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BJPsych Open. 2018 Jul 20;4(4):285-293. doi: 10.1192/bjo.2018.30. eCollection 2018 Jul.

Randomised clinical trial of community-based peer-led and psychologist-led group treatment for hoarding disorder.

Author information

1
Professor, Department of Psychiatry, University of Florida, USA; Department of Psychiatry, University of California, San Francisco, USA.
2
Professor, Department of Psychiatry, University of California, San Francisco, USA.
3
Post-doctoral Fellow, Department of Psychiatry, University of California, San Francisco, USA.
4
Peer Facilitator, Mental Health Association of San Francisco, USA.
5
Deputy Director, MFA, Mental Health Association of San Francisco, USA; Sonoma County Community Development Commission, USA.
6
Project Coordinator, Department of Psychiatry, University of California, San Francisco, USA; Cancer Care Network, University of California, Davis, USA.
7
Peer Supervisor, Mental Health Association of San Francisco, USA.
8
Project Manager, Mental Health Association of San Francisco, USA.
9
Research Assistant, Department of Psychiatry, University of California, San Francisco, USA.
10
Research Assistant, Mental Health Association of San Francisco, USA.
11
Executive Director, Mental Health Association of San Francisco, USA; Dignity Recovery Action International, USA.
12
Psychologist Supervisor, Mental Health Association of San Francisco, USA.
13
Assistant Professor, Department of Psychiatry, University of California, San Francisco, USA; California State University, East Bay, USA.

Abstract

Background:

Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.

Aims:

We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive-behavioural therapy (G-CBT).

Method:

We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3-25). Predictors of treatment response were examined.

Results:

G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = -1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).

Conclusions:

Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.

Declaration of interest:

C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers' honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.

KEYWORDS:

Hoarding disorder; cognitive–behavioural therapy; community treatment; peer treatment; randomised clinical trial; treatment outcomes

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