Category: Obsessive Compulsive and Related Disorders

Symposium

Treatment Compliance and Outcome in Group CBT for Hoarding Disorder

Friday, November 17
8:30 AM - 10:00 AM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: Hoarding | Treatment Integrity / Adherence / Compliance | Clinical Trial
Presentation Type: Symposium

The efficacy of cognitive-behavioral therapy (CBT) for hoarding disorder (HD) has been established, although outcomes are modest.  Several studies have noted problems of treatment compliance and attrition.  The aim of the present study was to identify patterns of treatment noncompliance and attrition, to determine the relationship between compliance and treatment outcome, and to understand clinical factors associated with poor compliance.  In this ongoing study, patients with HD who began a 16-week group CBT program (N = 48 to date; anticipated N = 80) were assessed using the Saving Inventory-Revised (SI-R).  Within-session compliance was assessed using the CBT adherence measure (CAM), a therapist rating scale of on-task behaviors such as adhering to the session agenda, making off-topic statements, and understanding the goals of the treatment.  Between-session compliance was measured using the Patient Exposure/Response Prevention Adherence Scale for Hoarding (PEAS-H), a therapist rating scale of homework completion (sorting/discarding assignments and refraining from acquiring).  Within- and between-session compliance in the middle sessions (sessions 5-7) were significantly associated with dropout rate; those showing less compliance were more likely to discontinue treatment prematurely.  Among patients completing the treatment, those showing reliable change on the SI-R at post-treatment were rated as exhibiting significantly better within- and between-session compliance than did those who did not show reliable change on the SI-R, and these differences were evident within the first few sessions.  Specifically, patients rated early in treatment as demonstrating poorer adherence to within-session expectations, and having poor quality of homework completion, were less likely to show reliable change at 16 weeks.  Poor within- and between-session treatment compliance was associated with self-reported difficulties in emotion regulation and low distress tolerance at baseline.  These preliminary results suggest that poor within- and between-session treatment compliance, evident as early as the first session, is a poor prognostic factor for CBT for HD.

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