Cognitive Rehabilitation for Hoarding Disorder (CREST Trial)
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: VA Office of Research and Development
No Placebo Group
Approved in 1 jurisdiction
Trial Summary
What is the purpose of this trial?Hoarding Disorder (HD) is serious and disabling in Veterans. Present in up to 7% of Veterans and even higher symptom rates in older Veterans; HD contributes to functional impairment and poor quality of life. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) has shown promising functional improvement and symptom reduction. To reduce burdens and barriers to implementation of CREST, the proposed project will individualize CREST based on cognitive testing and participant preferences, provide all care in the participant's home through telemedicine and home visits, and shorten the timeframe of treatment. A randomized controlled trial comparing 24 sessions of Personalized-CREST to case management for 130 adult Veterans with HD is proposed. Multifaceted functional and recovery outcomes including quality of life, HD severity, and sustained recovery outcomes will be examined throughout treatment and follow-up. By advancing the knowledge of the rehabilitative care of HD, we can interrupt the trajectory of this chronic and debilitating condition.
Will I have to stop taking my current medications?
The trial requires that participants be stable on their medications for at least 6 weeks, so you will not need to stop taking your current medications.
What data supports the effectiveness of this treatment for hoarding disorder?
Research shows that Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) can be effective for hoarding disorder, especially in older adults, by improving organization and reducing clutter. Additionally, group cognitive-behavioral therapy (CBT) has been shown to help reduce hoarding symptoms and improve related issues like anxiety and depression.
12345Is Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) safe for humans?
The research on Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for hoarding disorder in older adults does not report any safety concerns, suggesting it is generally safe for humans.
13456How is the treatment Personalized-CREST different from other treatments for hoarding disorder?
Personalized-CREST is unique because it combines cognitive rehabilitation, which helps improve thinking skills, with exposure and sorting therapy, which involves practicing decision-making about keeping or discarding items. This approach specifically targets the cognitive and decision-making difficulties associated with hoarding disorder, unlike standard cognitive-behavioral therapy (CBT) that primarily focuses on changing thought patterns and behaviors.
13456Eligibility Criteria
This trial is for adult Veterans diagnosed with Hoarding Disorder (HD) as their primary condition. Participants must be stable on medications for at least six weeks, voluntarily consent to join, and not have any neurodegenerative diseases or current psychosis. They should also not be undergoing any exposure-based psychotherapy.Inclusion Criteria
I am a veteran aged 18 or older.
Exclusion Criteria
I have never had a disease that causes the loss of brain function.
Participant Groups
The study tests a personalized Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), delivered via telemedicine and home visits over 24 sessions, against standard case management. The aim is to improve function and quality of life in Veterans with HD.
2Treatment groups
Experimental Treatment
Active Control
Group I: CRESTExperimental Treatment1 Intervention
Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) provides training in compensatory cognitive strategies to address the executive dysfunction typical of individuals with HD, then helps reduce the distress associated with discarding items via exposure therapy.
Group II: Case ManagementActive Control1 Intervention
Case Management (CM). CM is the most widely available and utilized intervention for HD and is considered standard of care. This form of treatment involves managing the functional, housing, and legal ramifications of HD. Additionally, CM often involves assistance with economic, health, and social resources while providing support for the client.
Personalized-CREST is already approved in United States for the following indications:
🇺🇸 Approved in United States as Personalized-CREST for:
- Hoarding Disorder
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
VA San Diego Healthcare System, San Diego, CASan Diego, CA
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Who is running the clinical trial?
VA Office of Research and DevelopmentLead Sponsor
San Diego Veterans Healthcare SystemCollaborator
References
Group cognitive-behavioural treatment with long-term follow-up and targeting self-identity for hoarding disorder: An open trial. [2019]Group cognitive-behavioural therapy (G-CBT) for hoarding disorder (HD) may be an intervention of choice, considering its efficacy, low costs, and impact on comorbid anxiety and depression. But although G-CBT and modifications of G-CBT have been applied, none has assessed G-CBT efficacy at follow-up. In the current open-label pilot study, we tested the efficacy of G-CBT at posttreatment and 6-month follow-up and whether the inclusion of targeted reasoning and self-identity components added to G-CBT efficacy.
Neuropsychological functioning in hoarding disorder. [2021]Hoarding disorder (HD) is increasingly viewed as distinct from obsessive-compulsive disorder (OCD). In particular, some researchers have suggested that HD is characterized by substantial problems of neurocognitive function; however, HD patients have not yet been compared to OCD patients in this respect. The aim of the present study was to compare neuropsychological test performance in HD patients (n=27), OCD patients (n=12), and healthy controls (n=26). Consistent with previous research, HD patients showed an attenuated ability to sustain attention and poorer employment of adaptive memory strategies compared to healthy controls. HD and OCD patients did not differ significantly on these measures, although moderate effect sizes suggested that hoarders showed somewhat greater attenuation of attentional capacity. Rates of true impairment on any particular neuropsychological test were fairly low across all three groups, although 67% of HD patients (compared to 58% of OCD patients and 42% of healthy controls) scored in the impaired range on at least one measure (odds ratio=2.22). Results are discussed in terms of emerging conceptualizations of HD as a distinct illness.
Implementation and evaluation of a community-based treatment for late-life hoarding. [2022]The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST).
Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder in Older Adults: A Randomized Clinical Trial. [2021]To compare the efficacy of Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with geriatric case management (CM) in a sample of older adults meeting DSM-5 diagnostic criteria for hoarding disorder (HD).
Comparison of a peer facilitated support group to cognitive behavior therapy: Study protocol for a randomized controlled trial for hoarding disorder. [2022]Although individual and group cognitive-behavioral therapy (CBT) is the standard treatment approach for hoarding disorder (HD), it requires trained mental health professionals with specialization in HD. There is a need to offer additional options and services due to the limited number of professionals with advanced training, combined with the high prevalence rate of individuals with HD. A structured support group led by trained facilitators or lay professionals using a facilitator's manual and participant workbook (Buried in Treasures or BiT), addresses this need and increases accessibility. Prior studies of BiT groups have shown decreased hoarding symptoms. Only one retrospective study compared BiT and CBT outcomes in a naturalistic setting and showed no difference. Thus, a well-powered randomized controlled trial is needed to directly compare these forms of treatment. This paper presents a non-inferiority controlled trial protocol that compares group CBT to group BiT. Three hundred participants with HD, 18years or older, are being recruited for a 16-week treatment study. Participants are randomly assigned to either the CBT or BiT group. The primary outcome is reduction in hoarding symptom severity. Secondary outcomes include reduction in other indices of hoarding symptomology, including functional impairment, physical clutter, cognition, and changes in neuropsychological functioning.
Cognitive Rehabilitation and Exposure/Sorting Therapy for Late-Life Hoarding: Effects on Neuropsychological Performance. [2021]Hoarding disorder (HD) is characterized by urges to save items, difficulty discarding possessions, and excessive clutter and has been associated with executive functioning deficits. A randomized controlled trial comparing Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with a care management control condition demonstrated the efficacy of CREST in reducing hoarding symptoms in older adults. The purpose of the current study was to assess whether CREST may also lead to improved executive functioning.