Cognitive Behavioral Approaches to Hoarding Disorder

Hoarding disorder is characterised by a persistent difficulty discarding or parting with possessions, resulting in clutter that compromises living spaces and daily functioning. Cognitive behavioural therapy (CBT) for hoarding has evolved from adaptations of obsessive–compulsive paradigms to models that address a unique constellation of emotional attachment, decision-making deficits and avoidance behaviours. Treatment typically begins with motivational enhancement techniques to resolve ambivalence towards change, followed by cognitive restructuring to challenge dysfunctional beliefs about possessions (for example, overestimation of responsibility or fear of loss). Graded exposure exercises require individuals to sort, discard and organise items in a stepwise fashion, while skills training teaches categorisation, decision-making and time management. Organisational interventions may involve coaching on spatial planning and harm-reduction strategies. Innovations include group-based formats that leverage peer support, internet-delivered clinician contact to bolster adherence and the integration of inference-based therapy to target reasoning biases. Increasingly, immersive tools such as virtual reality offer controlled simulations of cluttered environments, enabling safe rehearsal of discarding behaviours. Across these modalities, the goal remains to reduce clutter, alleviate distress and restore adaptive functioning, with a growing evidence base supporting sustained improvement and real-world generalisation.

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Cognitive Behavioral Approaches to Hoarding Disorder publication trend

The graph below shows the total number of articles in cognitive behavioral approaches to hoarding disorder across all publications each year (not limited to Nature Index journals).

Technical terms

Hoarding disorder: A psychiatric condition marked by persistent difficulty discarding possessions, resulting in clutter and impairment.

Cognitive behavioural therapy (CBT): A structured form of psychotherapy that combines cognitive restructuring with behavioural experiments.

Exposure therapy: A behavioural technique involving repeated, controlled confrontation with feared stimuli, here applied to sorting and discarding items.

Inference‐based therapy (IBT): A CBT variant targeting maladaptive reasoning processes by challenging inferential biases.

Saving cognitions: Dysfunctional beliefs about the necessity, safety or emotional importance of retaining possessions.

References

1. Enhancing group cognitive‐behavioral therapy for hoarding disorder with between‐session Internet‐based clinician support: A feasibility study. Journal of Clinical Psychology (2018).
2. Using Virtual Reality in the Inference-Based Treatment of Compulsive Hoarding. Frontiers in Public Health (2016).