1996: Cognitive behavioral model paper

Transcription

1 Randy Frost, PhD April 26, th Annual Conference on Hoarding and Cluttering 1947: Collyer brothers : Virtually nothing 1993: First systematic study Frost & Gross (1993). The hoarding of possessions 1996: Cognitive behavioral model paper Frost & Hartl (1996). Cognitive behavioral model of compulsive hoarding 1

2 2010 = = 46 Mataix-Cols et al., : First Hoarding Task Force Fairfax Co., VA 1999: First Hoarding and Cluttering Conference (San Francisco) 2004: First studies of neural correlates of hoarding Saxena et al. (2004). Cerebral glucose metabolism in obsessive-compulsive hoarding. Mataix-Cols et al. (2004). Distinct neural correlates of washing, checking, and hoarding : First genetic study Samuels et al. (2007)...results from the OCD collaborative genetics study 2008: First epidemiological study Samuels et al. (2008). Prevalence and correlates of hoarding 2

3 2009: A & E Hoarders TV show 2010: First Randomized Control Trial of CBT for hoarding Steketee et al. (2010). Waitlist control trial of cbt for hoarding 2010: Proposal for inclusion of Hoarding Disorder in DSM Mataix-Cols et al. (2004). Compulsive hoarding: A new disorder for DSM : More than 75 Hoarding Task Forces in US & Canada 3 Reality TV shows on hoarding More than 2 dozen hoarding research labs across the world Hoarding phenomenology Conceptual model of hoarding Interventions 3

4 Acquisition Saving Disorganization Acquisition Buying Free Things Stealing Passive 4

5 Buying Free Things Both Buying & Free Frost et al., 2009 Never 12% % Past Current 28% 60% Frost et al.,

6 Current Past Never % % Frost et al., 2012 Types of items Attachments Sentimental Instrumental Intrinsic 6

7 Condition of Home Clutter Mixed importance Behavior Churning Out of sight fear The Cognitive Behavioral Model 7

8 Biological Neural mechanisms Genetic Psychological Self-worth Attachment Attention Memory Categorization Complex thinking Decision-making 8

9 Emotional Attachment: identity, loss, mistakes, comfort Discarding this possession is like losing a friend. Throwing this away feels like abandoning a loved one. I can t tolerate getting rid of this. I love some belongings the way I love some people. Throwing this away is like throwing away part of me. My possessions are part of who I am. Responsibility & Waste Throwing this out wastes a valuable opportunity. I m responsible for the well-being of this possession. I must save this for someone who might need it. 9

10 Information & Memory I might lose important information if I get rid of this. Saving this means I don t have to rely on my memory. If I don t leave this in sight, I ll forget it. Control No one has the right to touch my things. 10

11 Aesthetics Core beliefs & vulnerabilities Information processing Attachments Negative Reinforcement Emotions Neg. Pos. Saving & Acquiring Positive Reinforcement 11

12 Acquisition Difficulty Discarding Clutter/Disorganization Individual Group Self-help/Support Groups Coaching/Case Management 12

13 % Reduction 0% -5% % -15% -20% -25% -30% -35% Partial ETA 2 =.223 Session CBT Wait list Partial ETA2 = % reduction Steketee et al., 2010, Depress&Anx, 27,

14 Group+H Group Bib Only Pre Mid Post Muroff et al., in press 14

15 It is hard to find a therapist It takes a lot of time It is expensive Maybe other approaches can help Internet Based self-help Self-help/Support Groups? Two Groups (17 & 11 people) 13 weekly 2-hour group sessions Facilitated by undergraduates Buried in Treasures (Tolin et al. 2007) Frost, Pekareva-Kochergina, & Maxner,

16 Mean Score Score Pre-Tx Mid-Tx Post-Tx Follow-Up Time Study 1 Study Study 1 Study Pre-Tx Mid-Tx Post-Tx Follow-Up Time 16

17 Mean Score Pre-Tx Mid-Tx Post-Tx Follow-Up Time Randomly assigned Wait List 13 weeks Immediate Support Group 13 weeks Facilitated by peer counselor Compare changes from pre to post Frost, Ruby,& Shuer,

18 Score HRS - Interview TX Wait Pre-Tx Post-Tx TX Wait Pre-Tx Post-Tx 18

19 SCI TX Wait 70 Pre-Tx Post-Tx FSG CBT Self-report Assessor Frost et al., 2012; Steketee et al.,

20 I first read the book and revved up my uncluttering. But when I re-read the book with my support group and did all the exercises, I understood myself better. I didn t just clear out some space. I changed. Facilitated by non-professionals Facilitator s Guide (Shuer & Frost, 2011) OCFoundation.org Buried in Treasures (Tolin et al., 2007) 15 Sessions 20 weeks 6-9 members per group 20

21 Community Collaboration Refinement of CBT for hoarding DSM-5 21