Web-based Acceptance and Commitment Therapy for Hoarding Disorder

Study Overview
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Brief Summary
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This study will help to determine if acceptance and commitment therapy delivered as a web-based intervention is a useful treatment for hoarding disorder and evaluate whether or not web-based treatment for hoarding is credible and acceptable. It may also help identify novel processes of change in hoarding treatment such as psychological inflexibility, mindfulness, and self-stigma.

Detailed Description
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The efficacy of an ACT self-help website for hoarding will be assessed through a randomized, waitlist-controlled trial. Participants will be recruited from within the United States through a variety of channels. Given the need to recruit a targeted sample with clinical levels of hoarding symptoms, online advertisements through Facebook and Google AdWords will be the primary recruitment method. Participants will complete an initial brief screening, provide consent, and then complete a baseline survey. Each of these steps will be completed online and participants will be automatically guided from each step to the next. That is, those who screen as eligible will be automatically directed to an online consent form, and those who provide consent will be automatically directed to begin the initial online baseline survey. They will be randomly assigned automatically upon completing the baseline survey to either use the ACT self-help website and receive supportive coaching for the next 8 weeks, or wait for the next 8 weeks. After 8 weeks, participants will be asked to complete a posttreatment survey. They will be asked to complete a final, follow-up survey after an additional 4 weeks after the posttreatment survey. After the follow-up survey is completed, waitlisted participants will be provided with access to the website. The website will implement a self-help version of ACT. Participants will be asked to complete 16 brief self-help website sessions, each taking around 15-20 minutes to finish, twice a week for eight weeks. Participants assigned to the website condition will also receive coaching.The purpose of coaching will be to help participants engage with the website and adhere to the intervention. Coaching will consist of an initial phone call of 10-15 minutes followed by weekly email contact during the 8-week treatment period. Coaches will be graduate students trained in clinical psychology.

Official Title
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A Randomized Waitlist-controlled Trial of Web-based Acceptance and Commitment Therapy for Hoarding Disorder

Conditions
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Hoarding Disorder

Intervention / Treatment
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* Behavioral: ACT Website and Coaching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years old or older Living in the USA Seeking help for clutter and/or hoarding Interested in testing a self-help website Scoring at or above the clinical cutoff of 41 on the Saving Inventory-Revised Exclusion Criteria: 17 years or younger Living outside the USA Not seeking help for clutter and/or hoarding Not interested in testing a self-help website Scoring below 41 on the Saving Inventory-Revised

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
Interventional Model Description: Participants will be randomly assigned with equal likelihood to receive the website and coaching immediately or to wait for 12 weeks before using the website.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ACT Website and Coaching Condition<br>Participants will be asked to complete 16 brief self-help website sessions, each taking around 15-20 minutes to finish, twice a week for eight weeks. Website exercises and examples primarily focus on hoarding, although some examples also discuss related mental health concerns such as anxiety, low mood, health behaviors, etc. The sessions use multimedia and are interactive. Participants assigned to the website condition will also receive coaching. The purpose of coaching will be to help participants engage with the website and adhere to the intervention. Coaching will consist of an initial phone call of 10-15 minutes followed by weekly email contact during the 8-week treatment period. Coaches will be graduate students trained in clinical psychology. | Behavioral: ACT Website and Coaching<br>* The ACT website includes sixteen sessions and is designed to teach a series of skills from ACT applied to hoarding. The intervention also includes brief supportive coaching (an initial phone call and weekly support over email).<br>|
| No Intervention: Waitlist Condition<br>Participants assigned to the waitlist will be asked to wait 12 weeks without intervention (access to the website or coaching). They will receive access to the website after 12 weeks, but supportive coaching will not be provided to waitlist participants. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Saving Inventory-Revised (SI-R; Frost et al., 2004) | A self-report measure of hoarding symptoms | Posttreatment (8 weeks after baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sheehan Disability Scale (Sheehan, Harnett-Sheehan, & Raj, 1996) | A self-report measure of functional impairment due to symptoms. Higher scores indicate greater impairment. Scores range from 0 to 30. | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| Clinical Global Impression - Improvement (CGI-I; Guy, 1976). | A self-report measure of overall improvement in symptoms | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| General Health Questionnaire-12 (GHQ-12; Goldberg, 1978) | A self-report measure of overall psychological distress | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| Stigma of hoarding items (Chasson et al., 2018) | Seven self-report items assessing stigma towards individuals with hoarding disorder. These items are not a standardized scale but have been used in previous research (Chasson et al., 2018). Three items assess perceived difference (Example: How like or unlike do you think is a person with obsessive-compulsive disorder compared to everyone else in the general population?), three items assess disdain (Example: How good or bad do you think is a person with hoarding disorder compared to everyone else in the general population?) and one item assesses blame: How responsible do you think a person with serious mental illness is for his or her condition? | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| Acceptance and Action Questionnaire for Hoarding (AAQH; Krafft et al., in press) | A self-report measure of hoarding-related psychological inflexibility | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| Five-Facet Mindfulness Questionnaire - Acting with Awareness (FFMQ-AA; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) | A self-report measure of the acting with awareness facet of mindfulness | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| Valuing Questionnaire-Progress (VQ-Progress; Smout, Davies, Burns, & Christie, 2014) | A self-report measure of progress toward personal values | Posttreatment (8 weeks after baseline) and follow-up (12 weeks after baseline) | 
| Credibility/Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000). | A self-report measure of the perceived credibility of and expectations toward a treatment. Only administered to treatment condition | After using first website session (approximately 0-1 weeks after baseline) | 
| System Usability Scale (Tullis & Albert, 2008) | A self-report measure of usability of a technological system. Only administered to treatment condition. High scores indicated greater usability, and scores range from 0 to 100. | Posttreatment (8 weeks after baseline) | 
| Treatment Evaluation Inventory-Short Form (TEI-SF; Kelley, Heffer, Gresham, & Elliott, 1989). | A self-report measure of treatment acceptability. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 1 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement Overall, I was satisfied with the quality of the program. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 2 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement The program was helpful to me. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 3 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement The program was easy to use. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 4 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I felt the program was made for someone like me. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 5 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I would recommend the program to other people with a clutter and/or hoarding problem. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 6 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement The psychological skills taught (ex. mindfulness, opening up) were helpful to me. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 7 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement The practice exercises (ex. discarding, goal setting) were helpful to me. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 8 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement This treatment fit well with my goals. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 9 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement Overall, I was satisfied with the coaching that I received. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 10 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement The website would have been just as useful without a coach. This is a novel satisfaction item specific to this study. Only administered to treatment condition | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 11 | Participants will be asked an open-ended question to gather qualitative feedback on the intervention. Only assigned to treatment condition. The question is, What did you like best about the Making Space program? | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 12 | Participants will be asked an open-ended question to gather qualitative feedback on the intervention. Only assigned to treatment condition. The question is, What was the most important thing you learned from the Making Space program? | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 13 | Participants will be asked an open-ended question to gather qualitative feedback on the intervention. Only assigned to treatment condition. The question is, What did you like least about the Making Space Program? Why did you like this the least? | Posttreatment (8 weeks after baseline) | 
| Novel satisfaction item 14 | Participants will be asked an open-ended question to gather qualitative feedback on the intervention. Only assigned to treatment condition. The question is, Do you have any other comments or suggestions regarding our Making Space program? | Posttreatment (8 weeks after baseline) |