Neziroglu Hoarding Presentation - Part 4

Jun 10, 2015 | Author: Bio Behavioral Institute

26. ERP for Acquisition Compulsion

         STEP 1: Construct an Exposure Hierarchy

         Create hierarchy of anxiety-producing situations

         Rate items in terms of how much anxiety you anticipate each of them will create (SUDS 1 to 100)

         STEP 2: Begin with the Lowest SUDS Item

         Begin with the item at the bottom of the list (lowest SUD)

         In vivo exposure, resist all urges to acquire multiples of items

         STEP 3: Repeat That Exposure Until the SUDS Peak is at least 50 Percent Less

         STEP 4: Go on to the Next Item

         Continue on with the hierarchy 

27. Sample E/RP Hierarchy

         Going to a garage sale and not purchasing any items

         Going to a garage sale and purchasing only one item

         Seeing an advertisement for a garage sale and not going to it

         Going window-shopping at the mall without purchasing anything

         Taking no brochures from the doctor’s office

         Taking one brochure from the doctor’s office

         Canceling your subscription to several newspapers or magazines

         Canceling your subscriptions to one newspaper or magazine

         Going grocery shopping and not purchasing multiples of items

28. Treatment Guidelines

         Best outcomes when performed in-home

         Therapist does not touch anything without permission

         All decisions made by patient

         3 ½ Box Technique

         Apply cognitive strategies during cleaning

29. Treatment Sessions

·        Identify target area

·        Aim for positive visual reinforcement

·        Apply 3 ½ Box Technique

·        Maintain gains made

·        Identify new target area

·        Or complete remaining from previous area

30. Medications

         Antidepressants

          SSRIs

          Tricyclics

          MAOIs

         Antipsychotics: gain insight

         Anticonvulsants: mood regulation

         Antianxiety Agents

         Stimulants: if hoarding is related to attention deficit disorder (ADD)

31. Effectiveness of SRIs in Treating Hoarding Disorder

         Studies investigating Hoarding Disorder treatment response yield conflicting results

         Case study: patient met diagnostic criteria for OCD and Hoarding Disorder

         Treatment: 12 weeks of venlafaxine (SRI)

         Patient showed over 60% decrease in the severity of her compulsive hoarding symptoms

         Patient showed less comorbid anxiety and OCD symptoms, and overall functioning at the end of the 12-week period
Saxena, S. (2011). Pharmacotherapy of compulsive hoarding. Journal Of Clinical Psychology, 67(5), 477-484. doi:10.1002/jclp.20792

·        24 Patients meeting the DSM-5 criteria for hoarding disorder were treated with venlafaxine extended-release for a 12 week period

·        Severity of hoarding assessed (pre & post):

·        UCLA Hoarding Severity Scale (UHSS)

·        Saving Inventory-Revised (SI-R)

·        Venlafaxine may be effective for treatment 

·        36% decrease in UHSS scores

·        32% decrease in SI-R scores

·        Saxena, S., & Sumner, J. (2014). Venlafaxine extended-release treatment of hoarding disorder. International Clinical Psychopharmacology, 29(5), 266-273.

·        Hoarders were treated with the SRI paroxetine (Paxil) for 12 weeks

·        Subjects were assessed using the

·        Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

·        Hamilton Depression Rating Scale (HDRS)

·        Hamilton Anxiety Scale (HAS)

·        Global Assessment Scale (GAS)

·        Clinical Global Impression/Improvement (CGI) scale

·        Paroxetine treatment yielded combined overall response rates of 50% for compulsive hoarders (“Response” rate defined as 25-35% and >35% decrease in Y-BOCS scores)

·        Saxena, S. (2011). Pharmacotherapy of compulsive hoarding. Journal Of Clinical Psychology, 67(5), 477-484. doi:10.1002/jclp.20792

32. Mean Symptom Improvement between CBT and Pharmacotherapy

·        Symptom improvement from Pharmacotherapy has been shown to be as great as or greater than that of CBT treatment. 

·        Compulsive hoarding mean symptom improvement (decline in Saving Inventory-Revised scores) :

·        Individual CBT: 27%-28%

·        Group CBT: 10%-21%

·        SRI (venlafaxine) treatment: 31%-37%

·        Saxena, S. (2011). Pharmacotherapy of compulsive hoarding. Journal Of Clinical Psychology, 67(5), 477-484. doi:10.1002/jclp.20792

33. Getting the Family Involved

·        Family members have the right to live without clutter

·        Families may seek treatment first

·        Because hoarders are notoriously resistant to treatment, family intervention is often necessary

·        The hoarder may not think hoarding behavior is a problem or may downplay the impact of hoarding on functioning.

34. Treatment Steps for Family Members: Psychoeducation

·        Psychoeducation on hoarding

·        Understanding the motivation behind hoarding behaviors

·        primary hoarding: Hoarding behavior is due to an emotional attachment to objects/animals and/or identity formation around hoarded items

·        secondary hoarding: Hoarding occurs as a peripheral consequence of another pathological process.  Examples include: dementia, depression, ADHD and OCD. 

·        - Understanding the therapeutic implications of primary vs. secondary hoarding  

·        Learning how to communicate more effectively with hoarder

·        Assertive vs. Aggressive vs. Passive communication style.

·        Use of validating statements
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