1 Treatments outcomes based on Frost and Hartl’s model are encouraging, but suggest that many sessions are required to produce change

and that clutter is slow to improve. The first case study reported that approximately 45 sessions were needed to completely reduce clutter.55 After 20 weeks of treatment, Steketee et al56 demonstrated a 16% reduction in Y-BOCS scores, while Saxena et al57 demonstrated a 35% reduction in Y-BOCS scores after 6 weeks of daily intensive treatment. Utilizing Steketee and Frost’s58 cognitive-behavioral treatment manual for compulsive hoarding, Tolin et al59 offered 26 individual sessions (in-office sessions and at least one home visit) over a 7- to 12-month period to 14 individuals. Inhibitors,research,lifescience,medical On average, treatment completers (n=10) demonstrated 25% improvement in their clutter and difficulty discarding, Inhibitors,research,lifescience,medical and 35% reduction in acquiring. Following this open trial, Steketee et al60 made minor modifications to the treatment and examined its efficacy in a randomized controlled trial. Findings from this trial indicated Inhibitors,research,lifescience,medical that improvements in hoarding symptoms were greater after receiving 12 sessions of cognitive behavioral therapy (CBT) than after waiting for a comparable period. After 26 sessions of CBT, 68% to 76% of patients were rated as improved by their therapists or themselves, respectively, and 41% of patients met criteria for clinically

significant improvement. Given that changes are slow to occur during

the treatment of compulsive hoarding, researchers have been examining alternative delivery models in hopes of increasing Inhibitors,research,lifescience,medical the cost-effectiveness of treatment. Using a multiple cohort pretest-post-test design, Muroff and colleagues examined Inhibitors,research,lifescience,medical the effectiveness of group CBT using Steketee and Frost’s treatment manual.32 After 16 to 20 sessions and two home visits, patients evidenced a mean reduction of 8.6 points on the Saving Inventory-Revised (SI-R), which is less than that produced from individual treatment using the same manual (18.7 or 16.9).59,60 After these investigators modified their research procedures to more thoroughly screen group members and utilized a more detailed and structured manual for the group, the Phosphoprotein phosphatase mean SI-R reduction in the final group was 14.25. As access to BEZ235 price clinicians trained in CBT for compulsive hoarding is limited, a Web-based self-help group has also been examined for its effectiveness. This Web-based treatment was also based on Steketee and Frost’s manual58 and required individuals to take active steps to reducing their hoarding behavior within 2 months of membership. After 6 months of memberships, SI-R scores decreased by an average of 6 points. These two group studies suggest that highly structured, in-person groups may lead to greater improvements in hoarding outcomes than less-structured groups.