Effect of Acceptance Versus Psychoeducation on Hoarding

Hoarding disorder (HD) is a mental health condition characterized by difficulty letting go of possessions, resulting in clutter that prevents use of active living spaces. Consequences associated with hoarding include strained family relationships, distress for children in the home, and increased burden on social services. Currently, the most empirically supported treatment for HD is cognitive-behavioral therapy (CBT), which includes such components as education about the nature of hoarding, challenging unhelpful thoughts, and exposure to distressing stimuli. Despite its demonstrated effectiveness, CBT does not result in clinically significant improvement for at least 50% of individuals, indicating the need for alternative interventions for those who do not respond to CBT. Acceptance and commitment therapy (ACT), an acceptance- and mindfulness-based therapy, is one potential alternative. The overarching aim of ACT is to improve psychological flexibility, the ability to act consistently with meaningful life directions in the presence of difficult internal experiences. Given the high levels of avoidance (e.g., of decision making, of distress) consistently observed in hoarding, increasing one’s range of responses to previously avoided stimuli in the service of more fulfilling activities may be a particularly useful skill. Furthermore, ACT has been found to be effective for clinical presentations related to HD, including anxiety disorders and obsessive-compulsive disorder. The current exploratory study compared the effects of acceptance-based training to psychoeducation on several measures of hoarding severity in a sample of college students with elevated hoarding. Participants (N = 47) completed a discarding behavioral task and self-report measures at postintervention as well as an online follow-up survey one week later. There were no differences in outcomes between conditions over time, suggesting that acceptance training was not more effective than psychoeducation alone. Hoarding severity and thoughts related to hoarding significantly decreased from baseline to one-week follow-up, indicating that both interventions improved hoarding symptoms in our sample. These findings also suggest that early intervention may be a useful approach to alleviating hoarding symptoms