Pilot trial of cognitive and behavioral treatment for hoarding disorder delivered via webcam: Feasibility and preliminary outcomes

Individual office-based cognitive behavioral treatment (CBT) for hoarding disorder (HD) has demonstrated clear improvement in symptoms, although the extent of gains, length of treatment and lack of trained clinicians remain problematic. The current pilot study examined the feasibility and effectiveness of a home-based CBT delivered individually via webcam (CBT-W) technology for seven adults with HD. Three clients received weekly CBT-W over an average of 35 weeks and four received more intensive treatment that averaged 23 weeks. Standard measures of hoarding severity were collected at baseline, post-treatment, and 3-month follow-up. Acceptability and feasibility of treatment were demonstrated in client interest to enter CBT-W, good attendance at scheduled therapy sessions, high completion rates of assessments and treatment, strong therapeutic alliance ratings, and reported comfort with the use of technology during the therapy sessions. Most clients showed gains immediately following CBT-W, and two were clinically significantly improved. Self-reported follow-up assessments showed generally stable outcomes. Webcam and internet technology may increase access to empirically supported treatment for hoarding and reduce clinician time and costs of CBT through in-home delivery. Research on larger samples is needed to determine overall efficacy and durability of CBT-W and to examine factors that affect outcomes.