsive hoarding disorder. Based on this example, this includes:

  • Initial referral or case consultation
  • A home visit and the formation of assessment goals
  • The creation of an overall plan of action through a joint agency case conference
  • The implementation of a chosen intervention strategy
  • The implementation of a support system and follow-up process
  • Case conclusion

At the time that a case of hoarding is identified, the first step is to make an objective assessment of the individual case in order to decide if intervention is absolutely necessary. At the moment that a task force or service provider has been granted access to a site where hoarding behavior is taking place, one of several tools identified by the current research available may be used in order to identify the severity of that specific case:

  • The Clutter Image Rating Scale
  • The Hoarding Rating Scale
  • The Service Utilization Questionnaire
  • The Saving Inventory-Revised

According to Chater, Shaw, and McKay’s research, the individual that is assessing the situation should follow up with the following four steps:

  • Ensuring one’s personal safety
  • Assessing the overall safety of the home
  • Identifying the particular service goals
  • Convening a team to appropriately handle the specific case

It should be noted that a critical part of the intervention process taken on by a hoarding task force involves building trust between all members of the task force and the client. This can be done utilizing a motivational approach that places focus on harm reduction, promotes safety, minimizes loneliness, and empowers the individual through providing educational resources.This is the most effective form of community-based intervention.

Effective Clinical Interventions

In terms of clinical approaches to treating compulsive hoarding disorder, the type of intervention that has proven to be the most thoroughly researched and, as a result, the most effective in successful treatment is cognitive behavioral therapy. That being said, some medication-based approaches have shown some promise and can be used on a case-by-case basis. Looking to a few particular cases where clinical approaches have been especially helpful, we can form an idea of what effective clinical interventions look like in the following information.

Cognitive Behavioral Therapy

There have been various improvements observed with CBT interventions for compulsive hoarding disorder as a symptom of obsessive compulsive disorder and for CBT interventions that were formed specifically for compulsive hoarding as a distinct mental disorder as defined by the DSM-V.

For individuals displaying hoarding behavior as a result of obsessive compulsive disorder, Exposure and Ritual Prevention has been implemented since the 1960s. Around 50 percent of people with OCD who hoard show no significant improvements in their condition with Exposure and Ritual Prevention but those who have shown improvements have displayed a significant reduction of their symptoms over both the short and long-term.

In terms of CBT for compulsive hoarding disorder as a distinct mental disorder, the most effective intervention strategy is largely based on protocol developed by Randy O. Frost and Gail Steketee. The most promising clinical approach available to those with compulsive hoarding disorder involves a combination of cognitive restructuring, motivational interviewing, and exposure as implemented through CBT. Virtually every study that has focused on this approach has shown a significant decrease in the severity of compulsive hoarding disorder symptoms. That being said, it should be noted that the improvement observed in these cases are not always statistically significant and many effect sizes are fairly modest. It seems that the biggest improvement found in these studies are based around cases that have been focused around female hoarders, younger people, and those who receive a greater number of home visits from various service providers.

It is our hope here at Hoarding Help Central that this information has been valuable to you. While more research on the most effective forms of intervention is needed, we have learned much in recent years that can be utilized to facilitate effective interventions for hoarding.