Testing an Acceptance and Commitment Therapy Website for Hoarding: A Randomized Waitlist-Controlled Trial

Hoarding disorder is relatively common and seriously affects those who experience it. However, it is difficult to access hoarding treatment, due to barriers such as availability and stigma. Moreover, only one treatment is well-established for hoarding (CBT), and it does not directly address important processes such as mindfulness and acceptance. Therefore, in order to make treatment more useful and easy to access, this study tested a self-help program that focused on teaching mindfulness and acceptance as related to hoarding. The self-help program was compared to a waitlist condition; participants were randomly assigned to use the website or wait 12 weeks. The website was structured as 16 self-help modules tailored for hoarding. The program was implemented as an 8-week treatment with a 4-week follow-up period, and supportive coaching was provided during the 8-week treatment period. The sample included 73 individuals with problematic hoarding symptoms; as is common in hoarding treatment studies, participants were mostly white and female. These participants were slightly less white and somewhat younger compared to participants in studies on traditional therapy. Overall, results suggested that the program was helpful and participants found it satisfactory. Those who used the website improved significantly more than the waitlist on overall hoarding symptoms, overall difficulties in functioning, self-stigma, and progress toward personal values. Many participants did not finish the program, and many still had a problematic level of hoarding symptoms after treatment, which suggests room for improvement. Participants overall found the website satisfactory and easy to use, and perceived it as likely to be helpful. It is unclear what processes led to improvement in the treatment condition, although increasing mindful awareness and reducing rigid responses to thoughts and feelings about acquiring belongings may have contributed. Future studies should test this treatment in more diverse participants and compare it to other types of treatment options. However, these results suggest that a self-help website teaching mindfulness and acceptance skills is likely to be useful for people with hoarding problems