Cognitive Rehabilitation and Exposure Therapy for Veterans with Hoarding Disorder

患有囤积症退伍军人的认知康复和暴露疗法

• 批准号: 10179338
• 负责人: Catherine Ayers
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179338
• 关键词: Activities of Daily Living; Aftercare; Age; Area; Behavior Therapy; Bipolar Disorder; Caring; Case Management; Chronic; Client; Cognitive; Cognitive Therapy; Compulsive Hoarding; Cost Savings; Decision Making; Development; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Disease; Distress; Elderly; Enrollment; Executive Dysfunction; Exposure to; Fire - disasters; Formulation; Funding; Health Care Costs; Healthcare Systems; Impairment; Individual; Interruption; Intervention; Investigation; K-Series Research Career Programs; Life; Link; Longevity; Measures; Mediating; Mediator of activation protein; Medical; Methods; Neurocognitive; Obsessive compulsive behavior; Outcome; Participant; Patients; Population; Problem Solving; Provider; Quality of life; Randomized Controlled Trials; Research; Sampling; Schizophrenia; Services; Severities; Sorting - Cell Movement; Source; Symptoms; System; Testing; Time; Treatment outcome; Veterans; Work; active lifestyle; care systems; cognitive rehabilitation; cognitive training; cost; disability; disability burden; efficacy evaluation; executive function; falls; family burden; flexibility; follow-up; functional disability; hazard; improved; innovation; middle age; mortality risk; motivational enhancement therapy; novel; older patient; prevent; primary outcome; public health relevance; reduce symptoms; response; secondary outcome; skills training; targeted treatment; treatment adherence; treatment choice; treatment effect; trial comparing

DESCRIPTION (provided by applicant): As a new addition to the Diagnostic and Statistical Manual-5 (DSM-5), Hoarding Disorder (HD) is defined by persistent difficulty parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep or dispose of. Clutter accumulates and fills living areas to prevent normal use of space, resulting in distress and/or disability. Hoarding symptoms cause significant impairment, increased medical problems, and poor quality of life for our Veterans, particularly our older Veterans. Providers treat Veterans for other medical or psychiatric complaints yet frequently miss an important source of disability and burden on our system. This insidious condition is costly to the VA system as patients continue to decompensate and need greater amounts of care over the lifespan. Given that over 6% of the population has HD, a higher proportion than are diagnosed with schizophrenia or bipolar disorder, further research on the mechanism and efficacy of an appropriate treatment is desperately needed. Current behavioral intervention methods for HD range from ineffective to relatively small gains. Case management is typically used to treat HD, which produces inadequate outcomes and clients resurface in systems of care. Cognitive-behavioral therapy (CBT) for HD includes multiple components (assessment: 2-3 sessions, case formulation: 2 sessions, skills training: 2-3 sessions, combined exposure and cognitive therapy: 15-20 sessions, and motivational interviewing: throughout) and yields poor responses rates (i.e. <20% symptom reduction) in older adults. Outcomes in midlife HD patients are not much better, with symptom reduction rates ranging from 14-29% in HD symptoms following a lengthy course (4-9 months) of CBT for HD. Executive dysfunction (ED) is linked to both HD symptom severity and poor outcomes of CBT for HD. Decision making, categorization, problem solving, inhibition, planning, organization, and cognitive flexibility difficulties are evident in HD patients across th lifespan, particularly in older patients. The VA has funded the development of an integrated behavioral treatment (Cognitive Rehabilitation and Exposure/Sorting Therapy; CREST) that targets both neurocognitive functioning and the core symptoms of HD (VA Career Development Award; Ayers PI). This treatment includes Compensatory Cognitive Training (CCT) to improve executive functioning and is combined with exposure therapy (ET) that targets avoidance of discarding/not acquiring. Preliminary results suggest that CREST is a highly feasible and acceptable treatment that doubles outcome rates compared to CBT for HD. Our proposed study will further develop this innovative intervention while testing whether it works through the mechanisms it targets and examining outcome moderators that may identify which patients are more likely to benefit. We propose to conduct a randomized controlled trial comparing six months (26 sessions) of CREST to six months of ET alone, in 136 participants with HD. Assessments will be administered at baseline, during treatment (sessions 7, 13, 21), post-treatment, and 3 and 6-month follow-up. The primary objective is to evaluate whether CREST significantly reduces hoarding symptoms and improves functional capacity and quality of life when compared to exposure therapy alone. We will also examine the impact of treatment mediators; treatment adherence, changes in executive functioning, avoidance, and symptom severity on outcomes. Age and executive functioning will also be explored as potential moderators. Finally, by repeatedly measuring treatment targets, we will examine time to maximum treatment effect. By providing a treatment for many Veterans with HD, we can alter the course of their symptom trajectory and negative consequences, resulting in both reduced burden on the healthcare system and improved quality of life for Veterans.

描述（由申请人提供）： 作为《诊断与统计手册》第五版（DSM-5）的新补充，囤积症（HD）的定义是由于与丢弃有关的痛苦、保存的冲动和/或难以决定保留或处理什么而导致的持续难以与财产分离。杂乱的东西堆积起来，填满了生活区，妨碍了空间的正常使用，从而导致痛苦和/或残疾。囤积症状会导致严重的损害，增加医疗问题，以及我们的退伍军人生活质量差，特别是我们的老年退伍军人。提供者治疗退伍军人的其他医疗或精神疾病的投诉，但经常错过一个重要的残疾来源和负担，我们的系统。这种潜在的疾病对VA系统来说是昂贵的，因为患者会继续失代偿，并且在整个生命周期内需要更多的护理。鉴于超过6%的人口患有HD，比诊断为精神分裂症或双相情感障碍的比例更高，迫切需要对适当治疗的机制和疗效进行进一步研究。 目前HD的行为干预方法从无效到相对较小的收益不等。病例管理通常用于治疗HD，其产生不充分的结果，并且客户在护理系统中重新出现。HD的认知行为治疗（CBT）包括多个组成部分（评估：2-3个疗程，病例制定：2个疗程，技能培训：2-3个疗程，暴露和认知治疗联合：15-20个疗程，动机访谈：全程），在老年人中的反应率很低（即症状减轻<20%）。中年HD患者的结局也好不到哪里去，经过长期（4-9个月）的CBT治疗HD后，HD症状的症状减轻率为14-29%。 执行功能障碍（艾德）与HD症状严重程度和HD CBT的不良结局相关。决策、分类、解决问题、抑制、计划、组织和认知灵活性困难在HD患者的整个生命周期中是明显的，特别是在老年患者中。VA资助了一种综合行为治疗（认知康复和暴露/分类疗法; CREST）的开发，该治疗针对神经认知功能和HD的核心症状（VA职业发展奖; Ayers PI）。这种治疗包括补偿性认知训练（CCT），以改善执行功能，并与暴露疗法（ET）相结合，以避免丢弃/不获取为目标。初步结果表明，CREST是一种高度可行和可接受的治疗方法，与CBT相比，HD的结局率增加了一倍。我们提出的研究将进一步发展这种创新的干预措施，同时测试它是否通过其目标机制起作用，并检查可能确定哪些患者更有可能受益的结果调节剂。 我们建议进行一项随机对照试验，在136名HD受试者中比较6个月（26次）的CREST与6个月的ET。将在基线、治疗期间（第7、13、21阶段）、治疗后以及3个月和6个月随访时进行评估。主要目的是评估与单独暴露治疗相比，CREST是否显著减少囤积症状，改善功能能力和生活质量。我们还将研究治疗介质的影响;治疗依从性，执行功能的变化，回避和症状严重程度对结果的影响。年龄和执行功能也将作为潜在的主持人进行探讨。最后，通过反复测量治疗目标，我们将检查达到最大治疗效果的时间。通过为许多患有HD的退伍军人提供治疗，我们可以改变他们的症状轨迹和负面后果，从而减轻医疗保健系统的负担，提高退伍军人的生活质量。

项目成果

Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder.

患有囤积症的老年参与者的治疗招募和保留。

• DOI: 10.1080/07317115.2015.1032467
• 发表时间: 2015
• 期刊: Clinical gerontologist
• 影响因子: 2.8
• 作者: Ayers,CatherineR;Dozier,MaryE;Mayes,TinaL;Espejo,EmmanuelP;Wilson,Ariel;Iqbal,Yasmeen;Strickland,Katrina
• 通讯作者: Strickland,Katrina

Psychometric Evaluation of the Saving Inventory-Revised in Older Adults.

老年人储蓄库存的心理测量评估-修订。

• DOI: 10.1080/07317115.2016.1267056
• 发表时间: 2017
• 期刊: Clinical gerontologist
• 影响因子: 2.8
• 作者: Ayers,CatherineR;Dozier,MaryE;Mayes,TinaL
• 通讯作者: Mayes,TinaL

An Exploratory Investigation of Animal Hoarding Symptoms in a Sample of Adults Diagnosed With Hoarding Disorder.

对被诊断患有囤积症的成年人样本中动物囤积症状的探索性调查。

• DOI: 10.1002/jclp.22417
• 发表时间: 2017
• 期刊: Journal of clinical psychology
• 影响因子: 3
• 作者: Ung,JenniferE;Dozier,MaryE;Bratiotis,Christiana;Ayers,CatherineR
• 通讯作者: Ayers,CatherineR