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Behavior Therapy for Obsessive-Compulsive Hoarding
By Dr Michael A. Gallo, Psy.D.
Hoarding is a less well-known form of OCD symptom but it can and will respond to behavior therapy (BT). It is important to remember that the key element which determines if behavior therapy will be successful is the motivation level of the patient. Except for very young children, no one can actually compel a person to engage in behavior therapy. The patient must want to conquer the illness in order for BT to be effective. This is especially true with obsessive-compulsive hoarding. It may be prudent to start with cognitive therapy to help a person recognize the necessity for ameliorating their OCD (i.e., acknowledging the distress and impairment that hoarding unnecessary items has wrought in their life.) Cognitive therapy can also help the person begin to rationally determine what they do and do not need to save. That is, they can utilize cognitive therapy to begin to normalize their behavior.
Behavior therapy is the next step. BT is essentially simple and always involves exposure to stimuli, which provoke obsessive anxiety. The person then must tolerate the anxiety until the distressful emotion begins to dissipate over time. This is referred to as desensitization. When we apply BT to hoarding we would probably take several approaches. The first would involve throwing away many of the useless items in a gradual but systematic fashion. One would start with the least anxiety provoking items and work their way up a hierarchy of obsessive stimuli. The patient will begin to learn that they can throw things away, tolerate the anxiety that results and eventually desensitize to the anxiety (i.e., the anxiety will go away with time.) Secondly, the person would set up certain rules for him or herself, which involve limiting their accumulation of new items. For example, this might involve telling themselves they will sort and throw out all junk mail before they bring the day’s mail into the house. These rules must be followed diligently so that they do not throw out some OC items but replace them with others. The essence of BT comes down to trusting in time to cause the anxiety to decline whenever we resist engaging in compulsive behavior.
In summary, behavior therapy is applicable to many situations. All that is required is for the therapist and patient to be flexible and creative in its application.
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