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Engaging individuals in dealing with their hoarding
Satwant Singh Nurse Consultant in CBT & MH
Newham, London, UK
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Aims for today
• To understand engagement issues and dealing with the complexities
• To develop creative ways of engaging individuals
• To improve the quality of life for these individuals
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What are the challenges faced by individuals when dealing with their hoarding issues?
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Challenges identified
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What do we know now?
• New classification in DSM V Persistent difficulty in discarding or parting with possessions
• Perceived need for this items
• Perceived distressed experience
• A psychological condition and not social
• It is not a symptom of OCD but may have OCD which makes it more complex- a different kind of hoarding (items are different)
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Definitions
Acquisition of and failure to discard
possessions which appear to be useless or limited value (Frost & Gross, 1993)
Significant distress or impairment in social, financial and occupational functioning caused by the hoarding- (Frost & Hartl, 1996)
Compulsive acquisition Living spaces sufficiently cluttered preclude
activities for what they are designed for
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Continuum
11/19/2014
Normal saving Clutter Hoarding
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Similarities and Differences
Individual with hoarding behaviours and non hoarding behaviours and non hoarders save the same things except in the:
Quantity
Emotional attachments (sentimental)
Perceived use of object (instrumental)
Over valued beliefs about items and self
The object as an extension of self
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Manifestations
2 subtypes:
Compulsive acquisition- bringing items in e.g. buy 1 get 3 free, good value, may need for self or others
Non compulsive acquisition- difficulties in discarding
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The Power of the Visual Image
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• Introducing an image creates the opportunity for a more detailed narrative
• Depth, clarity and focus
• An opportunity to reflect
• An opportunity to express thoughts and feelings
• …which may lead to a better understanding of the situation.
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Value of photographs
• Visual representation is a powerful tool to aid engagement and motivation
• The use of pre and post photographs motivates the individual to work on their issues and be open to explore their difficulties e.g. of letting go
• Provide a record how much has been achieved- the mind is accustomed to disqualify
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Our study
• 12 Participants
• Range of photographs of their environment
• Neutral environment
• Home environment
• Used the H.O.A.R.D. acronym tool.
• We were interested to know the impact it had for them
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HOARD Acronym Tool
5 Key questions developed from our first study using visual methods:
• H Tell me what HAPPENED in this picture?
• O What would you like to OVERCOME and what are your goals?
• A Can you imagine life without ALL of this stuff?
• R How is your life and RELATIONSHIPS affected by this problem?
• D What would you like to DO about it?
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Findings
Feeling isolated and vulnerable
Losing and misplacing
Lifestyle disruption
Metaphor and clutter
Rationalising the acquisition hoarded items
Failed previous support
Beneficial group support
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Exercise
We would like you to look at the photographs that you have brought along- pick one and use the HOARD acronym tool to answer the five questions. You do not have to share your photographs with anyone.
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Feedback
Having done the exercise what did you experience?
Visually
Emotionally
Motivationally
How has it helped you make sense of your difficulties?
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Next steps
Having used the used the H.O.A.R.D. acronym tool what are your next steps? Write them down- remember small steps
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DVD
Using the HOARD acronym tool and feedback from participants and family
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Colour and Hoarding
• Excessive clutter removes light from the environment
• Plastic bags, cardboard boxes etc make the environment dull, drab and achromatic
• Colour from furnishings (carpets and seating etc) disappears amidst the clutter
• Poor light and colour in the environment can exacerbate negative rumination and impact on motivation to change
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Our recent study
• 15 Participants chose a coloured sheet of card
• Choice: Red Yellow, Orange, Green
• Use it in their home environment
• We were interested to know which colour they chose and why
• We were interested to know how they used the card
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Findings
• Most popular choice was green (n=8)
• Then yellow (n=4)
• Then orange (n=2)
• Then Red (n=1)
• The card was most commonly placed in the kitchen (perhaps because of the association with the need for good hygeine)
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Qualitative Findings
• Three Major Themes
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Metaphorical connections
Clarifying Intentions
Practical motivator
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Practical Motivator
• “Its like having a spy, reminding me to keep going with the clearing”
• “I use it as a marker to remind me where to clear up- not too much at a time, but it’s a reminder”
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Clarifying intentions
• “ I cant avoid it, it reminds me that this pile needs sorting”
• “It helped me realise that I need colour in my life”
• “ I almost felt guilty looking at the card because it reminds me that I have to clear up this pile of stuff”
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Metaphorical connections
• “It alerts me of things to be done, just like a traffic light in the street”
• “Like a traffic light….get ready….go!”
• “Green is positive fresh and eye catching, it helps me declare war on clutter”
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Some key conclusions from our study
• The coloured card served as a reminder that items were gradually being removed.
• The permanent visibility of the card was important in motivation
• Colours previously hidden were revealed
• The need for colour and vibrancy was appreciated
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Colour card additional applications
• Individuals with hoarding disorder may have associated ADHD- difficulties in maintaining or sustained the focus on a task
• Distraction tends to be feature of avoidance in hoarding disorder- rather engage in activities that are not stressful/emotional- reengaging
• Progress in made if a continued and sustained focus on a particular task or area is maintained
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Using the colour card (1)
• Select a colour that is bright and has a personal significance to the individual- often it brings back memories of a happy time- can use these memories to help deal with the difficult emotions
• Identify an area to be worked on- place the colour card over the area e.g. above the pile to draw attention that this is the area to be worked on (photograph)
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Using the colour card (2)
• Individuals can write personal statements on the card, draw arrows etc to help them
• Work along side with them, draw their attention to the card to help with the focus and getting used to the concept of focusing on a specific area
• Once an area has been cleared photograph it and move the card to the next area
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Drawings
• Non threatening, non stigmatising, non-judgmental, allows appropriate disclosure (safe)
• If shared it allows engagement through discussion and exploration, development of trust and joint working
• It empowers the individual- they are in control
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Drawings
• It provides hope- a direction as how they would like their room to look like
• Allows the planning of stages and areas of work they would engage in
• A record of their progress
• Monitoring of the work they have done
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How to do drawings?
• Provide a rectangle to represent the room they want to work on
• Instruct them to draw out the furniture, items in the room and shade the areas that are cluttered (can use different colours)
• Draw out a second as to how they would like the room to look like (end product)
• Draw and shade on a weekly basis to monitor progress
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Example
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Exercise
• I would each of you like to draw out the layout of one of your rooms and shade the areas that are covered with things
• Draw a second one with how you would like your room to look like?
• Now list the steps that you would need to take to get from how it is to how you would like it to be.
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Clutter Rating Scale
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Clutter Rating Scale
• Tool to assess and measure degree of clutter usually administered by professional
• In this instance the individual to undertake the rating- empowerment, full involvement and responsibility
• Use the rating imaged for change e.g. current is 8 and would like to be 5
• Write the steps that need to be undertaken to get to rating 5
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Clutter Rating Image scale
• Use the CRI scale to monitor progress
• Helpful as it has a visual end product to aim for which is motivating
• Gives the individual control and empowerment and autonomy in dealing with their problem, helps develop skills to problem solve
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Plan
Having discussed the Clutter Imagine Rating Scale write down how you could use it in helping you deal with your hoarding issues?
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Conclusion
• Hoarding/ cluttering disorder is a complex and difficult condition to deal with
• Remember beneath the hoarding problem is a person-
• Be aware of your own prejudices- ability, others, services
• Engagement with the your hoarding issues is vital to help you deal with it.
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Conclusion
• Engagement is based on understanding, trust, mutual respect and being non judgemental
• Developing a shared compassionate understanding of the problem is vital in engagement
• The HOARD acronym tool is an useful tool to help individuals emotionally and physically distance themselves from their hoarding/clutter
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Conclusion
• The distancing allows the an individual to step back and acknowledge their issues- helps with engagement
• The colour card is an excellent tool to help focus on the areas are to be cleared- distraction in an avoidance
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Take away message from today
We would like you to reflect on your participation in this mini workshop today consider:
How would you use these tools to help you with your hoarding issues?
How would you put that into practice?
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Thank you
Thank you for your participation in the workshop today. If you need to contact me: Satwant Singh [email protected] Special thanks to Dr Colin Jones for his contributions to the research undertaken in this area and contribution to this presentation.
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References
• APA (2013) DSM IV. Arlington: American Psychiatric Publishing.
• Frost R.O. & Gross, R. C. (1993) The hoarding of possessions. Behaviour Research and Therapy, 31, 367-381
• Frost, R.O. & Hartl, T. L. (1996) A Cognitive Behavioural Model of Compulsive Hoarding. Behaviour Research and Therapy, 33, 897-902
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References
• Jones, C. & Singh, S. (2014). The potential benefits of colour in supporting
people with compulsive hoarding disorder. Journal of Mental Health Practice, Vol 18(3): 29-32.
• Jones, C (2013) Compulsive Hoarding: Visual , Narrative and Metaphor: the Value of the Story In Mendelson Z “ This mess is a place a collapsible anthology of collections and clutter” AND Publications London.
• Jones, C. & Singh, S. (2013). The Experience of Emotional Distancing in the Management of Compulsive Hoarding: A Visual Method Approach using the “HOARD” Acronym Tool. Journal of Cognitive Behavioural Psychotherapy Research, 2:41-46.
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References
• Singh, S. (2013). Hoarding- Miss Haversham Syndrome In Mendelson Z “ This mess is a place a collapsible anthology of collections and clutter” AND Publications London
• Singh, S. & Jones, C. (2013). Engaging in treatment sufferers of compulsive hoarding disorder. Journal of Mental Health Vol 17(4): 16-20.
• Singh, S. & Jones, C. (2013). Novel method in engaging compulsive hoarders in treatment. Advances in Cognitive Therapy Vol 14 (2): 8,11.
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References
• Singh, S. (2012). Behandelopties voor problematische
verzmelaars in O.R.V. Van Beers & E. Hoogdin (Eds.) in Problematische verzamelaars. Amsterdam: Uitgeverij Boom.
• Singh, S. Jones, C. (2012). Visual Research Methods: A novel approach to understanding the experiences of compulsive hoarders. Journal of Cognitive and Behavioural Psychotherapy Research, 1 (1): 36-42.
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