In-home Decluttering Augmentation of Group CBT for HD

Study Overview
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Brief Summary
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The primary aim of trial is to determine the clinical efficacy of in-home decluttering augmentation of group CBT for reducing hoarding severity in adults with HD. The trial takes place in Sweden.

Detailed Description
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Cognitive behavioral therapy (CBT) is the current evidence-based treatment for HD but the majority of sufferers remain symptomatic after CBT with impairing levels of clutter in their homes. Home visits, with a focus on in-home decluttering, have in previous research been shown to be a promising intervention when combined with CBT. However, augmenting CBT with subsequent home visits has not yet been tested in a randomized controlled trial (RCT). In response to this, in this trial, we aim to investigate the efficacy of a coordinated intervention, consisting of CBT and in-home decluttering for HD, in an RCT. In this trial, 90 participants with HD will initially receive 12 sessions of CBT through a psychiatric outpatient service. After CBT, participants will be randomized to receive either 10 home visits in 10 weeks, or to a wait list condition. Our hypothesis is that augmenting CBT with home visits will lead to a reduction in hoarding symptoms and clutter and improved daily functioning compared to wait list. We will also investigate the cost-economical aspects of the intervention. Results from this trial have the potential to reveal whether in-home decluttering should be added to CBT in order to reduce symptoms of hoarding and improve function in indviduals with HD.

Official Title
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In-home Decluttering Augmentation of Group Cognitive-behavior Therapy for Hoarding Disorder: The Joining Forces Randomized Controlled Trial

Conditions
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Hoarding Disorder

Intervention / Treatment
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* Behavioral: In-home decluttering practice


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 years or older. Hoarding disorder as primary psychiatric condition. Willing and able to understand and complete consent and study procedures. Living in the Stockholm county (Sweden) and within a 1-hour commute by public transport from the social services office. Exclusion Criteria: Concurrent CBT or having received CBT for HD during the last two years, for a minimum of 8 sessions including active strategies for reducing acquisition and practice of discarding with a qualified therapist or 8 previous in-home decluttering sessions with a qualified social worker. Unable or unwilling to allow study staff into home for home assessment. Animal hoarding or squalid (i.e. extremely unhygienic) home conditions that are deemed to put the personnel at risk during the in-home decluttering. A diagnosis of organic brain disorder, intellectual disability, psychosis, bipolar disorder without stable medication or with symptoms within the last 6 months, anorexia nervosa or alcohol/substance dependence or abuse. Major medical or neurological conditions that increase the risk of participation or that would prevent completing assigned behavioral practice tasks. Immediate risk to self or others, requiring urgent medical attention, such as high suicidality risk. Participant not able to read and communicate in Swedish. Currently at high risk for eviction (for instance having received a rättelseanmaning by the housing company or Swedish court). Potential participant lives in the same household as an already included participant.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: In-home decluttering<br>Study participants receive weekly sessions of in-home decluttering for 10 weeks. | Behavioral: In-home decluttering practice<br>* The in-home decluttering intervention comprises 10, 1.5-hour home-visits over the course of 10 weeks. These home visits are personalized, goal-oriented and focused on decluttering. They include 1) a brief check-in, 2) guided unclutter time 3) a reflective period during which participants share their thoughts and objectives for the coming week, and 4) homework assignments.<br>|
| No Intervention: Delayed treatment<br>Study participants receive weekly session of in-home decluttering after a 10 week delay. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Saving Inventory-Revised (SI-R) | The SI-R is a 23-item questionnaire with 3 sub-scales: 1) difficulty discarding, 2) excessive clutter, and 3) excessive acquisition. | Change from baseline (week 0) to post-treatment (week 10), | 
| Clutter Image Rating Scale (CIR) | Three sets of photographs, each comprising 9 photos of a room with varying levels of clutter. A selection is made as to which photograph best resembles the room of the participant. | Change from baseline (week 0) to post-treatment (week 10). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hoarding, clutter