Motivational interviewing to modify sorting and discarding behaviors in hoarding disorder

Abstract The act of sorting and discarding possessions is the fundamental health behavior that underlies clutter, a core symptom and signifier of hoarding disorder. In older adults, excessive clutter can cause hazardous conditions in the home that increase the risk of being unable to age in place safely. Current evidence-based treatments for hoarding require lengthy treatment dosages and primarily target fears surrounding sorting/discarding. Because not all older adults with hoarding disorder experience a fear-response when sorting/discarding, other targets for hoarding treatment must be evaluated in this population, including directly targeting motivation for behavior change. The current pilot study investigated motivation to sort and discard items as a treatment target for hoarding disorder in older adults. The rationale for this treatment study was that targeting motivation to engage in regular sorting/discarding of household clutter would result in decreased hoarding severity by creating a sustainable change in behavior. Fifteen participants (age 50 and up, M = 62) engaged in six in-home sessions of a novel intervention that combined intensive motivational interviewing with sorting practice (i.e., spending time engaging in the target behavior of sorting and discarding items in the home). This presentation will discuss the applications of motivational interviewing for hoarding disorder in older adults, including skills related to engaging, focusing, evoking, and planning. Our initial treatment outcomes suggest that motivation is a worthwhile treatment target for hoarding disorder.