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.

PROJECT NARRATIVE Hoarding Disorder (HD) is characterized by the acquisition of and failure to discard clutter, impacting millions of Americans, causing significant impairment, and representing a substantial public health, safety, and economic burden. Effective evidence-based treatment exists for HD, however, patient adherence to treatment is a frequent challenge, resulting in limited improvement for many. This Phase I STTR seeks to develop an innovative and interactive patient-provider digital health tool, Clutter-GO™, to facilitate increased support and patient adherence to this life-changing treatment, which has the potential to improve patient outcomes and reduce public health burden.