Cognitive Rehab and Exposure Treatment for Hoarding (CREST)

VA Office of Research and Development

Status: Completed

Conditions: Hoarding Disorder

Treatments: Behavioral: Exposure Therapy (ET); Behavioral: Cognitive Rehabilitation and Exposure/Sorting Treatment (CREST)

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT02402647

CLNA-005-14S

Details and patient eligibility

About

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.

Full description

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 with HD.

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.

Enrollment: 115 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 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

Exclusion criteria

• Diagnosis of:

  • psychotic disorder
  • substance abuse disorder as measured by the Mini-International Neuropsychiatric Interview (M.I.N.I.)68

• Current or history of any neurodegenerative disease

• Active suicidal ideation

• Concurrent participation in psychotherapy or ET for HD, or prior history of CREST for HD

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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115 participants in 2 patient groups

Cognitive Rehabilitation and Exposure/Sorting Treatment (CREST)

Experimental group

Description:

Compensatory Cognitive Training (CCT) is a manualized, low-tech, cognitive training intervention designed to target cognitive impairments common in people with psychiatric illness. The CCT modules specifically selected for CREST map onto known areas of HD neurocognitive deficits or weakness and include training in prospective memory, prioritizing, problem solving, planning, and cognitive flexibility. Symptoms of acquiring and saving are themselves avoidance behaviors that are performed to avoid internal distress related to negative thoughts and emotions. Avoidance serves to reduce distress related to the beliefs regarding the necessity and utility of possessions. In the CREST condition, the second part and the majority of treatment is dedicated to exposure therapy (ET) for discarding and not acquiring while in the control condition, the entire treatment will consist of ET.

Treatment:

Behavioral: Cognitive Rehabilitation and Exposure/Sorting Treatment (CREST)

Exposure Therapy (ET)

Active Comparator group

Description:

The investigators propose to use a robust control condition, exposure therapy (ET), with the same frequency and amount of therapist contact as CREST. Twenty-six weekly, individual ET sessions (6 months) will be delivered. The control group will receive ET for all 26 sessions and no cognitive training. As in CREST, the ET sessions will be manualized and copies utilized during session by both the patient and therapist.

Treatment:

Behavioral: Exposure Therapy (ET)