Motivational Interviewing to Enhance Behavioral Change in Older Adults with Hoarding Disorder

项目摘要 囤积症是一种心理疾病，对老年人有一系列独特的后果。 成年人，包括火灾和死于火灾，昆虫侵扰和医疗问题的风险增加。 与杂乱的生活空间有关的危险会因执行功能、注意力、 和专注囤积心理病理学源于适应不良的认知（例如，希望保持 其他人会丢弃的物品）和不适应的行为模式（例如，避免分类/丢弃 项目）。现存的治疗囤积症的方法有针对性的减少恐惧作为改变的机制， 通过专注于认知重建的认知行为疗法或专注于 暴露疗法老年人对囤积症的认知重建反应迟钝， 虽然暴露疗法增加了治疗反应，但这两种方法都需要漫长的六个月， 次给药结束我们的初步工作表明，减少恐惧可能不是一个普遍相关的目标 老年人的机制，为了满足老年人的具体需求，我们需要 确定其他机制。动机性面试是一种已经被典型地纳入 囤积治疗，并已被证明可以增加行为改变的动力， 老年人的一系列健康状况，包括身体活动，饮食和疾病管理。 因为分类/丢弃的核心是一种健康行为，囤积患者缺乏动力， 参与，动机性访谈可能会降低囤积的严重程度，通过引发更高水平的 分类/丢弃。拟议的项目将使用机械临床试验的方法，以确定是否 四个月的干预结合动机访谈和分类实践可以吸引 提出的目标，行为改变的动机，与四个月的分类剂量相比， 在农村居住的老年人的样本中单独练习。农村老年人囤积症 疾病代表了一个特别难以治疗的人群，因为他们不太可能经历外部 寻求治疗的激励因素（例如，邻居/市政官员的投诉）。这个项目 这将代表更广泛的研究过程中的第一步，以研究有效的治疗目标 因为晚年囤积症这项研究的长期目标是确定概念化是否 囤积作为一种健康行为缺陷的心理病理学可以为我们的发展提供信息， 在不同情况下对老年囤积症实施循证治疗。

Project Summary Hoarding disorder is a psychological condition with a unique constellation of consequences for older adults, including increased risk of fire and dying in a fire, insect infestation, and medical problems. Dangers related to cluttered living spaces are exacerbated by reduced executive functioning, attention, and concentration. Hoarding psychopathology results from maladaptive cognitions (e.g., desire to keep items others would discard) and maladaptive behavioral patterns (e.g., avoidance of sorting/discarding items). Extant treatments for hoarding have targeted fear reduction as the mechanism of change, either through cognitive-behavioral therapy focusing on cognitive restructuring or behavior therapy focusing on exposure therapy. Older adults have a lackluster response to cognitive restructuring for hoarding, and, although exposure therapy increases treatment response, both approaches require a lengthy six-month dose. Our preliminary work suggests that fear reduction may not be a universally relevant target mechanism for older adults, and that to be responsive to the specific needs of older adults, we need to identify other mechanisms. Motivational interviewing is a technique that is already typically incorporated into hoarding treatment and has been demonstrated to increase motivation for behavioral change across a range of health conditions for older adults, including physical activity, diet, and disease management. Because sorting/discarding is at its core a health behavior that hoarding patients lack the motivation to engage in, motivational interviewing is likely to decrease hoarding severity by eliciting increased levels of sorting/discarding. The proposed project will use a mechanistic clinical trials approach to determine if a four-month intervention combining motivational interviewing with sorting practice can engage the proposed target, motivation for behavioral change, when compared to a four-month dose of sorting practice alone in a sample of rural-dwelling older adults. Rural-dwelling older adults with hoarding disorder represent a particularly difficult to treat population, as they are less likely to experience external motivating factors to seek treatment (e.g., complaints from neighbors/municipal officials). This project would represent the first step in a broader course of research to investigate efficacious treatment targets for late life hoarding. The long-term goal of this research is to determine if conceptualizing the psychopathology of hoarding as a deficit in a health behavior can inform our development and implementation of evidence-based treatment for geriatric hoarding across contexts.