Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive–compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive–compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities.

中文翻译：

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对囤积障碍的认知行为疗法的批判性回顾：我们如何改善结果？

囤积问题的心理治疗历来与不良结果有关。当被视为强迫症的一个亚组时，与表现出其他强迫症信念和行为的个体相比，具有囤积信念的个体不太可能对治疗做出反应。当使用认知行为疗法将其视为自身疾病时，个体报告的症状平均改善约 25%。然而，只有不到三分之一的人经历了具有临床意义的变化。此外，不定期评估功能和生活质量的变化。在本文中，我们回顾了当前对囤积问题的概念化和治疗，以阐明如何改进囤积障碍的治疗。在进行治疗之前使用减少危害的方法对于确保个人安全可能很重要。研究应该通过包括增强客户的人际交往功能和调节情绪的能力（即基于方言行为疗法和基于心理化的治疗）的策略来测试治疗结果是否得到改善，尤其是在丢弃和整理物品时。我们还应该使用现代学习理论来改进暴露活动的交付。