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

This study will compare two behavioral interventions for hoarding disorder in older adults.

Study Overview

• Status: Completed
• Conditions: Hoarding Disorder
• Intervention / Treatment: Behavioral: RECLAIM: Reducing Clutter and Increasing Meaning; Behavioral: Sorting Practice

Detailed Description

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, other mechanisms need to be identified.

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 with hoarding disorder.

• Study Type: Interventional
• Enrollment (Actual): 48
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Mississippi
    • Starkville, Mississippi, United States, 39762
      • Mississippi State University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 60+
• Live within a 60-minute driving radius of Starkville, MS
• Have a primary psychiatric diagnosis of hoarding disorder

Exclusion Criteria:

• Major cognitive impairment
• Active psychosis, drug use, or acute suicidal ideation
• Concurrent psychotherapy focused on hoarding
• Changed psychotropic medications within the past three months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: RECLAIM: Reducing Clutter and Increasing Meaning; Participants will receive a combination of motivational interviewing and sorting practice to reduce hoarding symptoms.	Behavioral: RECLAIM: Reducing Clutter and Increasing Meaning; Participants will receive 16 weekly 1-hour treatment sessions in their home delivered by Masters-level clinicians with the assistance of undergraduate researchers. Each treatment session will involve a combination of motivational interviewing (MI) and sorting practice. The rationale behind the sorting practice is to develop the skill of sorting and the formation of a daily sorting routine. The MI portion of the initial session will involve an evaluation of client strengths and individual biopsychosocial goals. The initial and subsequent sessions will include a variety of MI techniques, including decisional balancing, developing discrepancy, personalized feedback, and reinforcement of responsibility of sense of self-efficacy.
Active Comparator: Sorting Practice; Participants will receive sorting practice only to reduce hoarding symptoms.	Behavioral: Sorting Practice; Participants will receive 16 weekly 1-hour treatment sessions in their home delivered by Masters-level clinicians with the assistance of undergraduate researchers. Clinicians will encourage participants to sort objects during each session while refraining from use of any specific cognitive or motivational therapeutic techniques. Participants will be asked to record the frequency and duration of any sorting/ discarding they did during the previous week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of Sorting/Discarding Behavior	As a behavioral indicator of motivation to engage in sorting/discarding behavior, participants will be asked to report at their weekly treatment sessions the frequency of sorting/discarding items in the previous week. Data were analyzed as percentage of days sorted between sessions (assessed at sessions 2-16). Mixed effects models were used to analyze data such that participants with at least one timepoint were included in the analyses.	Four months
University of Rhode Island Change Assessment Questionnaire	The University of Rhode Island Change Assessment Questionnaire (URICA) is a 32-item Likert scale that assesses readiness for change. Scores for readiness for change are calculated by subtracting pre contemplation items from the other summed items. Scores range from -2 to 14, with higher scores indicating greater readiness for change.	Four months
Apathy Evaluation Scale	The Apathy Evaluation Scale is an 18-item measure of an individual's deficits in goal-directed thoughts and behavior. Scores range from 18-72, with higher scores reflecting more apathy.	Four months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment Acceptability/ Adherence Scale	The Treatment Acceptability/ Adherence Scale is a 10-item self-report measure of a patient's perception of the acceptability of a treatment as well as their anticipated adherence to the protocol. Scores range from 10-70, with higher scores indicating greater acceptability and perceived adherence.	Immediately after session 1
Saving Inventory-Revised	The Saving Inventory-Revised is a 23-item measure of the three core hoarding symptoms (urges to save, difficulty discarding, and excessive clutter). Scores range from 0 to 92, with higher scores indicating greater symptom severity.	Four months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clutter Image Rating	The Clutter Image Rating is a three-item pictorial rating scale of clutter level in the bedroom, kitchen, and living room. Assessor ratings of the CIR will be used for the proposed project. Scores of the three rooms are averaged to create a composite score ranging from 1-9, with higher scores indicating greater clutter levels.	Four months
Behavioral Approach Task for Sorting/Discarding	The Behavioral Approach Task for sorting/discarding involves the participant sorting items in a cluttered part of their home for 15 minutes. The speed of sorting (# of items sorted) will be used as a behavioral indicator of hoarding severity. The lower limit is 0 items sorted; there is no upper limit of number of items to be sorted.	Four months

Collaborators and Investigators

• Sponsor: Mississippi State University
• Collaborators: National Institute of Mental Health (NIMH)

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2022
• Primary Completion (Actual): December 10, 2025
• Study Completion (Actual): December 10, 2025

Study Registration Dates

• First Submitted: January 14, 2022
• First Submitted That Met QC Criteria: February 2, 2022
• First Posted (Actual): February 14, 2022

Study Record Updates

• Last Update Posted (Actual): July 16, 2026
• Last Update Submitted That Met QC Criteria: June 17, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders; Obsessive-Compulsive Disorder; Hoarding Disorder
• Other Study ID Numbers: 21-561; 1R15MH127565-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All data collected will be shared using the NIMH Data Archive (NDA) following safe harbor requirements for de-identification. Data dictionaries currently available in NDA will be used for most measures assessed (e.g., PROMIS measures), but new data dictionaries will be created for unique data elements (e.g., reported frequency of sorting behavior) and standardized measures not currently entered in the NDA (e.g., Clutter Image Rating). Data will be deposited in the NDA twice per year over the course of the study and once the study is complete. Each manuscript based off the study will have specific analytic files deposited to the NDA once the manuscript is accepted for publication.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No