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Obsessive Compulsive and Related Disorders

A Behavioral Paradigm to Assess for Change in Difficulty Discarding Clutter in the Home: Psychometric Properties of the Hoarding-Behavioral Avoidance Task (H-BAT)

(PS2-63) A Behavioral Paradigm to Assess for Change in Difficulty Discarding Clutter in the Home: Psychometric Properties of the Hoarding-behavioral Avoidance Task (H-BAT)

Friday, November 15, 2024

10:00 AM – 11:00 AM EST

Location: Franklin Hall, Level 4, Marriott Downtown

Author(s)

JW

Jarrod Williams, B.S.

Graduate Research Assistant
Mississippi State University
Mississippi State, Mississippi, United States

Co-Author(s)

Mary E. Dozier, Ph.D.

Assistant Professor
Mississippi State University
Mississippi State, Mississippi, United States

Abstract Text: Hoarding disorder is characterized in part by difficulty discarding items (American Psychiatric Association, 2022). Given the reliance on and limitations of self-report measures in assessing symptom severity in people with hoarding (Levy et al., 2019), the development of direct behavioral assessments for hoarding symptoms is needed. Fear-related emotion is relatively common among individuals with hoarding disorder, particularly before sorting and discarding tasks (Dozier et al., 2020). Therefore, adapted behavioral measures typically used for anxiety-related disorders may be useful in assessing hoarding-related difficulties. The purpose of this investigation was to examine the psychometric properties of a behavioral assessment developed for hoarding disorder. Behavioral avoidance/approach tasks (BATs) are often used for assessing change in fear-based disorders, including obsessive-compulsive disorder and social anxiety; however, their use for hoarding disorder is still nascent. To meet this need, our team developed a hoarding behavioral avoidance task (H-BAT) to assess patients’ ability to sort and discard clutter and their concurrent levels of distress using a 15-minute standardized sorting task. 19 adults enrolled in a hoarding treatment study in rural Mississippi completed the H-BAT as part of a comprehensive baseline assessment. The majority of participants identified as women (n = 18) and 26% of participants identified as non-White (n = 4 Black or African American; n = 1 Biracial). Nine participants repeated the H-BAT after six sessions of an in-home hoarding treatment focusing on increasing sense of self-efficacy for sorting and discarding (Dozier & Nix, Under Review). Consistent with previous findings of emotion ratings during sorting tasks, approximately one-third of participants reported feeling anxious or fearful at the start of the task, and 43% reported feeling a happy emotion (e.g., optimistic). Paper was the item type most frequently sorted, followed by clothing. For participants who completed treatment, there was an average increase in sorted items by 33% (Cohen’s d = .43). Although there was no change in the percent of items discarded, the increase in the speed of sorting resulted in more items being discarded during the H-BAT following six sessions of treatment (28% increase; Cohen’s d = .17). The results suggest that the H-BAT may be a useful assessment tool when measuring change in hoarding-related difficulties and distress. The H-BAT allows for measurement of the change in quantity/percentage of items discarded and sorting speed, both of which can be valuable when evaluating treatment response. Our participants were predominantly women seeking treatment in rural Mississippi, limiting the generalizability of our findings. Therefore, future research should seek to investigate the psychometric properties of the H-BAT with other populations.