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Intolerance of uncertainty as a factor in hoarding treatment

Michael G Wheaton1, Rachel Van Boxtel2, Carolyn I Rodriguez3

  • 1Barnard College, New York, NY, USA.

Journal of Psychiatric Research
|December 30, 2025
PubMed

Insights

Intolerance of uncertainty (IU) significantly decreased after hoarding disorder treatment. Smaller reductions in IU predicted worse hoarding symptom outcomes, suggesting IU interventions may improve treatment efficacy.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Behavioral Science

Background:

  • Hoarding disorder (HD) is characterized by persistent difficulty discarding possessions, leading to clutter.
  • Current treatments, including cognitive-behavioral therapy (CBT), offer limited symptom improvement.
  • Intolerance of uncertainty (IU) is a potential factor in HD, but its impact on treatment outcomes is not well understood.

Purpose of the Study:

  • To investigate the role of intolerance of uncertainty (IU) in hoarding disorder (HD) treatment outcomes.
  • To examine changes in IU following a 16-session skills group (BIT+ Workshop) for HD.
  • To determine if IU predicts treatment response in individuals with HD.

Main Methods:

  • Forty-one adults diagnosed with hoarding disorder participated in the study.
  • Participants completed the Buried in Treasures (BIT+) Workshop, a 16-session CBT-based group program with in-home practice.
  • Intolerance of uncertainty and hoarding symptom severity were measured before and after the intervention.

Main Results:

  • Initial levels of IU did not predict symptom improvement.
  • A significant decrease in IU was observed post-treatment.
  • Greater reductions in IU were associated with better hoarding symptom outcomes, independent of baseline severity.

Conclusions:

  • While high initial IU does not preclude treatment benefit, IU reduction is a significant contributor to hoarding symptom improvement.
  • Augmenting current HD treatments with interventions targeting IU may enhance treatment efficacy.
  • Further research should explore the integration of IU-specific strategies into existing therapeutic models for hoarding disorder.
Abstract

Keywords:
Cognitive-behavioral therapy (CBT)Hoarding disorderIntolerance of uncertainty

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