# Functional and Cognitive Rehabilitation of Hoarding Disorder

> **NIH VA I01** · VA SAN DIEGO HEALTHCARE SYSTEM · 2022 · —

## Abstract

Hoarding Disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to
devastating personal and public health consequences. HD is defined by persistent difficulty discarding or
parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making
decisions about what to keep and what to discard. Subsequent accumulation of clutter can become so
dangerous that it puts individuals at risk of falls, fires, infestations, food contamination, medication
mismanagement, social isolation, nutritional deprivation, and eviction. Medical problems, activities of daily
living (ADL) impairment, decreased quality of life, and functional disability are associated with HD symptom
severity. HD starts early in life, does not remit if left untreated, and increases in severity with age. The highest
rates of HD are seen in older adults, with up to 25% experiencing HD symptoms. The population of older
Veterans is substantial, with 41% expected to be over the age of 65 by 2030. Recent research has found that
Veterans with HD experience more medical and psychiatric comorbidities; thus, Veterans represent a group
with high needs for effective HD treatment to reduce disability and improve multiple aspects of functioning.
 Dr. Ayers’ group has developed and evaluated Cognitive Rehabilitation and Exposure/Sorting Therapy
(CREST) in randomized controlled trials. The CREST intervention provides compensatory cognitive strategies
to address the executive dysfunction typical of individuals with HD, and then uses exposure therapy to reduce
the distress associated with discarding items. CREST improves HD symptoms and functioning in Veterans with
HD, but the intensive nature of the program (6-8 months) burdens mental health clinics and slows progress.
Given that the home is the primary site of clutter and the need for sorting of a large volume of items during
treatment, a home-based treament approach is needed. To reduce the burdens and barriers to implementation
of CREST, we will use a novel approach, referred to as Personalized-CREST, designed to reflect a precision
medicine approach to evidence-based treatment for HD. Personalized-CREST will be more individualized
(matching cognitive strategies to Veteran needs and priorities), more efficient (shorter timeframe over 12
weeks), and easier to access (in-home sessions and home-based video telemedicine [HBVT] sessions).
Recent pilot data suggest that HBVT for HD is feasible, efficacious, requires minimal adaptation, and is a
preferred. Based on 73 non-Veteran community Personalized-CREST completers, results indicated statistically
significant decreases in functional impairment, disability, and of HD symptom severity.
 The proposed randomized controlled trial will compare Personalized-CREST to a case management
(CM) control condition for 130 adult Veterans with HD. Personalized-CREST will be delivered twice a week in
the home (one face-to-face and one HBVT session) f...

## Key facts

- **NIH application ID:** 10378634
- **Project number:** 5I01RX003367-02
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Catherine Ayers
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10378634

## Citation

> US National Institutes of Health, RePORTER application 10378634, Functional and Cognitive Rehabilitation of Hoarding Disorder (5I01RX003367-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10378634. Licensed CC0.

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