Tolerance-building exercises gradually teach patients to resist the urge to acquire. At first, patients simply drive by a store they would like to visit without stopping to go inside. Then they learn to walk right past the store. In the final stage they enter the store, pick up an item that they really want to buy, put it down and leave. Similar exercises teach hoarders to discard items they already have and do not need. Helping hoarders declutter their homes bit by bit is far more effective than hiring a cleaning service to remove everything in one shot: the sudden and dramatic loss can enrage hoarders or plunge them into depression; some go into hoarding hyperdrive to replace what was taken from them.
In one test of hoarding-specific CBT, 18 volunteer hoarders immediately began a course of treatment, completing 26 one-hour-long sessions over several months; another 19 volunteers had to wait 12 weeks before beginning the same treatment program. In those first 12 weeks volunteers receiving hoarding-specific CBT improved far more than wait-list participants on measures of clutter and difficulty discarding items, indicating that the treatment was working and that improvements were not just an effect of time. At the conclusion of the study, after all 37 participants had completed their treatment, 26 (70 percent) had improved in some way and therapists concluded that nine patients (24 percent) were "very much improved."
Some of Tolin's neuroimaging studies suggest that hoarding-specific CBT changes the brain activity of compulsive hoarders. In one small study six compulsive hoarders completed 16 weekly 90-minute CBT sessions. Before treatment, activity in the cingulate cortex and insula was unusually high when hoarders had to make choices about their possessions, as observed in earlier studies. When their treatment was complete, the activity in these regions was much lower, sometimes approaching levels seen in healthy participants, although their habits had not changed much. Tolin thinks that even if therapy changes brain activity relatively quickly, significant changes in behavior require more time.
To increase awareness about hoarding-specific CBT, Steketee, Frost and Tolin and co-authored a book entitled Buried in Treasures. The book has become the basis for peer-organized support groups for people with problematic clutter—especially for those who cannot afford one-on-one therapy. In typical Buried in Treasures workshops, which are free, between eight and 12 participants complete many of the same exercises and homework assignments central to hoarding-specific CBT over a period of 20 weeks, guided by a peer "facilitator." In various trials of the Buried in Treasures workshops, symptoms of hoarding declined by between 22 and 27 percent and, in one study, an inspector judged more than 70 percent of participants as "much" or "very much" improved after visiting their homes. Buried in Treasures workshops, which originated in Massachusetts, are now active in San Francisco and Miami and will soon begin in New York City.
In 2007, not long after moving into his Easthamptom home, Shuer met Frost through colleagues and volunteered to run a series of Buried in Treasures workshops. In the process, Shuer began to change his self-image and his habits. "Over time my self-esteem and identity shifted," he says. "I learned that I didn't need those props anymore to have a social life. I don't feel a sense of loss or pain anymore when I give something up." He is now the director of Mutual Support Services, a component of the mental health and social services organization ServiceNet, and he continues to sort through his colossal collection, getting rid of what he does not really need and cannot accommodate in his home. A recent photograph that he provided depicts a charming and neat living room: no boxes of knickknacks or piles of magazines and concert flyers; nothing draped on the beige couches; one stray pillow and some cat toys on the carpet; and a single bookshelf with framed pictures, vases and figurines carefully arranged.
"I have learned to limit myself," Shuer says. "I'm not saying that I can never get anything again. If I find a cool book, I now know that I have to make space for it on the bookshelf. I have more free time and a much happier partner who really appreciates it. She loves me but she definitely did not love living with all that stuff."
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5 Comments
Add CommentSome folk collect things because the objects may have a use in the future. For folk who have not lived in times of plenty, objects bought today and stored may mean the difference between life and death in the future when these objects are unattainable. ?Is it hoarding when folk have a years supply of food ahead?... or when they collect warm cloths or trade goods or tools for when there is a prolonged power outage? If the folk in the article had ordered, sorted, boxed their "goodies" would they be labeled borders?
Reply | Report Abuse | Link to thisThe definition of hoarding given here is "The excessive accumulation of stuff and the refusal to discard it, RESULTING IN PROBLEMATIC CLUTTER". This implies that the diagnosis is dependent on the amount of storage or living space available to the individual. In other words, the bigger your apartment or house, the less likely you are to be diagnosed as a hoarder because "problematic clutter" is less likely to accumulate. So I guess, the less money you have the sicker you are.
Reply | Report Abuse | Link to thistoopik Any situation which might occur (without sufficient notice) that would require enough food and the ability to be self-sufficient without power or fuel to last for a year seems too remote to be a realistic way to spend my time, energy and money. I'd guess that perpetually being in the process of preparing this way would indicate some sort of maladaptive thinking, but maybe not the same as most hoarding.
Reply | Report Abuse | Link to thisIt does get 'worse'. i can not believe i used to throw them away. Last few years I started holding onto all the dead AA and AAA batteries. Hey you never know when you might need some Manganese oxide!
Reply | Report Abuse | Link to thisBlessed to have 32 hectares, all 'junk' goes into the installation. is it junk? Is it art? No its junk art, the hoarder's perfect excuse. Here you find all my old cars fridges stoves tvs, blenders, sprayers, shoes, booyts, broken cups ad nauseum... Looks great! and occasionay i recover stuff i or someone else can use.
Dear J A: Please recycle that old stuff. The metal alone will have a much greater use than sitting and rusting or waiting for that possible person to use it. You can probably get real money for it too.
Reply | Report Abuse | Link to thisDonate old clothes and just trash the broken cups. It's a great DIY project. Hope you can get some help too.