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

项目摘要 囤积障碍是一种心理疾病，对老年人有一系列独特的后果 成年人，包括火灾风险增加和死于火灾、虫害和医疗问题。 与杂乱的生活空间相关的危险因执行功能、注意力、 和专注力。囤积精神病态是由不适应的认知(例如，想要 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)。现有的治疗囤积症的方法也将减少恐惧作为改变的机制 通过以认知重建为重点的认知行为疗法或以认知重建为重点的行为疗法 暴露疗法。老年人对囤积的认知重组反应平淡，而且， 尽管暴露疗法增加了治疗反应，但这两种方法都需要长达六个月的时间。 剂量。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要，我们需要 确定其他机制。激励性面试是一种典型的已经被纳入的技术 转化为囤积治疗，并已被证明增加了整个行为改变的动机 老年人的一系列健康状况，包括体力活动、饮食和疾病管理。 因为分类/丢弃本质上是一种健康行为，囤积病人缺乏动力 参与，激励性面试可能会通过引发更高水平的 排序/丢弃。拟议的项目将使用机械性临床试验方法来确定 将激励性访谈与分类练习相结合的为期四个月的干预措施 建议的目标，行为改变的动机，与四个月的分类剂量相比 在农村老年人的样本中单独练习。有囤积症的农村老年人 障碍是一种特别难以治疗的人群，因为他们不太可能经历外部 寻求治疗的诱因(例如，邻居/市政官员的投诉)。这个项目 将是更广泛的研究过程中的第一步，以调查有效的治疗目标 为晚年的生活囤积。这项研究的长期目标是确定是否将 将囤积作为一种健康行为的缺陷的精神病理学可以使我们的发育和 对跨背景的老年人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.