A Behavioral Paradigm to Assess for Change in Difficulty Discarding Clutter in the Home: Psychometric Properties of the Hoarding Behavioral Approach Task (H-BAT)

Assessment of hoarding disorder is complex. Ideally, measurement should capture acquiring and discarding behaviors directly, assess motivations for hoarding, assess item content, and be easily administered to effectively monitor treatment progress. This study aims to introduce the Hoarding Behavioral Approach Task (H-BAT) as a tool that can accomplish these goals as part of home-based care. The H-BAT was administered to 45 rural-dwelling adults with hoarding disorder during a comprehensive assessment in participants’ homes. The H-BAT consisted of a 15-minute sorting task using participants’ items while subjective units of distress (SUDS) ratings and emotional responses were collected every five minutes of the task. Administration included counting the number and category of items sorted and discarded. Validity was assessed through correlations with established measures of hoarding severity and neuropsychiatric constructs. Sensitivity to change was examined through pre- and post-treatment comparisons. Results show the H-BAT demonstrated promising psychometric properties as a measure to track behavioral change across treatment. Participants exhibited variability in sorting behaviors, with paper items sorted most frequently. SUDS ratings correlated significantly with hoarding, anxiety, and depression. Speed of sorting was unrelated to processing speed or set-shifting. Depression symptom severity was negatively correlated with percentage of items discarded. Processing speed was negatively correlated with final SUDS ratings. Emotion ratings showed shifts from fear-based emotions to happiness post-task. Sensitivity to change analysis revealed increased sorting speed following treatment. There is initial evidence that the H-BAT is a feasible tool for assessing and tracking hoarding behaviors in home-based care settings.