Integrating Treatments for HD and PTSD: A Clinical Report

This report details the course of psychotherapy methods and outcomes for a 57-year-old White man who sought services for hoarding disorder (HD) and posttraumatic stress disorder (PTSD). Over 14 months, he completed 54 treatment sessions that spanned two distinct treatment approaches. Given his presentation and the conceptualized relations among his symptoms, therapy was sequenced to address PTSD symptoms prior to undergoing cognitive–behavioral therapy (CBT) for HD. The implications of this decision were key to his treatment progress and outcome, and they are reviewed in detail. Together, treatment consisted of psycho-education, cognitive restructuring, and a combination of in-clinic and home-based exposures. Results were positive, with the client experiencing a decrease in self-reported HD and PTSD symptoms, reduction in home clutter and decreased distress related to discarding, and increased feelings of self-efficacy. In light of limited data addressing treatment for individuals with HD who have a salient trauma history, the major aim of this report is to detail how each step of the client’s treatment was approached, what factors and data were considered for reaching specific decision points, and how the sequencing of treatment is believed to have contributed to the positive outcome achieved