Cognitive rehabilitation and exposure/sorting therapy for hoarding disorder: A randomized controlled trial

Hoarding disorder (HD) is one of the most common and impairing neuropsychiatric conditions in late life. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for HD is effective in reducing HD symptoms and improving functioning when compared with case management. In the current trial (NCT02402647), we compared CREST to a robust control condition, exposure therapy (ET), to determine if CREST provides additional benefit to HD symptom reduction, functioning, and quality of life over ET.

One hundred fifteen Veterans with HD were randomized to receive 26 once weekly, 1-hr manualized individual sessions of CREST (n = 59) or ET (n = 56). CREST included seven sessions of cognitive rehabilitation therapy, while ET included seven sessions of psychoeducation with both groups completing the same manualized ET for 26 sessions. Participants completed assessments at baseline and posttreatment. Outcome measures included assessments of HD symptom severity, functional capacity, self-reported functioning, self-reported disability, and quality of life. Linear mixed-effects models were used to examine change at posttreatment.

Participants were mostly male (64%) and White/non-Hispanic (72%) and on average were 62 years old with 16 years of education. Participants averaged a 42% improvement in HD symptoms posttreatment (ΔSI-R = 24.3 ± 17.8), but groups did not differ on improvement in HD symptoms, functional capacity, disability, or quality of life. The CREST group reported greater improvements in interpersonal functioning at posttreatment (d = 0.48, p = .012).

Exposure-based treatment is highly effective for HD. Both CREST and ET groups demonstrated significant reductions in HD symptoms. CREST participants demonstrated additional improvement in self-reported interpersonal functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).