A naturalistic study of emotion regulation-enhanced cognitive-behavioral group therapy for hoarding disorder in a community setting

Abstract

Background: Cognitive-behavioral group therapy for hoarding disorder (HD) is efficacious, but outcomes are modest and dropout rates are generally high. Clinical challenges in this population include high rates of comorbidity and difficulty regulating and tolerating negative emotions, which may reduce engagement with discarding exposures and lead to increased dropout. Methods: In the current naturalistic study, we evaluated standard group cognitive-behavioral therapy enhanced with a three-session emotion regulation module in a large sample of individuals (N = 115) seeking treatment for HD at a community mental health clinic. We evaluated outcomes for distress tolerance, as well as hoarding symptoms and comorbid depression and anxiety symptoms. Results: Distress tolerance was significantly improved at post-treatment, Hoarding symptoms, anxiety, and depression were also significantly decreased. Distress tolerance predicted more severe hoarding symptoms at baseline, but improvement in distress tolerance was not significantly associated with improvement in hoarding symptoms. Limitations: The primary limitation was the absence of a control treatment condition, but HD is known to be a chronic condition which tends not to improve in waitlist control conditions. Conclusions: Integrating emotion regulation strategies may provide an important pathway to improving treatment outcomes for hoarding disorder.

Keywords

• Hoarding
• Emotion regulation
• Distress tolerance
• Cognitive-behavioral therapy