Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

Cognitive behavioral therapy for compulsive buying disorder

To our knowledge, no psychotherapy treatment studies for compulsive buying have been published. The authors conducted a pilot trial comparing the efficacy of a group cognitive behavioral intervention designed for the treatment of compulsive buying to a waiting list control. Twenty-eight subjects were assigned to receive active treatment and 11 to the waiting list control group. The results at the end of treatment showed significant advantages for cognitive behavioral therapy (CBT) over the waiting list in reductions in the number of compulsive buying episodes and time spent buying, as well as scores on the Yale–Brown Obsessive Compulsive Scale—Shopping Version and the Compulsive Buying Scale. Improvement was well-maintained at 6-month follow-up. The pilot data suggests that a cognitive behavioral intervention can be quite effective in the treatment of compulsive buying disorder. This model requires further testing.     

Use of behavioral techniques by paraprofessional staff: A review and proposal

Paraprofessionals are increasingly being employed to provide direct care to children and adults who have behavioral deficits and excesses, such as those labeled developmentally disabled, mentally ill, or delinquent. Behavioral techniques, if effectively taught to paraprofessionals, offer ways of both teaching new skills to clients and reducing their undesirable behaviors. This article describes the methods that have been used to teach paraprofessionals to use behavioral techniques, how these skills can be maintained on the job, and the effects upon client behavior that result from this teaching of paraprofessionals. In addition, a system for teaching staff to implement and continue to use behavioral techniques is proposed.     

Use of paradoxical techniques in a school setting

Abstract

Family therapists have used paradoxical methods of intervention in a variety of settings and with a variety of problems. This case study report is the first to demonstrate the use of paradoxical interventions with pre-adolescent and adolescent children in a school setting. These types of interventions could be of great value because they require limited verbal ability and insight on the part of the students, produce rapid results, and are particularly suitable for oppositional students.     

Changing behavior with behavioral techniques

The following report describes how a combination of reward and punishment was used to change the behavior of an acting-out third grade student. Punishment was used to suppress the undesirable behavior and a reward system was used to reinforce the new desirable behavior. The subject dropped from an average of .20 times per day in getting out his seat to an average of 0.12 over a five-week period.     

Cognitive-behavioral treatment of compulsive hoarding: a multiple baseline experimental case study

The present case study describes a cognitive-behavioral intervention directed at helping a 53 year old female suffering from compulsive hoarding decrease clutter and improve decision-making and sorting techniques. The intervention focused on decision-making training, exposure and response prevention, and cognitive restructuring. Ratios of cluttered space to overall space were calculated for floor and furniture tops for each of five rooms over a period of 17 months. Clutter decreased substantially in each of the rooms targeted for intervention, while clutter ratios remained stable for a room used as a baseline control (no intervention). In addition, D.'s scores on self-report measures of obsessive-compulsive symptomatology decreased after 9 months of intervention suggesting that the treatment protocol affected symptoms of hoarding distress, as well as clutter. Despite previously reported difficulties in the treatment of compulsive hoarding, our results provide preliminary evidence that a cognitive-behavioral intervention can be successful in reducing hoarding symptoms. Suggestions for future research include streamlining the treatment program and testing its efficacy on large clinical samples.     

Acceptability of behavioral staff management techniques

This study describes an extension of Kazdin's work on acceptability of behavior therapy methods to the assessment of acceptability in the developing field of behavioral staff management. An instrument for assessing acceptability of behavioral staff management techniques was developed and then used to assess staff evaluations of four techniques that have been researched in the staff management literature (instruction, reinforcement, punishment, self-management). The effects on acceptability of problem difficulty and duration of supervisor-staff interaction were also investigated. Staff identified the techniques as having differing degrees of acceptability, with instruction rated most acceptable, followed in order by self-management, reinforcement, and punishment. Ancillary studies supported the reliability and validity of the scale. Results are placed within the context of a recent behavioral supervision model, and discussed in terms of social validity and consumer satisfaction issues. Implications for delivering behavioral staff management interventions are presented.     

Hoarding in a compulsive buying sample

Previous research has indicated that many compulsive buyers also suffer from compulsive hoarding. The present work specifically examined hoarding in a compulsive buying sample. Sixty-six treatment-seeking compulsive buyers were assessed prior to entering a group therapy for compulsive buying using the Compulsive Buying Scale (CBS), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)-Shopping Version, the Compulsive Acquisition Scale (CAS), the German-CBS, the Saving Inventory-Revised (SI-R), the Maudsley Obsessive Compulsive Inventory (MOCI), the Barratt Impulsiveness Scale (BIS-11), and the Structured Clinical Interview for DSM-IV Axis I (SCID). Inclusion criteria were current problems with compulsive buying according to the proposed diagnostic criteria for compulsive buying by McElroy, Keck, Pope, Smith, and Strakowski [(1994). Compulsive buying: A report of 20 cases. Journal of Clinical Psychiatry, 55, 242-248]. Our results support the assumption that many but not all compulsive buyers suffer from compulsive hoarding. A significant association between the SI-R and the compulsive buying measures CBS, Y-BOCS-SV, German-CBS, and the CAS-Buy subscale was found, which is mostly caused by the SI-R subscale acquisition. The SI-R subscales clutter and difficulty discarding were more closely associated with the CAS-Free subscale and with obsessive-compulsive symptoms. Hoarding compulsive buyers reported more severe buying symptoms and obsessive-compulsive symptoms and presented with a higher psychiatric co-morbidity, especially any current affective, anxiety and eating disorder. Specific therapeutic interventions for compulsive buyers who also report compulsive hoarding appear indicated.     

Spontaneous decay of compulsive urges: the case of covert compulsions

It is well established that many patients with obsessive-compulsive disorder have covert, or internal, compulsions. Empirical studies of this phenomenon, however, are limited. The present study followed the paradigm developed by Rachman and his colleagues for the study of overt compulsions. Patients with urges to carry out covert compulsions underwent an experimental procedure in which their compulsive urges were provoked, followed by a period of response prevention. The strength of the compulsive urges and associated discomfort were monitored. There was marked, and relatively rapid, spontaneous decay of both the compulsive urges and the discomfort. Implications of these results are discussed.     

Multi-component behavioral treatment of trichotillomania: a case study.

A 21-year-old female with a 13-year history of compulsive hair pulling was treated via a multi-component behavioral intervention strategy. Dependent variables included both quasi-direct behavioral frequency counts (i.e., number of hairs pulled) and physical trace, natural erosion measures (i.e. size of bald areas). Results indicated dramatic decrease in number of hairs pulled from treatment through 40 weeks post-initiation of baseline. These findings were discussed with regard to situational-specificity of trichotillomania and reliance upon experimenter-derived rather than subject-controlled data collection sources.