Therapist-Delivered Video CBT for Hoarding Disorder: A Retrospective Observational Study of Clinical Outcomes from a Large Real-World Sample of Adults

Hoarding disorder (HD) affects approximately 2–3% of adults and is associated with substantial functional disability and limited access to evidence-based care. The aim of the current analysis was to examine the naturalistic effectiveness of therapist-delivered video cognitive-behavioral therapy (CBT) for HD in a large real-world sample, and to characterize individual-level treatment response, time-to-response, and moderators of outcome.

This retrospective, observational analysis examined clinical data from 305 adults diagnosed with HD who received therapist-delivered video CBT through an online specialty therapy platform between September 2021 and February 2026. Hoarding symptom severity was assessed using the Hoarding Rating Scale–Self Report (HRS-SR). Linear mixed models examined symptom change from baseline to three timepoints: session 10, session 20, and each patient’s final session.

HRS-SR scores decreased from M = 22.4 ( SD = 7.6) at baseline to M = 16.4 ( SD = 8.2) at final session (Hedges’ g = 0.81, 95% CI: 0.68–0.94). By the final session, median percent improvement was 25.0% [IQR: 3.0–46.7%]. A total of 39.3% of patients achieved ≥35% HRS-SR reduction, 27.4% of patients who began above the clinical threshold achieved remission, 36.4% demonstrated reliable improvement, and 22.9% of eligible patients achieved clinically significant change. Among patients who achieved and maintained ≥35% reduction through their final session (n = 120), median time to first response was session 9, with 54.2% responding within 10 sessions. Analyses of secondary outcomes showed significant improvements in clutter severity, depressive and anxiety symptoms, stress, quality of life, and functional disability (Hedges’ g = 0.21–0.47). Greater baseline severity, more sessions, and longer treatment duration significantly moderated outcomes; prior OCD treatment history did not.

Findings suggest that therapist-delivered video CBT for HD, delivered remotely in a real-world setting, produces outcomes consistent with controlled trials and may be a clinically effective and scalable approach for a condition historically underserved by mental health systems.

Author Summary

Hoarding disorder is a common and debilitating condition affecting millions of adults, yet most people with hoarding disorder never receive effective treatment. Barriers including cost, limited availability of trained therapists, shame, and reluctance to allow others into the home make access to care particularly challenging. In this study, we examined outcomes for 305 adults with hoarding disorder who received cognitive-behavioral therapy delivered by trained therapists via video through an online specialty platform– the largest real-world study of this treatment approach to date.

We found that treatment produced meaningful reductions in hoarding symptom severity, consistent with what has been observed in controlled clinical trials, and that improvements extended to clutter, mood, quality of life, and everyday functioning. Notably, among patients who responded to treatment, over half showed meaningful improvement within the first 10 sessions, a finding not previously reported for hoarding disorder. These results suggest that video-delivered therapy can reach patients who might not otherwise access care and can produce clinically meaningful outcomes at scale.

Our findings support the continued development and dissemination of video-based treatment for hoarding disorder.