Neural Mechanisms of CBT Response in Hoarding Disorder
Condition: Obsessive Compulsive Disorder
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder; Hoarding Disorder
Study type: Interventional

Summary: 
      The purpose of this research is to measure changes in brain activity with functional magnetic
      resonance imaging (fMRI) before and after cognitive-behavioral therapy for compulsive
      hoarding. Cognitive-behavioral therapy aims to help people change the thoughts and behaviors
      that maintain symptoms of hoarding. The investigators intend to enroll approximately 80
      people with hoarding disorder and 40 people with no psychiatric disorder, between the ages of
      20 and 60, for this study. The investigators believe that after treatment there will be
      changes in the brain activity of individuals with compulsive hoarding.
    

Detailed description: 
      The long-term goal of the proposed research is to improve clinical outcomes for Hoarding
      Disorder (HD), a common and potentially debilitating condition that poses a severe public
      health burden. The PI has developed and tested a cognitive-behavioral therapy (CBT) that
      appears moderately effective, although there is clear room for improvement. In the present
      study, the investigators propose to merge this line of research with the PI's recent
      NIH-supported neuroimaging research that points to specific functional abnormalities in
      regions of interest (ROIs) related to cognitive and affective decisionmaking processes.
      Patients with HD n = 80) will be randomized to CBT or wait list (WL). At pre-treatment,
      mid-treatment, and post-treatment, patients will undergo functional magnetic resonance
      imaging (fMRI) during an acquiring and discarding decision-making task that has been used
      successfully in the investigators' previous work. In addition, patients will complete a
      number of laboratory tasks designed to assess decision-making capacity and impairment. A
      group of healthy control (HC) participants (n = 40) will also complete these measures as a
      normative control group. The primary aim of the proposed study is to determine the extent to
      which the observed patterns of neural activity in HD change following CBT. Under this aim,
      the investigators predict that HD patients (vs.HCs) will show greater hemodynamic activity in
      ROIs associated with cognitive and affective aspects of decision-making. The investigators
      further predict that HD patients receiving CBT (vs. WL) will show decreased activity in those
      ROIs, and will no longer differ from HCs following CBT. A secondary aim of the proposed study
      is to determine the relationship between change in activity in brain regions of interest and
      hoarding-related symptoms and impairments. The investigators expect, that hemodynamic
      activity in the target ROIs will correlate with symptoms of HD and with performance on
      decision-making tasks; and that change in brain activity will correspond to both symptom and
      mechanism changes over the course of treatment. Finally, an exploratory aim is to explore,
      using both data-driven and model-constrained approaches, patterns of pre-treatment neural
      activity that predict response to CBT. The investigators predict that among treated HD
      patients, pre-treatment activity in the target ROIs will correlate significantly with HD
      symptom change from pre- to posttreatment. Results of the proposed study are expected to
      elucidate the neural mechanisms of successful response to CBT treatment for hoarding
      patients, and to set the stage for further treatment development and possible improvements in
      outcome for this disorder.
    

Intervention name(s): Cognitive Behavioral Therapy
Intervention type(s): Behavioral
Intervention description(s): Group cognitive-behavioral therapy for hoarding disorder, 16 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Hoarding Disorder; Clutter; CBT; Cognitive behavior therapy; fMRI; Obsessive compulsive disorder (OCD); Healthy control