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Symposium

Obsessive Compulsive and Related Disorders

Broadening the Reach of CBT for Hoarding and OCD: Engagement, Equity, and Sustainable Care

4 - (SYM 37) Co-designing a Family Accommodation Support Program for Hoarding Disorder: Development, Acceptability, and Clinical Outcomes

Saturday, June 27, 2026
12:09 PM - 12:30 PM PDT
Location: Yerba Buena Salon 5, B3 Level
Keywords: Hoarding, Psychoeducation, Group Therapy
Abstract Body
Hoarding disorder (HD) has significant and enduring impacts not only on individuals with the condition but also on their families, who frequently experience distress, burden, and involvement in accommodating hoarding behaviours. Despite this, family-focused interventions remain limited. The present study describes the co-design, development, and evaluation of a psychoeducational group intervention for relatives and carers of individuals with hoarding disorder, aligned with principles of affirming, equitable, and sustainable cognitive behaviour therapy (CBT).
The program was initially developed by Little and Nedeljkovic through qualitative interviews with family members, which identified unmet needs related to understanding hoarding, managing family accommodation, and reducing carer burden. Subsequent refinements were informed by qualitative research with adult children of individuals with hoarding disorder, highlighting the interpersonal and communicative processes underpinning accommodation behaviours, and by further feasibility and outcome evaluation work with carers. This iterative, co-designed process ensured the intervention was responsive to lived experience and relevant across diverse family roles.
Across multiple pilot cohorts, relatives and carers participated in a structured group intervention incorporating psychoeducation, communication and boundary-setting skills, harm-minimisation strategies, and self-care. Pre- and post-intervention outcomes indicated high acceptability, significant improvements in knowledge and confidence, and reductions in perceived burden and impact of hoarding, with mixed effects on accommodation behaviours. Qualitative feedback supported the accessibility, relevance, and sustainability of the group format.

These findings highlight the value of co-designed, family-focused CBT interventions in addressing the systemic impacts of hoarding disorder. Integrating lived-experience perspectives may enhance engagement and sustainability in the delivery of evidence-based CBT across routine care settings.