Comparing peer-led support groups with therapist-led support groups for treating hoarding disorder / Kevin L. Delucchi.

Format:

Book

Author/Creator:

Delucchi, Kevin L., author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Final research report

Language:

English

Subjects (All):

Group psychotherapy.

Outcome assessment (Medical care).

Physical Description:

1 online resource.

Place of Publication:

Washington, DC : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: Hoarding disorder (HD) has a profound public health burden and affects about 2% to 6% of the population, but treatment options are limited. The standard of care is cognitive behavioral therapy (CBT), but access to CBT is limited. Individuals may not seek treatment for multiple reasons, including lack of trained providers, poor insight into their illness, stigma, unwillingness to seek help from mental health providers, or cost restrictions. Alternative forms of treatment, particularly community-based treatments, are needed. Preliminary evidence suggests that manual-based peer-facilitated treatment (PFT) for HD may be as effective as CBT; however, PFT has never been directly compared with CBT. AIMS: Aim 1 (primary): Compare the effectiveness of manual-based group CBT and PFT in a randomized clinical trial. Aim 2 (secondary): Identify individual characteristics predicting treatment response. Aim 3 (secondary): Determine whether treatment preferences are associated with treatment adherence and outcome. Aim 4 (secondary): Determine whether HD treatment affects neurocognitive function. METHODS: A total of 323 adults with HD were randomly assigned to CBT or PFT. HD severity was assessed at baseline, immediately after treatment (6 months postbaseline), and ≥3 months posttreatment, then examined using a test of noninferiority (1-tailed t test). Participants received manualized group CBT led by psychologists (n = 160) or workbook-based group PFT led by peer facilitators (n = 163). The primary outcome was posttreatment hoarding symptom severity (Saving Inventory-Revised [SI-R]; score range, 0-92). Secondary outcomes included hoarding-related functional impairment, symptom severity at ≥3 months, response (Saving Inventory-Revised [SI-R] change ≥10 points), and remission (SI-R change ≥14 points and SI-R score <42 points at the posttreatment assessment). RESULTS: Of participants, 74.6% were female and 59% were white. The mean age was 59 (SD, 10.7). Of randomized participants, 71.5% (n = 231) completed treatment, 247 provided follow-up data (including 16 noncompleters), and 183 (56.7%) provided longitudinal data (mean 14 months posttreatment; range, 3-25 months). Dropout rates did not differ between CBT and PFT. CBT participants attended more sessions (mean, 73.3% of groups; SD, 34.0) than did PFT participants (mean, 57.7% of groups; SD, 34.6) (t = −4.09; df = 1; P < .0001). The test of the hypothesis assuming inferiority of PFT to CBT at posttreatment on SI-R scores was rejected (mean difference between conditions = 1.82 points; t = −1.71; P = .04), indicating no significant difference between groups. Mean pretreatment and posttreatment SI-R scores for the entire sample were 65.6 (SD, 11.7) and 46.8 (SD, 14.6), respectively, equaling a 17.8-point (26.7%) symptom reduction (t = 18.96; df = 1; P < .00001). Of participants, 66% responded to treatment (SI-R reduction ≥10 points). Treatment gains were maintained at 3 months posttreatment. Most participants expressed no strong preference for either treatment, and preference did not affect treatment outcome. More severe hoarding severity at baseline was the only participant-related variable that independently predicted improved treatment outcome for CBT. For PFT, higher pretreatment hoarding severity and better homework adherence were significant predictors of improvement. Multiple measures of neurocognitive function improved after treatment. CONCLUSIONS: Group PFT is as effective as group CBT for the treatment of HD, providing an alternative avenue of care for individuals with this functionally impairing disorder. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: Longitudinal follow-up assessment was not planned before study initiation but was developed after data collection had started. Subpopulations were not formally examined, although there were no differences in treatment outcome by sex, age, race, insurance status, or psychiatric comorbidity.

Notes:

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