Clutter-GO: Facilitating Delivery and Adherence in Evidence-Based Treatment for Hoarding Disorder via a Patient-Provider Digital Health Tool

PROJECT SUMMARY/ABSTRACT
Hoarding Disorder (HD) is characterized by the acquisition of and failure to discard materials regardless
of their actual value, resulting in a dysfunctional accumulation of possessions. The disorder affects 2.5%
of the U.S. population daily (~6.5 million individuals). HD causes significant functional impairment,
reduced quality of life, and represents a substantial public health, safety, and economic burden. The only
evidence-based treatment (EBT) for HD is a specialized form of cognitive-behavioral therapy (CBT). The
treatment is associated with large effect sizes on average; however, many do not respond due to limited
adherence to at-home behavioral assignments. On average, patients with HD complete less than half of
their assigned CBT homework. Between-session behavioral avoidance and distress, lack of in-the-
moment support and accountability, and limited methods to objectively measure homework completion
all contribute to low patient adherence, which in turn predicts treatment non-response. The current Phase
I STTR seeks to develop and assess an asynchronous telehealth tool and digital support resource to
assist in facilitating delivery of and adherence to CBT for HD. Clutter-GO™ will consist of a web-based
clinician portal and patient-side mobile app designed specifically for HD treatment. The platform will allow
clinicians to access expert-created EBT homework assignments that can be pushed to patients’ mobile
devices. Unlike traditional pen and paper homework lists and logs,
Clutter-GO™ will contain a library of
step-by-step behaviorally interactive multimedia homework assignments. Thus, patients can do
assignments by themselves with increased real-time support and tracking. The platform allows for just-
in-time psychoeducation videos, coping skills, emotional processing, and therapeutic accountability via
asynchronous connection to therapists, who can monitor objective results immediately. Importantly, a set
of image and video capture tools with visual overlays make it easy to track progress over time to promote
positive reinforcement. Ultimately, use of Clutter-GO™ is expected to facilitate patient adherence,
treatment effectiveness, provider fidelity, and dissemination of EBT for HD. The overall goal of the project
is to create a rigorously vetted and highly usable platform for Phase II testing, via four stepwise Aims.
Aim 1 is to complete initial development of the product build based on input from internationally known
experts in HD treatment. Aim 2 is to iteratively refine the clinician user interface (UI) via consultation and
user acceptance testing (UAT) with (N = 20) licensed clinicians who treat HD. Aim 3 is to iteratively refine
the patient UI via consultation and UAT with (N = 12) individuals diagnosed with HD. Finally, Aim 4 is to
confirm the platform by allowing the expert consultants and licensed clinicians re-test the patient-vetted
product for a final round of iterations. The primary outcome criterion is exceptional platform usability as
measured by an industry-standard usability scale shown to predict ultimate product success. Positive
results will be followed by a Phase II application to test the clinical efficacy of Clutter-GO™ in a large
randomized controlled trial and to continue improvements via large scale UAT.

Grant Number: 1R41MH138146-01
NIH Institute/Center: NIH
Principal Investigator: Margo Adams Larsen