Cognitive rehabilitation and exposure/sorting therapy for hoarding disorder: A randomized controlled trial.

IF 6 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2026-08-01 DOI:10.1037/ccp0001022

Catherine R Ayers, Jessica J Zakrzewski, Mary E Dozier, Tina Mayes, Michael Thomas, Elizabeth W Twamley, Alexis Carty-Campbell, James Pittman

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Abstract

Objective: Hoarding disorder (HD) is one of the most common and impairing neuropsychiatric conditions in late life. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for HD is effective in reducing HD symptoms and improving functioning when compared with case management. In the current trial (NCT02402647), we compared CREST to a robust control condition, exposure therapy (ET), to determine if CREST provides additional benefit to HD symptom reduction, functioning, and quality of life over ET.

Method: One hundred fifteen Veterans with HD were randomized to receive 26 once weekly, 1-hr manualized individual sessions of CREST (n = 59) or ET (n = 56). CREST included seven sessions of cognitive rehabilitation therapy, while ET included seven sessions of psychoeducation with both groups completing the same manualized ET for 26 sessions. Participants completed assessments at baseline and posttreatment. Outcome measures included assessments of HD symptom severity, functional capacity, self-reported functioning, self-reported disability, and quality of life. Linear mixed-effects models were used to examine change at posttreatment.

Results: Participants were mostly male (64%) and White/non-Hispanic (72%) and on average were 62 years old with 16 years of education. Participants averaged a 42% improvement in HD symptoms posttreatment (ΔSI-R = 24.3 ± 17.8), but groups did not differ on improvement in HD symptoms, functional capacity, disability, or quality of life. The CREST group reported greater improvements in interpersonal functioning at posttreatment (d = 0.48, p = .012).

Conclusions: Exposure-based treatment is highly effective for HD. Both CREST and ET groups demonstrated significant reductions in HD symptoms. CREST participants demonstrated additional improvement in self-reported interpersonal functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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囤积障碍的认知康复和暴露/分类疗法：一项随机对照试验。

目的：囤积障碍（HD）是晚年最常见和最有害的神经精神疾病之一。与病例管理相比，认知康复和暴露/分类治疗（CREST）在减轻HD症状和改善功能方面是有效的。在当前的试验（NCT02402647）中，我们比较了CREST和一个强大的对照条件，暴露疗法（ET），以确定CREST是否比ET对HD症状减轻、功能和生活质量有额外的益处。方法：115名患有HD的退伍军人随机接受26次，每周一次，1小时的CREST （n = 59）或ET （n = 56）。CREST包括7个疗程的认知康复治疗，而ET包括7个疗程的心理教育，两组都完成了26个疗程的相同的手动ET。参与者完成了基线和治疗后的评估。结果测量包括HD症状严重程度、功能能力、自我报告功能、自我报告残疾和生活质量的评估。线性混合效应模型用于检查治疗后的变化。结果：参与者主要是男性（64%）和白人/非西班牙裔（72%），平均年龄为62岁，受教育程度为16年。参与者治疗后HD症状平均改善42% （ΔSI-R = 24.3±17.8），但两组在HD症状、功能能力、残疾或生活质量改善方面没有差异。CREST组在治疗后人际功能有较大改善（d = 0.48, p = 0.012）。结论：暴露治疗对HD非常有效。CREST组和ET组均表现出HD症状的显著减轻。CREST参与者在自我报告的人际功能方面表现出额外的改善。（PsycInfo数据库记录(c) 2026 APA，版权所有）。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.