Dr. Michael Tompkins spoke to an enthusiastic crowd at the North Shore Center for Hoarding & Cluttering conference September 29 and 30th. The topic was “Cognitive and Behavioral Interventions for Hoarding Disorder”.
Dr. Tompkins is a licensed psychologist and a founding partner of the San Francisco Bay Area Center for Cognitive Therapy where he specializes in the treatment of anxiety disorders and obsessive-compulsive spectrum disorders. He is Assistant Clinical Professor at the University of California, Berkley, Diplomate and Certified Supervisor of the Academy of Cognitive Therapy, and a supervisor for the Beck Institute for Cognitive Behavior Therapy. He is also the author of seven books, including Digging Out: Helping Your Loved One Manage Clutter.
The doctor started his presentation by explaining that we don’t know what causes hoarding disorder. “What we want to focus on is what variables maintain the behavior and focus treatment this way. It is a psychiatric condition and most people have one or more co-occurring psychiatric conditions or deficits, like depression. Seventy percent of those with hoarding disorder meet the criteria for depression. The depression needs to be treated first in order to treat the issue of hoarding.”
He listed four factors indicating that someone may be having this problem of hoarding;
- Excessive acquisitions – shopping excessively, buying in bulk,
- Difficulty discarding things – keeping everything
- Cluttered living space – cannot use their space as it is intended
- Distress and impairment being experienced – dilapidated homes, highly isolate, highly uncomfortable living conditions
Dr. Tompkins spoke about the fact that decision-making skills and problem solving skills are often lacking for people with hoarding behaviors. They are afraid of making a mistake and they don’t want to be left with a regret. Sometimes people are not open to help with this condition because they have certain core beliefs about things like; perfectionism, waste, lost opportunities, attachment, memory (tend to doubt their memory), control, responsibility, personal identity, and value of objects. These may not be reasonable beliefs but nevertheless are very real to the person who holds these thoughts. It is through therapy that you get people to look at things differently and to question the beliefs. “We don’t unlearn something but by bringing in new learning, the old beliefs can be inhibited or balanced.”
Organizing and categorizing present problems to the person who hoards. There is often a significant executive function disorder with research supporting the fact that there is a high rate of ADHD (Attention deficit hyperactivity disorder) with hoarding disorder.
There are positive reinforcers for those with the disorder. One will experience pleasure in acquiring which keeps fueling the behavior. Relief from stress comes from acquiring. People with this problem do not have “keep rules”, which is why they tend to keep everything. Dr. Tomkins took the group of participants through an exercise of organizing by going through their own purses and dividing belongings into three categories;
- Easy to let go
- Moderately hard to let go
- Impossible to let go
It is a process that has to be worked through with the person to help develop one’s own rules. “You have to work with the behavior AND the beliefs and thoughts that contribute to the behavior.”
Problem solving skills have to be taught. Dr. Tompkins showed the audience an approach to teaching this skill;
- Define the problem and contributing factors.
- Generate as many possible solutions as possible.
- Evaluate and select one to two feasible solutions.
- Break solution into manageable steps.
- Implement steps.
- Evaluate outcome.
If necessary, the process is repeated until the person is able to identify an effective solution.
To correspond with the process, Dr. Tompkins gave a list of questions to assist in decision making;
- Do you really need this? (Not very effective as the answer will always be “Yes”).
- Do you already have enough of these?
- Will this add something new to what you already have?
- Do you have a specific plan to use it?
- What are the advantages of letting go of this now?
- Do you have space for this?
- Will you really use this in a reasonable time frame?
Cognitive Behavior Therapy (CBT) is the only psychological treatment that has been studied in the treatment of hoarding. Dr. Tompkins pointed out that due to the risk of dementia, it is harder to use cognitive intervention with older adults. It is more complicated working with this group when it comes to hoarding. For more information check out the following Association for Behavioral & Cognitive Therapies fact sheets at http://www.abct.org/Information/?m=mInformation&fa=fs_HOARDING
For a short and concise insight into Dr. Tompkins expertise, view this YouTube clip. https://www.youtube.com/watch?v=zTAuju9HiI0
It was evident from the participation and engagement of the crowd that Dr. Tompkins’s presentation at the conference was highly beneficial and appreciated. If you would like to find out more about our North Shore Center for Hoarding & Cluttering program, go to our website at http://nselder.org/north-shore-center-for-hoarding-decluttering/ or call North Shore Elder Services at 978-750-4540.
*Starting in November, there will be ten week group meetings; Monday’s groups are 10:30am – 12pm and 1:30pm – 3:00pm. Thursday’s groups are 10:30am – 12pm and 1:30pm-3:00pm.