Making Decisions About Saving and Discarding

Chapter 7 teaches clients about the role of avoidance and habituation of discomfort in discarding. A thought listing exercise helps clarify thoughts that occur during decision-making about whether to keep or discard items. Clients develop questions to use and personal rules for when to keep or discard items. Imagined discarding helps with gradual saving and discarding exercises. Behavioural experiments help test beliefs, and clients learn to practice thought listing during in-home practice. Potential assistance in cleaning out clutter is discussed.

Assessing Hoarding Problems

Chapter 2 guides clients in how to measure hoarding symptoms and related problems. Standard forms and scoring instructions in the chapter allow clients to determine the severity and impact of their hoarding and acquiring behaviors, as well as thoughts about hoarding, daily living activities, and home safety. Clients begin to record information from each session on their own personal session form. A home visit helps plan the treatment. Options to work with a coach are considered, along with simple homework that will be useful for the next session.

Changing Beliefs: Thinking Your Way Out of the Hoarding Box

Chapter 8 provides clients with strategies for changing beliefs about non-acquiring, sorting, and discarding. These include a review of problematic thinking styles, self-generated questions about possessions, advantages and disadvantages, the downward arrow method, and the use of thought records to track thinking and emotions. Other methods include defining need versus want, perfectionism and considering the value of time. Clients can select the methods that work best for them to try out as homework.

Reducing Acquiring

Chapter 5 focuses on reducing problematic acquiring behaviors and the factors that help maintain this. Forms provide some questions about acquiring to help with decision-making and developing a hierarchy for gradual practice with non-acquiring. Strategies include evaluating the advantages and disadvantages of acquiring particular objects, practice exercises, and finding alternative pleasurable activities that can replace enjoyment from acquiring. A review of problematic thinking patterns and use of the downward arrow method to understand fears about not acquiring are included. Two scales are used to clarify the difference between a real need versus a wish to acquire items. Homework assignments help consolidate this learning.

Skills Training

Chapter 6 encourages clients to learn problem-solving skills and task reminders to help remove impediments that can interfere with progress on hoarding. They also learn to sort and organize items they want to keep or remove using a personal organizing form that guides decisions. This includes a plan for where to keep objects and papers and guidelines for how long to keep certain papers. Preparation for organizing includes assembling materials needed for filing and storing items. Several forms for clients to use help guide the process.

Planning Your Treatment

Chapter 4 begins treatment planning by establishing goals and rules for treatment so that clients make all decisions about whether to keep or remove their possessions. Visualization exercises clarify thoughts and feelings about cluttered and uncluttered rooms and about not acquiring desired items. A practice form helps clients understand their reactions to initial efforts at non-acquiring or discarding. Homework focuses on basic practice exercises.

Introduction

Chapter 1 summarizes hoarding symptoms, including problems processing information, patterns of thinking about possessions comorbidity, and why hoarding persists even when it causes serious problems. The chapter describes treatment for hoarding and how to use this workbook. Hoarding disorder (HD) refers to excessive urges to save objects, with accompanying difficulty discarding or removing them from the home and clutter that impairs functioning and is often distressing. Hoarding is often accompanied by excessive acquiring behaviors.

Maintaining Your Gains

Chapter 9 includes forms to assist clients in re-evaluating their hoarding and acquiring to determine progress during therapy. Clients review their hoarding model and initial therapy goals, as well as all of the treatment methods used so they can decide which ones worked best and they should continue to use. Clients try to anticipate potential problems that might occur in the coming months to decide on strategies for continuing to work on their hoarding and whether to schedule booster sessions..

Developing Your Personal Hoarding Model

Chapter 3 encourages clients to learn to develop their own model for understanding why hoarding and acquiring symptoms developed and persist. The formulation includes personal and family vulnerability factors, cognitive processing problems, reasons for saving possessions, and positive and negative emotions that encourage hoarding and acquiring behaviors. A brief Thought Record helps identify problematic thinking about saving and acquiring. A graphic illustration of a hoarding model and instructions for developing a functional analysis of acquiring behavior are provided. Homework strategies are included.