#OTalk 22nd May 2018 – The role of Occupational Therapy in compulsive hoarding

 

This weeks #Otalk is on the topic of “hoarding” and will be hosted by Orla Hughes (@Orlatheot).

What is compulsive hoarding?

Compulsive hoarding, or hoarding disorder, is a pattern of behaviour that is identified by the following characteristics:

  1. Having difficulty or an inability to discard possessions (NHS Choices, 2015).
  2. Excessively acquiring objects, regardless of their monetary value, which prevents use of living and work spaces (Tolin, Frost, and Steketee, 2014).
  3. As a result, considerable impairment or distress in occupational, social, or other critical areas of functioning is present (American Psychiatric Association, 2013).
  4. The hoarding symptoms are not restricted to symptoms of another mental or physical condition, for example, food storing issues as a symptom of Prader-Willi Syndrome (Mataix-Cols et al., 2010).

This condition was formerly recognised to be a symptom of obsessive–compulsive disorder (OCD) but due to recent research, it is now classed as a separate diagnostic entity by healthcare providers and in the Diagnostic and Statistical Manual of Mental Disorders (Pertusa et al., 2010; Royal College of Psychiatrists, 2016).

The prevalence of compulsive hoarding

Clients who have the behaviours of hoarding and acquiring are common issues faced by staff in health, social-care, housing and environmental services (Dissanayake, 2012). A prevalence rate of 2-5% in the population have been found through studies in Europe and the United States (Bratiotis, Schmalsich and Steketee, 2011). Yet, when analysing these figures, in studies such as Samuels et al. (2008), it is not clear whether the 4% of participants who were found to compulsively hoard would have met the new diagnostic criteria outlined for the condition in this study. As a result, more research is needed in this field to quantify the population who compulsively hoard.

Current MDT practice

Although guidance is provided for working with hoarding symptoms within OCD, there is no specific guidance for working with compulsive hoarding (NICE, 2005). However, the NHS Choices website describes the condition and recommends Cognitive Behavioural Therapy (CBT) as the common treatment for the condition (NHS, 2015). A comprehensive search of the literature, from the fields of psychology and psychiatry, revealed that compulsive hoarding is mainly treated with both CBT and medication (Tolin D.F. et al., 2015). Serotoninergic drugs, such as fluvoxamine, have seen benefits for clients, yet no medication is currently advertising to treat compulsive hoarding (Saxena, 2008; Soares, Fernandes, and Morgado, 2016). CBT can include motivational interviewing, psychoeducation, developing cognitive techniques highlighting dysfunctional beliefs, and the graded discarding and sorting of items (Steketee and Frost, 2014). This combination has shown modest clinically-significant results for clients finishing treatments and therefore papers call for further studies to investigate the issues these clients confront and how to improve their well-being (Tolin D.F. et al., 2015; Vilaverde, Gonçalves, and Morgado, 2017).

Compulsive hoarding and occupational therapy

Compulsive hoarding can decrease occupational engagement in many areas of life, appropriate for occupational therapy input, such as functional independence, roles, and the social and physical environment (Dissanayake, 2012). Recent quantitative research, conducted by Dissanayake, Barnard, and Willis (2017), investigates the role of occupational therapy in the assessment and treatment of compulsive hoarding and calls for further research involving occupational therapy and this population which can begin to inform clinical practice.

Here are the questions we will be discussing:

  1. How would compulsive hoarding affect a person, how they perform their occupations, and interact with their environment?
  2. Do you feel equipped to work collaboratively with this population?
  3. What ethical issues do you predict you would encounter with this population?
  4. What occupational therapy interventions could be utilised?
  5. Finally, what could the role of occupational therapy be in this setting (the assessment and treatment of compulsive hoarding)?

References

American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders. 5th edn. Arlington, VA: American Psychiatric Publishing.

Bratiotis, C., Schmalisch, S., and Steketee, G. (2011) The Hoarding Handbook: A Guide for Human Service Professionals. Oxford: Oxford University Press.

Dissanayake, S. (2012) ‘Clearing the Clutter,’ in OT News, February 20 (2) pp.24-25 published by The Royal College of Occupational Therapists: London, UK

Dissanayake, S., Barnard, E., & Willis, S. (2017): “The emerging role of Occupational Therapists in the assessment and treatment of compulsive hoarding: An exploratory study”. New Zealand Journal of Occupational Therapy, 64 (2) 22-30.

Mataix-Cols D, et al. (2010) ‘Hoarding disorder: a new diagnosis for DSM-V?,’ Depression Anxiety, 27(1), pp. 556–572.

NHS Choices (2015) Hoarding Disorder. Available at: https://www.nhs.uk/conditions/hoarding-disorder/ (Accessed on 2nd December 2017).

NICE (2005) Obessive-compulsive disorder. Available at: https://www.nice.org.uk/guidance/cg31/evidence/cg31-obsessivecompulsive-disorder-full-guideline2 (Accessed on 22nd February).

Pertusa A, et al. ‘Refining the diagnostic boundaries of compulsive hoarding: a critical review,’ Clinical Psychology Review, 30(1), pp. 371–386.

Polkinghorne, D.E. (1989) ‘Phenomenological research methods,’ In R.S Valle and S. Halling (Eds.), Existential phenomenological perspectives in psychology. New York, NY: Plenum Press, pp.41-60.

Royal College of Psychiatrists (2016) Hoarding. Available at: http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/hoarding.aspx (Accessed on 2nd December 2017).

Samuels J.F. et al. (2008) ‘Prevalence and correlates of hoarding behavior in a community-based sample,’ Behav Res Ther, 46(1), pp. 836–844.

Saxena S. (2008) ‘Neurobiology and treatment of compulsive hoarding,’ CNS Spectrum, 13(14), pp. 29–36.

Soares, C., Fernandes, N., and Morgado, P. (2016) ‘A review of pharmacologic treatment for compulsive buying disorder,’ CNS Drugs 30(4) pp. 281–91.

Steketee, G., and Frost, R. O. (2014) Compulsive hoarding and acquiring: Therapist guide. 2nd edn. New York, NY: Oxford University Press

Tolin, D.F., Frost, R.O., and Steketee, G. (2014) Buried in Treasures. Help for Complusive Acquiring, Saving, and Hoarding. Oxford: Oxford University Press.

Tolin D.F. et al. (2015) ‘Cognitive behavioral therapy for hoarding disorder: a meta-analysis,’ Depression Anxiety, 32(3), pp. 158–66.

Vilaverde, D., Gonçalves, J., and Morgado, P. (2017) ‘Hoarding Disorder: A Case Report,’ Frontiers in Psychiatry. Available at: https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00112/full (Accessed on 10th November 2017).

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#OTalk 8th May 2018 – Podcasts as a Tool for CPD

This weeks #OTalk is on the topic of “Podcasts as a Tool for Continuing Professional Development” and will be hosted by Stephanie Lancaster (@TheOutLoudOT).

Stephanie Lancaster has practiced as an OT for over 25 years.  She is currently an assistant professor in the Department of Occupational Therapy at the University of Tennessee Health Science Center in Memphis. Stephanie blogs at www.stephanielancaster.com and hosts a podcast for people interested in OT called On The air (www.OnTheAir.us). She is currently pursuing a doctorate in education in the field of Instructional Design & Technology and is writing a dissertation on the impact of podcasting on the education and growth of occupational therapy students.

Here is what Stephanie had to say… A podcast is generally described as a series of digital audio files that can be accessed online and downloaded and listened to on an electronic device. The term podcast was coined in 2004 by British journalist Ben Hammersley through a combination of the words iPod and broadcast.  Since that time, podcast carriers such as iTunes have helped to propel this type of media file into popularity, with millions of downloads and live or on-demand daily across the globe. Podcasting has begun to be explored in formal education settings as an educational technology tool that has been used at an increased frequency in recent years for a variety of reasons. The range, flexibility, ease of use, accessibility, and affordability (most podcasts can be accessed for free) of podcasts make this medium a viable platform for learning not just for students but also for individuals seeking professional development, including occupational therapy practitioners. With a variety of learning opportunities available through listening to podcasts, this technology opens up options for learning about a wide variety of topics related to the practice of occupational therapy.

Questions for the OTalk Chat:

Q1: How often do you listen to podcasts?

Q2: What do you see as the benefits of listening to podcasts?

Q3: Do you feel that listening to podcasts helps you to learn and grow professionally?

Q4: How often you reflect on, think about, and/or talk about things you have heard on podcasts after you listen?

Q5: What podcast and/or podcast episode do you recommend that others in the field of OT listen to and why?

Post Chat

Chat Host: Stephanie Lancaster @TheOutLoudOT

On the #OTalk Account: @helenotuk

Online Transcript

#OTalk Healthcare Social Media Transcript May 8th 2018

The Numbers

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29 Participants
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#OTalk Participants