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Randomized Controlled Trial
. 2018 Mar/Apr;79(2):16m11072.
doi: 10.4088/JCP.16m11072.

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial

Catherine R Ayers  1   2   3   4 , Mary E Dozier  4   5 , Elizabeth W Twamley  3   4   5   6 , Sanjaya Saxena  3 , Eric Granholm  2   3   4 , Tina L Mayes  5 , Julie Loebach Wetherell  2   3   4
Affiliations
Randomized Controlled Trial

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial

Catherine R Ayers et al. J Clin Psychiatry. 2018 Mar/Apr.

Abstract

Objective: To compare the efficacy of Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with geriatric case management (CM) in a sample of older adults meeting DSM-5 diagnostic criteria for hoarding disorder (HD).

Methods: Fifty-eight older adults with HD were enrolled in a randomized controlled trial between December 2011 and March 2014. Thirty-one participants received CREST, and 27 participants received CM. Both interventions consisted of 26 individual sessions over a period of 6 months and included several home visits by the study therapists (CREST) or nurses (CM). The Saving Inventory-Revised (SI-R) and the UCLA Hoarding Severity Scale (UHSS) were the main outcome measures.

Results: Participants in the CREST condition had significantly greater improvement on the SI-R than participants in the CM group (group × time interaction: β = 3.95, SE = 1.81, P = .029), with participants who completed the CREST condition averaging a 38% decrease in symptoms and participants who completed the CM condition averaging a 25% decrease in symptoms. In contrast, there was not a significant group × time interaction effect on the UHSS (β = 1.23, SE = 0.84, P = .144), although participants did report greater improvement in symptoms in the CREST condition (35%) than in the CM condition (24%). Treatment gains were maintained at 6-month follow-up.

Conclusions: CREST appears to be an efficacious treatment compared to CM for older adults, but CM also showed meaningful benefits.

Trial registration: ClinicalTrials.gov identifier: NCT01227057​.

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Conflict of interest statement

Potential conflicts of interest: None.

Figures

Figure 1.
Figure 1.
Flow of Participants Through Each Phase of the Study Abbreviations: CREST = Cognitive Rehabilitation and Exposure/Sorting Therapy, HD=hoarding disorder.
Figure 2.
Figure 2.
Hoarding Symptom Severity on Outcome Measures as a Function of Treatment Group for 58 Participants Receiving CREST or CM for Hoarding Disordera aData are predicted values based on mixed models with standard error bars. Abbreviations: ADL-H = Activities of Daily Living–Hoarding scale, CM = case management, CREST=Cognitive Rehabilitation and Exposure/Sorting Therapy, SI-R = Saving Inventory-Revised, UHSS = UCLA Hoarding Severity Scale.
See this image and copyright information in PMC

References

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    1. Ayers CR, Dozier ME. Predictors of hoarding severity in older adults with hoarding disorder. Int Psychogeriatr. 2015;27(7):1147–1156. - PMC - PubMed
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    1. Iervolino AC, Perroud N, Fullana MA, et al. Prevalence and heritability of compulsive hoarding: a twin study. Am J Psychiatry. 2009;166(10):1156–1161. - PubMed

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