Intolerance of uncertainty as a factor in hoarding treatment

J Psychiatr Res. 2025 Dec 23;194:116-122. doi: 10.1016/j.jpsychires.2025.12.044. Online ahead of print.

ABSTRACT

PURPOSE: Hoarding disorder (HD) involves difficulty discarding clutter. Existing treatments for HD (including cognitive-behavioral therapy [CBT]) yield only partial symptom reduction. Identifying factors that contribute to hoarding may inform potential treatment mechanisms. One such factor is intolerance of uncertainty (IU), the tendency to maladaptively respond to the unknown via fear, discomfort, and avoidance. While IU has been linked to hoarding symptoms, its role in treatment outcomes remains understudied.

METHODS: 41 adults with HD completed the Buried in Treasures (BIT+) Workshop (a 16-session manualized skills group using CBT principles, with 10 additional supervised in-home uncluttering practice). IU and HD symptom severity were assessed pre- and post-treatment.

RESULTS: Pre-treatment IU did not significantly predict improvement in hoarding symptoms (β = .15, p = .31). However, IU significantly decreased following treatment (t = 2.23, p = .017). Smaller reductions in IU significantly predicted worse hoarding symptom outcomes, accounting for baseline severity (β = .41, p < .01).

CONCLUSIONS: Results suggest that high initial levels of IU may not prevent patients from benefiting from hoarding treatment via the BIT+, but that reduction in IU accounts for a significant increment in hoarding treatment gains. Given the room for improvement evident in HD treatments, future research might consider augmenting existing treatment with IU-specific interventions to boost treatment efficacy.

PMID:41468625 | DOI:10.1016/j.jpsychires.2025.12.044