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How can a deeper understanding of mental health help us see our world, and ourselves, differently? Hosted by therapist Kurt White and journalist Mary Wilson, each episode of Unravelling explores a complex mental health topic with insights from both professionals and people with lived experience. Whether you're trying to make sense of the world or just the slice of it inside of your head, Unravelling is here to foster a more compassionate and informed perspective on life.
The content of this podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified health care professional for any health concerns. Take care of yourself out there.
Mary:Welcome to Unravelling. This is a podcast that sees the world through the lens of mental health. I'm Mary Wilson, a journalist.
Kurt:And I'm Curt White, a social worker and psychotherapist. Now, Mary, what do you, what do you know about hoarding and hoarding disorder? Have you ever seen the TV shows about that?
Mary:Yes. I think so many of us have seen those TV shows. I think one is on TLC, and it's called Hoarding Buried Alive. And it's a show that really pulls you in and is quite disturbing. I think I remember watching it, after school, and I came home from high school and flipped on the TV, and you would see these homes that were very dark and dirty and just, piles and piles of things.
Mary:And, these poor people who were living with the disorder could barely make their way through their home. There's one image in my mind now of a woman who was actually sleeping on top of piles and piles of garbage and clothes and things that they had purchased and forgotten about. The tags were still on them. It was really a hard show to watch, but it was one of those things where you also couldn't stop watching.
Kurt:Yeah. It's not really a very pretty picture of things that gets painted in the TV shows. There's a kinda visceral ugliness to it that to to sort of see it on screen. Maybe might leave some people wondering, why can't people just clean it all out? You know?
Kurt:Get some help and clean it all out. Get a dumpster. And that's part of what these, shows do, actually, isn't it?
Mary:Yeah. And you feel the satisfaction as a viewer of, oh, now it's everything's better. It's all cleaned out. But, of course, what we're learning is it's a more deep rooted issue than that. You can't just throw away stuff and things and everything's better.
Kurt:That's right. It has much more to do with the meaning of things, like you say, as the field is coming to really understand. It's not just a failure to throw things out. It's a whole cycle of how how did these things get here in the first place and what makes them hard to get rid of and stay gone.
Mary:And there's so many different ways that people are becoming attached to these objects, and we're going to explore that today. We're lucky enough to have one of the leading researchers in the field of hoarding disorder. That's Doctor. Randy Frost.
Kurt:Yes. Doctor. Frost, a friend of the show, a past podcast guest. Folks might remember him from the diagnosis episode that we did about a year ago. But this is such an area of expertise of his, we wanted to have him back.
Kurt:Charming little story he told about actually a student that wanted to do a research project about it, and he and really most other people thought that this was such a rare problem that you'd you'd never find enough folks to to do research project with. But she really wanted to, and they put an ad in the paper, and hundreds of people responded. And it really caused him to sort of rethink lot of things about this and to research it further, and he has come to be really such a leading expert. So we're we're very lucky to have him. Doctor Randy O.
Kurt:Frost is the Harold Edward and Elsa Sipula Israel professor emeritus of psychology at Smith College. He's published hundreds of articles and book chapters about hoarding disorder and other topics. He has been on expert panels about hoarding disorder, appeared on national media, toured, given lectures lectures in in The The US and internationally about this topic. He's the author of the Oxford Handbook of Hoarding and Acquiring and of the book Compulsive Hoarding and the Meaning of Things as well as several other books on this topic.
Mary:Yeah, he's a real expert in this field, so I'm looking forward to learning exactly how this disorder works. Let's dive right into that interview.
Kurt:Well, professor Frost, welcome to Unravelling again.
Dr. Frost:Thank you. Nice to be here.
Kurt:Absolutely. So today, I wanted to talk with you specifically about hoarding and hoarding disorder. Sure. This is a specialty or one of the world's specialists on this topic as I understand it, actually.
Dr. Frost:Uh-huh. Yeah.
Kurt:Paint a picture for us. What does it usually look like for the person who's experiencing it?
Dr. Frost:Well, there are a couple of things that are are involved here. It is a a great deal of clutter, covering all parts of the living areas of the home. And in order to be considered hoarding, it's got to be in the living areas of the home. So if you've got a bunch of clutter in your attic or your garage or outbuilding or even even in a storage locker, It's not really considered hoarding until it impinges on the living areas of the home. The nature of the items that are saved, quite interestingly, don't seem to be any different than the nature of items that are saved by anyone else.
Dr. Frost:This is one of the points at which there were some stereotypes that developed about hoarding behavior, in part because there is a diagnostic criteria for obsessive compulsive personality disorder that's described as an inability to discard worthless or worn out things even if they have no sentimental value.
Kurt:Mhmm. Mhmm.
Dr. Frost:So that that became kind of the benchmark for hoarding. People said, well, it's only hoarding if they're saving worthless things that don't make any sense. Well, that's not quite true from the research that we've done. It's clear that people with hoarding disorder save virtually everything that comes in. Sometimes it includes things that are brand new.
Dr. Frost:We've had houses filled with new clothes with the tags still attached or appliances in boxes that fill the house. This notion that that's only worthless and worn out things are trash is is incorrect from the standpoint of what what makes up hoarding disorder. Mhmm.
Kurt:It might or might not.
Dr. Frost:It might or it might not. Yeah. Yeah.
Kurt:In Chicago, I had moved into an apartment that had been occupied by a man that sounded like had this and saved primarily newspapers. But as I understood it, it was floor to ceiling newspapers. And I think he had passed away. And it made sense it was a pristine apartment because everything was, nothing had been touched. He hadn't been anywhere in it for decades and decades, I think.
Kurt:I thought it's surprising, you know, when you Yeah. Find things like
Dr. Frost:that. The other characteristic of these homes is the sort of chaos inside. The clutter, it's it's not well organized, not like everything is is neatly, labeled and arranged. Now often there are pathways, but usually it's just piles of stuff forming the walls of the pathway. It's stuff that may have value.
Dr. Frost:It's also stuff that's not well organized, which are the two main things you see when you walk into someone's home. Now, sometimes you get more squalid conditions. And that's not in the majority of cases. A minority of cases have more squalid conditions. Usually, those are associated more with people who have trouble letting go of things that they perceive to be wasteful, like food they bought that started to go bad.
Dr. Frost:Now there are also some cases where it gets a little bit more bizarre. And so this notion of holding onto things extends to things that are part of your body sometimes. And and that that starts to look a little bit sort of on the edge of something much more serious in terms of cognitive kind of things. But Mhmm. Sometimes looks as though especially the beliefs associated with these things a a bit delusional, when in fact it's not.
Dr. Frost:But that that's one of the distinctions that you have to make in in, trying to diagnose hoarding disorder. Mhmm.
Kurt:Is that similar to the way that sometimes OCD thoughts can sound unrealistic to the point of being almost delusional, but are not?
Dr. Frost:Yeah. Absolutely. There is some overlap in some of the cases where letting go of something, you can't articulate why it is you're saving it. You just can't let it go. That not just right experience feeling is one that is common to some forms of OCD.
Kurt:Is there usually an emotional attachment to the objects that's being saved? What does that look like?
Dr. Frost:Yeah, the nature of the attachments. And here's where it gets pretty interesting because the diagnostic code focuses on the behavior. It doesn't say anything about the nature of the attachment. And when it comes down to it, if we're looking for a core for the disorder, really that core is somehow wrapped up in the nature of the attachments. And I think of the attachments that we see as coming into a couple of different areas.
Dr. Frost:And the first area has to do with the sense of identity or opportunity. And it covers a couple of different things. The notion that this object represents an opportunity for me in some way. And if I throw it away, I've lost that opportunity. That way of thinking about it, you know, as we as we mature as human beings, we learn that in order to take advantage of opportunities that are in front of us, we have to let some of them go to take advantage of others.
Dr. Frost:But what if we never got that message? What if we never learned to do that? We just couldn't tolerate letting go of an opportunity. What would happen eventually is that our lives would become we'd become ineffective. We we wouldn't be able to manage.
Dr. Frost:The other pieces of this kind of attachment have to do with identity though, and one of them has to do with wanting to keep things that allow me to create a new identity. So one of the cases we describe in our in our book stuff is a woman who had cookbooks, three, four hundred cookbooks. And she saved recipes from the newspaper. She saved magazines that had recipes in them, but she never cooked. And what she said was, well, if I get rid of them, I won't be able to do what I wanna do.
Dr. Frost:I want I I wanna see myself as a good cook and a great entertainer. I love to have have dinner parties for my friends. And having these things allowed her to live that fantasy and only as a fantasy, not as real life because she couldn't get her home was too crowded and she had too many recipes to choose from to be able to put that into practice. So it was really this her behavior is being reinforced by this dream she had of becoming a great cook. That's this sort of opportunity for a fantasized future here.
Dr. Frost:And you hear this in males, it looks a little bit different. For males, what happens is you see them saving everything because I might be able to use that someday, or I might have a plan to fix this thing. And I'm saving this broken thing because I'm going to fix it and use it. So that's who I am. But they never get around to actually fixing it or using those things.
Dr. Frost:So you see the same fantasized future being a part of the attachment to the object and the reason for saving it. And sort of the opposite of that is this sense of wanting to to preserve an idealized past. Mhmm. So anything that I had some kind of interaction with in the past, it feels like if I if I try to throw this away, it feels like I'm losing that piece of myself. Mhmm.
Dr. Frost:Another kind of attachment has to do with the level of distress that this creates. So this the woman I'm talking about had was an art history major in college thirty years ago. And she had all these art history books and she put one in the sell pile and not in the keep pile, and she started to cry. And what she said was, I just feel like I wanna die. And and that's a refrain that you hear over and over again with folks with this problem when they're trying to get letting something go.
Dr. Frost:It feels like I it feels like I'm gonna die. It's just such an intense level of distress. And so she she put in the recycle box and kept going. We went on something else and I came back and said, well, how do you feel about that now? And and she couldn't see it.
Dr. Frost:And so what happened was the anxiety, the distress had come down. Now if I hadn't been there and she picked up this book and felt this horrible way, she would have saved because there's no there there there's no reason for her in her mind to to punish herself this way, to experience it's a it's an escape behavior. So she's escaping this this horrible feeling. The third of these is a little bit different, and it goes back to something I said earlier, and that's the sense of the functionality of these things. That that the the motivation for some of the things, saving some of the things is a fear of waste.
Kurt:And
Dr. Frost:and it's the sense of responsibility that is not unlike the responsibility since we see with people who have OCD. That I am responsible for not wasting or harming a possession. And so how does that play out? Well, we have cases, people who do things like they save the cardboard boxes, boxes and use them stationary so they don't waste it, so they don't throw it away. One of our cases, a woman who could not get rid of she had a three quarters full trash bag.
Dr. Frost:She couldn't throw it away because it would waste the quarter space that's left. So this fear of waste, it's almost as though it's a sense of scrupulosity, an OCD kind of scrupulosity, that that leads them to feel guilty. And so the the motivation here is guilt rather than fear of loss. And one's a fear of harm. And here what we see is a tendency in people with hoarding disorder to anthropomorphize these objects.
Dr. Frost:So one of our cases, a woman who who, had had struggled with hoarding for many years and had cleaned her home and and was living without without clutter. Mhmm. And I had gotten to know her quite well. And and I I said, is it fair to describe you as someone who's gotten over their hoarding problem? And she said, no.
Dr. Frost:And I'll tell you why. And she wrote me this thing, and it was a description of what it was like for her to try to throw out a used yogurt container. And the focus was on the fact that if she threw this yogurt container into the bin, the recycled bin, it would be moist inside, and it would be uncomfortable. And and then at the it would have to suffer that discomfort on its way to being destroyed. And that that just tore at her, and she she was a very elaborate description.
Dr. Frost:She stopped in the middle and said, you know and you know, I know this sounds crazy. I know this this just doesn't make any sense, but it's how I feel. Yeah. Yeah. And so it's not delusion because it's not ego syntonic.
Dr. Frost:Mhmm. But it's yet yet she she had this feeling and can't can't shake that feeling. Mhmm. So there there are those three, the the opportunity identity, the fear of distress, and the fear of waste and harm. The fourth is a more approach behavior, a sense of pleasure from objects.
Dr. Frost:And here, you know, it it it it says though people with hoarding disorder have a special kind of aesthetic appreciation for the physical characteristics of objects. And I like to think of it a little bit like the appreciation that kids have for physical objects. So you give a kid, a four or five year old, a toy that comes in a box, and they're as interested in the box as
Kurt:they are in the That's right.
Dr. Frost:And as they get older, they start to make a distinction between the box and the thing, the box is sort of useless now, but what if they never get over that? What if that developmental step never happens? People with hoarding disorder are sort of in many ways aesthetically driven, and it's this pleasure part of hoarding disorder that's so unusual. Because you don't see that in other disorders like OCD.
Kurt:No. It's and it's different than the anxiety disorders generally, isn't it? I mean, it's not it's usually an avoidance strategy or avoidance behavior. Yeah. Many of these things on both sides of this are actually quite relatable in interesting ways, aren't they?
Kurt:I find that fascinating.
Dr. Frost:Yeah. And many of the things most of these reasons for saving are reasons that all of us have for I mean, they're reasons we all have. It's just that these are so exaggerated. And this beauty thing, this aesthetic thing is so strong, a large percentage of people with hoarding disorder collect things that they intend to use for some kind of aesthetically pleasing project.
Kurt:Oh, yeah.
Dr. Frost:But they almost never produce anything.
Kurt:That's interesting. Is this something that develops at a particular time in life generally speaking?
Dr. Frost:It's interesting. When you see it clinically, you typically see it in people 50 and over. But when we start looking carefully at these people's lives, it appears as though the behaviors start to develop between age 10 and 20.
Kurt:Oh. Oh. So people go a long time without
Dr. Frost:So people go a long time. And now those behaviors, as they start, they're not clinically significant, really. I mean, they're not extreme, but they're there. And they they sort of get more extreme as you go through the decades until by the time people are 50, that's when you see these real severe cases of hoarding. 50 and over.
Kurt:50 and over. Are there are there correlates with childhood trauma or things like that? Or I'm just
Dr. Frost:Well, there there are some correlates with trauma. It's not clear that it's just childhood trauma, but in one of the studies we did, we found that about half of our hoarding cases had had significant trauma. Trauma that would be sort of the baseline for PTSD diagnosis. In the same study, we had a sample of people with OCD, and about a quarter of them had had some significant trauma. So there's a difference there with hoarding much higher level of trauma than OCD.
Dr. Frost:But when we looked at the prevalence of PTSD in either of them, there were no differences. So it suggests maybe hoarding has a function to buffer the the development PTSD symptoms after trauma's occurred.
Kurt:Mhmm. How do how do you treat it?
Dr. Frost:Well, one of the things that's apparent in in hoarding is that once these things enter the home, they basically never get looked at again. Mhmm. Cause of all the new stuff coming in and things getting covered up and being in the pile for decades. And so what that means is that when you look at the nature of these attachments, to really treat it, we've got to change these attachments because we can go in and clear out the home, but that's not going do much good. That's what early attempts were like.
Dr. Frost:People would go in and clear out the home.
Kurt:Just like a thing that got out of control.
Dr. Frost:Yeah. And it looked great, and it was great for early TV shows, and even some of these TV shows still do this. They go in and have a cleaning crew come in and clean it out, and then it looks great. But, you know, in truth, I've been contacted by people who are on some of these shows, and the quarter holding the stuff is back in short order. Yeah.
Dr. Frost:And so it's really the nature of the attachments that you have to change. How can you change those attachments? We can't we can't tell people not to feel this way, But what we know is that when when things come into the house, they never get looked at again. So there is no opportunity for them to process, to think through the true value these things have for them, to really talk their way through it. And so what we do in treatment is to get them to process these things.
Dr. Frost:Now it takes a long time and it's not something that can be done on an emergency basis because if someone's home is so filled that they that it's condemned, we you know, this process would not get them back into the home for some time because they've got to work through and change these attachments before they're able to let go of things. So you have to treat that those emergency cases a little bit differently than other cases. But going through these things, I had, this experience with, I had created a video, training video for how to work through this process with someone. And and I used one of my students as an actress to be the patient. So we worked through this and I presented this at a conference.
Dr. Frost:And there was a woman at the conference who had she had called me actually for was she called me from California. The conference was in Boston. The week before the conference, she called me and said, I've got this problem. What do I do? And I said, well, if you have the chance, come to this conference.
Dr. Frost:And so she came. She was in the audience and she came up to me afterwards and she said, you know, that video wasn't very convincing. And you're acting, number one. Turns out she's an acting coach.
Kurt:Oh.
Dr. Frost:So she said, if you want a real video of what this is like, why don't you do it with me? And I said, great. And so we started doing that, and she went back to California, and she would film these clips of herself trying to get rid of stuff.
Marnie:Hey, Randy. So this I don't even wear contacts. I don't know where the hell I got this, But it's in my life and it needs to not be in my life. It's just a good little compact holder for people who wear contacts. I'll just bring it to my exercise class tomorrow and I'm sure one of the people there will think it's cool and take it.
Marnie:Thanks.
Dr. Frost:And boy, you can really see what this is like because she was articulate number one, articulate and and dramatic in the sense that she really showed herself. She's, you know, with lots of lots of concerns, lots of angst and depression and anger and hatred toward me for getting her involved in this. You know? And over the course of the next two years, she sent me 200 or more of these
Kurt:things. Yeah.
Marnie:Hey, Randy. Hey, Randy. Hey, Randy. Hey, Randy. Hey, Randy.
Marnie:So this was a mug from when my daughter was little, a Halloween mug, a pen that kinda works. I don't need a kinda works pen. And here's another favorite box because it does the smart thing. This is an instruction manual in like every language possible on how to use a hot iron. I thought it was really cute especially because it had a spider.
Marnie:Can you see the spider? I just love seeing pictures of animals. See, look how beautiful that is. But what am I gonna do with it? I mean, it is from June.
Marnie:June's over. Very cool. Very much going into recycling. So it's going to go as well. I really wanna do this.
Marnie:I really wanna put a plant in it. Oh, Randy. I really wanna put a plant in it. Alright. I'm gonna think on it.
Marnie:This is gonna have to be an I think on it till tomorrow because I really don't wanna let it go. I'll think on it and get back to you. Bye. Hey, Randy. So I don't even know if I did this one before, but my friend loves Norman Rockwell, and I'm giving him my plates from Norman Rockwell.
Marnie:I couldn't be happier. It gives me so much joy to give other people joy. So he's at the door, I'm giving it to him now. Thanks.
Dr. Frost:And I just went to the same conference. It was in Chicago this year, and and she and I did a presentation together.
Kurt:Oh, that's wonderful.
Dr. Frost:And she said, you know, it's just amazing to me to look back and see how much difficulty I had with this because now I can get rid of things easily. You know, so it's a it's a remarkable kind of thing, but it's it's
Kurt:People have to really work through the root of it in a heart wrenching way.
Dr. Frost:Yeah. A
Kurt:heart With wrenching someone else that can help. It sounds like that therapy part of it is
Dr. Frost:really Yeah, it's going to be a lot of discomfort. A lot of discomfort. But the thing is, by doing the same thing with all the anxiety disorders, you just have to learn to tolerate it and get to the point where you know, you do feel bad, but you know it's okay to feel bad. So that piece of it looks a lot like an anxiety disorder. But it's not just anxiety, it's depression, it's anger, it's frustration, it's some kind of nostalgic feeling almost that that you have to experience and get used to.
Dr. Frost:Grief, I guess, is probably a good way of describing it.
Kurt:What what does it do to people's relationships with loved ones if they're struggling with that?
Dr. Frost:Yeah. Here's a real real bugaboo, a real problem in that by the time people come in for treatment, they're 50, 60 years old, they've had decades worth of conflict with their families. And many times, if it's a serious case, the family members have given up on them and said, we won't have anything more to do with you. So then you get these basically lonely people now who've got nothing left except all this stuff, and the stuff doesn't do anything for them. Even though it's hard for them to get rid of it, it doesn't really do anything for them emotionally.
Dr. Frost:And so that kind of fractured fam family is the most common family type we see in hoarding disorder. And and people with hoarding disorder are more likely to be either divorced or never married. So they start out alone to begin with for the most part. Not not all of them, but quite a number.
Kurt:I have a friend that grew up with parents that hoarded together. And think a very painful experience that the sort of collecting of, you know, non valuable objects seem to be more important than the human part of the relationship.
Dr. Frost:Yeah. The experience of growing up in that kind of environment is pretty damaging. And people who have done so have described it as knowing as a child that your parents care more about things than they do you. That's their childhood experience. And you carry that for a long time until you find out what this is really like, that this is a disorder.
Dr. Frost:Parents have little control over it.
Kurt:Yeah. What is it that usually gets people to come into treatment? It takes so long. Is it sort of like substance abuse where something forcibly interrupts a pattern
Dr. Frost:with a Sometimes sometimes there's an ultimatum from family members. You're I'm not gonna allow the grandchildren to visit you if you don't do something, or I'm gonna leave you. Or sometimes the authorities come in and say something about it.
Kurt:Those are those emergency kind of cases.
Dr. Frost:Emergency personnel can't get through, can't get in in case a fireman can't get in there if there was a fire and so forth. And so there are pressures that come to bear on people with this problem. Sometimes his neighbors complaining about about the stuff that accumulates outside. And sometimes people just get to the point where they they're tired of it. Mhmm.
Dr. Frost:You know, and they can't quite control it.
Kurt:Mhmm. Yeah. Yeah. So the diagnosis of hoarding disorder focuses on the discarding part of it. But but where does this stuff come from?
Kurt:How does it get into people's houses and lives?
Dr. Frost:Yeah. That's a great question. Real flex point in hoarding disorder, the diagnosis was being put together, we still had relatively limited information about hoarding, about the diagnosis of hoarding. And we did have a number of articles indicated that among people who fit this set of criteria that we talked about, a large number of them acquired excessively. But what does it mean to acquire excessively, and how do you measure it?
Dr. Frost:And how do you know what a large number is? And so those are questions we didn't really know much about the answer to. But now looking at it, what we know is that one of the studies we did for instance, we found that about eighty percent of the people acquired excessively who had hoarding disorder, but most of the rest of them, all but just a small percentage, most of the rest of them said they avoided places where they might acquire things.
Kurt:Oh, I see.
Dr. Frost:Yeah. So even though they said, I don't have a problem with acquiring, it's because they were avoiding
Kurt:these They were taking active steps not to Exactly. Do
Dr. Frost:And so as the research continued, what we have found since the diagnostic code was put in place in 2013 is that if you look at excessive acquisition as a variable alongside difficulty discarding, they both are powerful predictors of one unidimensional concept. And in fact, the acquisition may be a little stronger than difficulty discarding. Oh, wow. So it really is at the core of this disorder. So I think the next round of the diagnostic code, we may see a change in the diagnostic code to incorporate acquisition into the diagnostic criteria rather than being a specifier.
Dr. Frost:Right now, once you get the diagnosis, you have to specify whether it's with excessive acquisition or not. Mhmm. And I think that may change with the next iteration because acquisition is so important. And we know in treatment, if we can we can treat people for difficulty discarding, but unless we also treat them for acquisition, you know, there's stuff just gonna keep coming in.
Kurt:Yeah. Yeah.
Dr. Frost:And it's a little bit easier to treat the acquisition part.
Kurt:What do you do for that?
Dr. Frost:Well, there are two major things we do that seem to work fairly well. The first of them is we know that what happens with people when they're out and in the middle of an acquiring episode is that their attention is narrowly focused on that object. And so narrowly focused on that object that they have lost the context of their life. So they're thinking about this object and how great it is, but they're not thinking about the fact that they don't have money for it. They don't have room for it.
Dr. Frost:They already have one of these at home. And all those variables that would play if you're trying to decide to acquire something are gone because this focus of attention is on how great my life's gonna be with this. So the first thing we do is we we have them sit down with us and we generate a set of questions that they think they should ask themselves, before they acquire something. And for the most part, it's the same. Everybody comes up with the same questions.
Dr. Frost:Do I have anything like this? Do I really need it? Do I have money for it? Do I have space for it? Can I do something else I have that will suffice instead of getting this?
Dr. Frost:All those kinds of questions. And we put them on a piece of paper and in our workbook, have them write that in in one of the pages of the workbook and cut it out and carry it with them. Wherever they go, if they wanna buy something, they pull these things out and they go through and they make a decision.
Kurt:Check it, check it against. Yeah. Yeah. It's interesting. You reminded me of a person I knew in Chicago a long time ago who had some other serious mental illness, but used to used to pick up used cat litter on the side of the road that other people had thrown out.
Kurt:And he could tolerate it that the staff in the place he lived would throw it out, although he didn't like it. But he couldn't stop collecting new And if you asked him, what are you getting this for? He didn't, you know, he said, well, never know when it's gonna come in handy, you know, which sounds like a punch line or something, but he was really quite serious. I think he had a kind of a thought that he needed it.
Dr. Frost:Yeah, there might be some use for it.
Kurt:There might be some use for it. And he was gonna find, he didn't know where it was yet. But he needed to, and I think it was probably physically painful for him to walk by. Exactly. Something like that on And the street again, and not take
Dr. Frost:that's where this avoidance conditioning comes Avoid experiencing that sense of loss by not buying something, by actually buying it. So it's a negative reinforcement of the behavior. The other way we treat acquisition is to treat it a little bit like we would be setting up a physical fitness routine. If you're going to run a marathon, you don't start out running 20 miles. You start out by running one mile and just work your way up.
Dr. Frost:And so what we do is we create a hierarchy of situations for them where they can go into a situation and feel the urge to acquire something. And we then want them to walk away once they've done that. And then we want them to work their way up the hierarchy till they get to the point where they go into a store, they find something they really want, they pick it up, they think about it, they feel it, and they put it down and walk away and experience that sense. And we we actually run these at this conference that I go to, the International OCD Foundation Conference. Every year, we run non shopping trips.
Dr. Frost:So we take groups of people into the store and we have them go through the process of identifying something they wanna get, putting it back on the shelf and walking out. And you can really see the light bulbs go off for them because what happened, I'll give you an example of one woman that we did the first year we did it. She had one of the therapists going with her and she identified a cookbook, picked up the cookbook, looked at it, found a recipe that she wanted, really thought she'd like this recipe. And she put it back on the shelf. We had to rate her urge and distress and they were way up at the top.
Dr. Frost:And she said, I'm going to walk out. It's going to be hard. I'm going to walk out, but I might come back and get it. Might come back and get it. So we had them go to the front of the store and do the ratings again and then go out of the mall to the parking lot and do another rating.
Dr. Frost:And what happened is by the time she got to the parking lot, that rating had gone from a 10 down to about a three. And then and and that surprised her because she one of the things she said to the therapist when she was doing this is, if I don't get this, I'm not gonna stop being able to stop thinking about it. I'm just gonna obsess about this all day about not getting this. But on the parking lot, not only did she say, you know, that didn't happen, and I don't feel so bad now. And not only that, but she said, I I can't remember what the recipe was for.
Dr. Frost:Yeah. Yeah. So this kind of tolerance for the distress is what we're teaching them by doing these non shopping trips.
Kurt:Does it get easier for folks over time, that that kind of distress, you know, working that muscle to build it? Because it sounds agonizing.
Dr. Frost:Yeah. Once once they've done it enough Mhmm. Then it gets easier to experience. It doesn't necessarily mean they feel less distress for a while. I mean, eventually they do.
Dr. Frost:It takes a long time, but you you can learn to tolerate that feeling. Now the other thing we know, and it's probably something that goes into this whole process, is that people with hoarding disorder have high levels of anxiety sensitivity and low levels of distress tolerance. So they get anxious easily and they don't tolerate it very well. And so those are things that we're basically trying to adjust as we go through. But the way we adjust them is to experience this distress.
Kurt:Experience it. Yeah. Yeah. And, I mean, and that's sort of core to the way you approach anxiety disorders. Right?
Kurt:It's that it's a it's a kind of avoidance behavior, you know, and you you have to sort of get people to tolerate the hard things so that you build that muscle and it gets easier. Yeah. Yeah. That's very interesting. It reminds me also a bit of substance use disorders in way, that there's this kind of like intense overwhelming craving that is worse with Q exposure, but then it's better without it.
Kurt:You can work that muscle over time and with distance and practice. But for some it never is totally As
Dr. Frost:a therapist, you have to be careful because can't denigrate their attachment. I mean, you can't and you can't challenge the attachment. You have to let them experience this and learn from it. So the idea is, okay. It's not that important that you throw this away.
Dr. Frost:What is important is that you learn something by being without it. Mhmm. Because we can't you know, the the biggest mistake therapists starting out with hoarding make is that if they're trying to process something, the person pulls something out, the therapist gives them reasons why they should throw it away. And what do they do? They give reasons why they should keep it.
Kurt:Right. Right.
Dr. Frost:I had a therapist start out this way and I said, well, why don't you do the opposite? And so he did. You know, this woman said, it was a dress that her grandmother owned. She was very close to her grandmother. She pulled it out and he says, well, that was your grandmother.
Dr. Frost:You should probably wanna keep that. All of a sudden she looked shocked and said, yeah, but I have all these other stuff in my grandmother's. So they switched roles. It's this ambivalence that has to be worked through. It's straight out of motivational interviewing.
Kurt:Yeah. Yeah. I was gonna say that's that kind of, that's that sort of internal work to preserve a certain equilibrium. And
Dr. Frost:Exactly. And and that's what they have to work through. Mhmm. And our our role is just to be there as sort of an observer. Mhmm.
Dr. Frost:And maybe to help keep them on track, not to not to argue with them to throw stuff out, but to help them stay on track to solve this problem. Mhmm.
Kurt:You know, now my experience of you talking about this is that you've given a lot of really powerful success stories and you seem energized by that. Find that interesting because this is a hard problem
Dr. Frost:actually It's for a lot a hard problem but I think the thing that I find exhilarating is that these folks are so interesting. Mhmm. And so but and they're hurting.
Kurt:Yeah.
Dr. Frost:And and and they're they tend to be quite bright and and you you wanna get them involved in thinking about what's happening to me and how do I understand what's happening to me and that's where the passion comes out in terms of their because the idea is to try to get people to celebrate their possessions. And you'd think they would be celebrating their possessions but they don't because they have so many and they're not discriminating among the ones that they could easily celebrate. Yeah.
Kurt:And actually stopped functioning to do the things that we might hope a possession would Exactly.
Dr. Frost:Exactly. Yeah. Yeah. As
Kurt:you pointed out, it's it's not such an uncommon problem to have. Many people who are listening may well have someone in their life that that is affected by this. Perhaps a close someone, who knows. What would you say to that person to help them, I think, navigate relationship, be of help to this person who is themselves clearly in distress. Right?
Dr. Frost:Yeah. I think the first step and if if you know someone, the first step is to is to get them to start thinking about this in a different way. And keep in mind for most people with this problem, everyone around them has criticized them for it and criticize them to such an extent that they probably hide it from their friends. And so you gotta be careful about not sort of overreaching into their world, but take it at the first if you can get people with this problem to start thinking about wanting to learn more about it. That's and and once they do, they'll get into this world and see into the the world of of of hoarding disorder and treatment, you'll you'll start to see what's out there, and you get get a better understanding of yourself.
Dr. Frost:And once they start to understand themselves a little bit, that's when they can develop some motivation to do this. And, you know, in motivational interviewing terms, once people start thinking about it, we want to somehow maximize the discrepancy between where they are right now and where they want their life to be. So this focus on values and goals, think, is important. There are some new data out on ACT therapy for treatment of hoarding that's starting to look pretty good. And the focus, I think the reason it's good, is the focus there is on values.
Dr. Frost:And that's where I think we need to start with folks. What is it that you want out of your life? You know, you're 60 years old. You got what? Twenty, thirty years left.
Dr. Frost:What do you want out of those thirty years? And and, you know, they'll go through a series of things. Well, what is it like now? And how do you get there? Sort of incorporate in that this sense of how do we figure out which objects you should really treasure and which ones aren't giving you what you want?
Dr. Frost:That kind of investigation really, I think, is a good starting point without without being critical and without, you know, going in and, you know, the tendency and and you can see it with anyone in a helping profession. We're all taught to try to help someone in the quickest easiest way possible. And you go into someone's home and look at this and you think, gee, in about four hours I could have this place looking much better. But boy, that's
Kurt:It's much larger or it could feel hopeless, I think, in the sense of being overwhelming on the other end of
Dr. Frost:it. Yeah. I think that's the first thought most people with hoarding problems have. When they do decide maybe I should do something about it, they say, well, I can't. It's just hopeless.
Dr. Frost:But getting them to start thinking about objects to treasure, getting them to start thinking about working through what the real value of these possessions is for them. The only way to do that is to start letting some of them go and then you know what's valuable and you also learn, okay, I really wanted that and I really would like to have kept it and maybe I should have, but it's gone and the world's not gonna end. Yeah. Yeah. Which is another lesson that that doesn't come through.
Dr. Frost:If you never throw anything away, you don't learn that, you know, you can do without something that you really wanted.
Kurt:Yeah. Yeah. That's very inspiring, actually, I think. I I think, the idea of helping people to find, you know, a value in their life, you know, to find a way to actually enjoy the thing, to get the result that the behavior promises but doesn't deliver on.
Dr. Frost:Yeah. Exactly. Exactly. That's a good way of putting it.
Kurt:Yeah. Yeah. Well, Professor Frost, thank you so much for talking with us again. I've learned really a lot.
Dr. Frost:Well, thank you for having me. I enjoyed it.
Kurt:And thank you again to Doctor. Frost. And also thank you to Marnie Cooper, whose voice we heard there showing us some of her process about her struggles in trying to get rid of items. Joining me again also is Mary. Hi, Mary.
Mary:Yeah. Hi. Yeah. Those videos were so helpful to doctor Frost and his research, and they're really helpful to all of us in really understanding the emotions that are behind this of, you know, it's not just throwing away stuff. It is a process.
Mary:And we're lucky that we get to talk with Marnie Cooper herself next episode and go deeper into this. Hoarding disorder is something she's still dealing with, although she has come such a long way, which she credits Doctor. Frost with being able to live freely today. But it's something that is still part of her life, and we're going to learn much more and really helps us have so much more empathy and compassion to the people that have to deal with this.
Kurt:And this is the very person doctor Frost spoke about, having called him, and and, well, he was about to present conference. And he said, come to the conference. Right? This is her.
Mary:Yes. This is her. And she actually presented alongside him eventually and is really passionate about helping other people sort of come out of the shadows and share their stories and get help.
Kurt:A big part of what we wanna do here, I think, is to shine a light on things that are especially misunderstood in the field of mental health. And and I think that the diagnosis of hoarding disorder and the behavior of hoarding is really a misunderstood problem. I think maybe the very best way to challenge people's assumptions about that is to talk to someone who has struggled with it themselves.
Mary:Yes. And it takes so much courage to be willing to speak about it. So I really hope that you'll join us next episode when we hear from Marnie.
Kurt:Absolutely. Unravelling is brought to you by Brattleboro Retreat. Our producers at Charts and Leisure are Andrew Adkin, Hans Buteau, and Jason Oberholzer.
Mary:And you can find us on social media by searching Brattleboro Retreat. Brattleboro Retreat is committed to exploring diverse perspectives on mental health. While we invite hosts and guests to share their insights, the views expressed are their own and do not necessarily reflect the policies or positions of the hospital or its staff.