Tolin David F, Frost Randy O, Steketee Gail, Muroff Jordana
Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Depress Anxiety. 2015 Mar;32(3):158-66. doi: 10.1002/da.22327. Epub 2015 Jan 14.
Hoarding disorder (HD) is a new diagnosis in DSM-5 (American Psychiatric Association, 2013). Cognitive-behavioral therapy (CBT) appears promising for the treatment of HD, and has been tested in both individual and group settings.
The present study used meta-analytic techniques to examine the overall strength of effect of CBT on HD, as well as on its component symptoms (clutter, difficulty discarding, and acquiring) and associated functional impairment. Potential demographic and treatment-related moderators of CBT response, as well as the presence of clinically significant change were also examined. From 114 published articles, 10 articles comprising 12 distinct HD samples (N = 232) met inclusion criteria and were retained for analysis.
HD symptom severity decreased significantly across studies with a large effect size. The strongest effects were seen for difficulty discarding, followed by clutter and acquiring. Functional impairment showed the smallest effect in the moderate range. Female gender, younger age, a greater number of CBT sessions, and a greater number of home visits were associated with better clinical outcomes. Reliable change was found in the majority of samples for each outcome domain. Rates of clinically significant change, however, were lower (percentage ranged from 24 to 43). Thus, in most cases, study patients' post-treatment scores remained closer to the HD range than to the normal range.
CBT is a promising treatment for HD, although there is significant room for improvement. Results are discussed in terms of treatment refinement for HD, and additional moderator variables are suggested for further study.
囤积障碍（HD）是《精神疾病诊断与统计手册》第5版（美国精神病学协会，2013年）中的一种新诊断。认知行为疗法（CBT）在治疗HD方面似乎很有前景，并且已经在个体和团体环境中进行了测试。
本研究使用荟萃分析技术来检验CBT对HD及其组成症状（杂乱、丢弃困难和物品获取）以及相关功能损害的总体治疗效果强度。还研究了CBT反应的潜在人口统计学和治疗相关调节因素，以及临床显著变化的存在情况。从114篇已发表的文章中，10篇文章包含12个不同的HD样本（N = 232）符合纳入标准并被保留用于分析。
在各项研究中，HD症状严重程度显著降低，效应量较大。丢弃困难方面的效果最为显著，其次是杂乱和物品获取。功能损害在中等范围内的效果最小。女性、年龄较小、CBT疗程数量较多以及家访次数较多与更好的临床结果相关。在每个结果领域的大多数样本中都发现了可靠的变化。然而，临床显著变化的发生率较低（百分比范围为24%至43%）。因此，在大多数情况下，研究患者的治疗后分数更接近HD范围而非正常范围。
CBT是一种有前景的HD治疗方法，尽管仍有很大的改进空间。从HD治疗的优化角度对结果进行了讨论，并提出了其他调节变量以供进一步研究。
