CBT for Hoarding Disorder: A Group Therapy Program Therapists Guide

Comprised of a therapist manual and client workbook, CBT for Hoarding Disorder guides group leaders through a comprehensive CBT group program for patients struggling with hoarding disorder. Filling the need created by the inclusion of hoarding disorder (HD) as its own diagnosis in the DSM–5, this program which was created by a group of four clinical psychologists experienced in research and treatment of  problematic hoarding behavior prioritizes experiential learning, repeated practice, skills building, and real–world discarding progress.

The therapist manual provides step–by–step, evidence–based guidance for treating hoarding with a focus on proven methods for behavior change rather than complex cognitive interventions. It contains the latest research on hoarding disorder and emphasizes the cognitive, emotional, and motivational factors involved in discarding and decision–making. The client workbook features accessible, straightforward content, including coping cards that summarize key lessons, homework assignments, motivational tools, and practice exercises for decision–making and emotion regulation skills. Easy to implement without home visits, this is a cutting–edge treatment program for professionals and group leaders of all educational backgrounds treating problematic hoarding behavior across a wide variety of treatment settings and disciplines.

Part I Introductory Information for Clinicians

What is Hoarding Disorder?

Diagnosing Hoarding Disorder

What Causes Hoarding Disorder?

How DWe Target These Factors in Treatment?

Implementing Group CBT for Hoarding Disorder

Does This Treatment Work?

What Does the Group Look Like?

WhIs This Group Designed For?

Use of the Manual

Troubleshooting Common Problems

Measuring Outcomes

Part II Treatment Manual

Chapter 1 Welcome tThe Class

1. Welcome tthe Declutter Class

Sorting and Discarding

Bringing Clutter from Home tGroup

Staying on Schedule

Photos

Class Task: Introduce Yourself!

2. Class Rules and Guidelines

Treatment Contract

Class Confidentiality Contract

3. What is Hoarding Disorder?

4. What Will I Learn in This Class?

Learn More About What Contributes tYou Having Clutter

Learn Evidence–Based Skills tReduce the Clutter in Your Home

Learn How tApply the Skills on a Consistent Basis

5. How Well Does the Declutter Class Work?

6. Homework

Chapter 2 Why DI Have SMuch Stuff?

1. Homework Review

Class Task: Homework Review

2. Rewards

Individual Rewards

Class Task: Brainstorm Rewards

Class Rewards

3. Meet the Bad Guys

Decision–Making and Problem Solving

Intense Emotions

Unhelpful Thinking

Waxing and Waning Motivation

4. Setting Goals

CLASS TASK: Setting SMART Goals

5. Homework

In/Out Logs

Chapter 3 Making Decisions and Solving Problems: Part 1

1. Homework Review

2. Making Decisions and Solving Problems

3. Making Decisions and Minimizing Distractions

Guidelines for Discarding

Class Task: Making Your Own Guidelines

Scheduling the Time t Work on Discarding

Class Task: Identifying the Best Time for Discarding and Planning Your Day

4. Making Decisions and Improving Organization

How Much is To Much?

Class Task: Identifying if I Have To Much Stuff

Where DThings Belong?

Class Task: Make Your Own Categories

5. Putting Skills Together tDiscard Better

Follow the Flowchart for Discarding

Class Task: Using the Flowchart tHelp with Discarding

6. Homework

Chapter 4 Making Decisions and Solving Problems: Part 2

1. Homework Review

2. Making Decisions: Acquiring

Understanding High–Risk Situations

Class Task: Identifying High–Risk Situations

Understanding Healthy vs. Unhealthy Acquiring

Class Task: Identifying Common Unhealthy Reasons for Acquiring

Guidelines for Acquiring

3. Solving Problems

Class Task: Identifying Problems That Maintain My Clutter Problem

Learning How tSolve Problems

Class Task: Practice Problem Solving

4. Discarding Practice

5. Bad Guy Re–evaluation

6. Homework

Chapter 5 Intense Emotions: Part 1

1. Homework Review

2. About Intense Emotions

Class Task: Class Discussion About Intense Emotions

Class Task: Identifying the Intense Emotions That Lead tClutter

3. Tackling Intense Emotions That Lead tAcquiring

Class Task: Identifying Negative Beliefs About Emotions

4. Homework

Chapter 6 Intense Emotions: Part 2

1. Homework Review

2. Tackling Intense Emotions That Get In the Way of Discarding

Accepting Our Emotions and Being Our Own Boss

Class Task : Being Your Own Boss: Acquiring

Class Task: Being Your Own Boss: Discarding

Recognizing When Emotions Are Taking Over

3. Bad Guy Re–evaluation

4. Homework

Chapter 7 Unhelpful Thinking: Part 1

1. Homework Review

2. How Thoughts Influence Emotions

Class Task: Identifying How Thoughts Lead tEmotions

3. Identifying Unhelpful Thoughts

Common Unhelpful Thoughts in People with Hoarding Disorder

Class Task: Identifying Unhelpful Thoughts That Lead tDifficulty Discarding

4. Homework

Chapter 8 Unhelpful Thinking: Part 2

1. Homework Review

2. Tackling Unhelpful Thoughts

Question the Thoughts

Class Task: Practice Questioning Your Thoughts: Acquiring

Class Task: Practice Questioning Your Thoughts: Discarding

What Would You Say ta Friend?

Class Task: How Would I Advise a Friend?

3. Bad Guy Re–evaluation

4. Homework

Chapter 9: Waxing and Waning Motivation: Part 1

1. Homework Review

2. Improving Motivation

The Pros and Cons of Continuing Your Efforts

Class Task: Identifying Pros and Cons of Continuing Your Efforts

3. Acting on Your Top Goals and Values

Focusing on Goals and Values

Class Task: Identifying My Life Goals and Values

Class Task: Are My Life Goals Consistent with My Acquiring and Discarding Behaviors?

4. Homework

Chapter 10 Waxing and Waning Motivation: Part 2

1. Homework Review

2. Improving Motivation tDiscard

Visualize Your Decluttered Space

Class Task: Using Your Imagination tVisualize Your Decluttered Space

3. Being Motivated By Your Values

4. Checking In on Long–Term SMART Goals

5. Bad Guy Re–evaluation

6. Homework

Chapter 11: Putting It All Together: Part 1

1. Homework Review

2. Troubleshooting Common Barriers

Barrier 1: Areas Getting Recluttered

Barrier 2: Cannot Access the Final Home for Objects

3. Putting It All Together

Class Task: Putting the Skills Together

4. Homework

Chapter 12 Putting It All Together: Part 2

1. Homework Review

2. Troubleshooting Common Barriers

Barrier 3: Conditions That Interfere with Discarding

Barrier 4: Not Having Information About What tKeep or Not Keep

3. Putting It All Together

4. Homework

Chapter 13: Putting It All Together: Part 3

1. Homework Review

2. Troubleshooting Common Barriers

Barrier 5: My Family Member AlsHas Hoarding Disorder

Barrier 6: I Feel Like I Can t Get Rid of Items If They Are Worth Money

3. Putting It All Together

4. Homework

Chapter 14 Putting It All Together: Part 4

1. Homework Review

2. Troubleshooting Common Barriers

Barrier 7: Being Overly Careful When Discarding

Additional Barrier (optional)

3. Putting It All Together

4. Homework

Chapter 15 Staying Well in the Future: Part 1

1. Homework Review

2. Reviewing Progress

What You ve Learned

Choosing How You Think About Progress

Class Task: Write Down Your Thoughts About Your Progress

3. Practice Discarding

Class Task: Discarding Practice

4. Homework

Chapter 16: Staying Well in the Future: Part 2

1. Homework Review

2. Maintaining Motivation

My Rewards for Working on My Hoarding Problem

Class Task: Identify Some Goals and Rewards

3. Wrap–Up and Questions

Appendix A: Clock Sign

Appendix B: Bad Guy Reminder Cards for Participants

References

David Tolin is Founder and Director of the Anxiety Disorders Center/Center for Cognitive Behavioral Therapy at The Institute of Living, USA. He is also Adjunct Professor of Psychiatry at Yale University School of Medicine.  He was the 2014 President of clinical psychology division of the American Psychological Association, and the recipient of the awards for Distinguished Contribution to the Science of Psychology, Distinguished Contribution to the Practice of Psychology, and Lifetime Contribution to Psychology from the Connecticut Psychological Association. An internationally recognized expert in the study and treatment of hoarding disorder, Dr. Tolin is the author of Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding (second edition, 2014), as well as Doing CBT: A Comprehensive Guide to Working with Behaviors, Thoughts, and Emotions (2016), Face Your Fears: A Proven Plan to Beat Anxiety, Panic, Phobias, and Obsessions (Wiley, 2012),and Treating Trichotillomania: Cognitive Behavior Therapy for Hair Pulling and Related Problems (2007). He was a featured expert on the A&E series Hoarders and the host of the VH–1 series The OCD Project.  He has been a recurrent guest on programs such as The Dr. Oz Show and The Oprah Winfrey Show.

Blaise Worden is a clinical psychologist at the Anxiety Disorders Center/Center for Cognitive Behavioral Therapy The Institute of Living, USA, where she runs and directs cognitive–behavioral treatment groups for hoarding disorder. She has co–authored book chapters on the phenomenology of both hoarding and obsessive–compulsive disorder, and provides educational talks to community organizations about HD treatment.

Bethany M. Wootton is a clinical psychologist and Senior Lecturer in Clinical Psychology at the University of New England, Australia. She has an interest in the treatment of anxiety and related disorders. Her research focuses on the development and evaluation of remote treatments in order to improve access to evidence–based treatments for these conditions.

Christina Gilliam is a clinical psychologist and Director of Educational Programs at the Anxiety Disorders Center/Center for Cognitive Behavioral Therapy at the Institute of Living, USA. She is an expert in providing and training others in cognitive behavioral therapy for anxiety disorders, obsessive compulsive and related disorders, and she has published journal articles and book chapters in these areas.