Got Too Much Stuff

Got Too Much Stuff?
How to deal with all that clutter
and deal with your anxiety about
letting it go.

Presented by
Stephnie Thomas, MS, NCC, LGPC
Anxiety Disorders Specialist,
The Anxiety and Stress Disorders Institute of Maryland, LLC

Voicemail: (410) 938 8457 ext 2
Cell: (410) 236 1470

Stephniet@verizon.net

Has your
“clutter”
become
“hoarding?

First Step
 Take a look around your house (or apartment).
 Is your stuff helping you live a productive, healthy
life?
 Is it getting in the way?
 Are other people bothered by your clutter?
 Are you too embarrassed to have friends or
handymen come in to your home or areas of your
home?

Can you walk around all your
furniture easily?
.

Has your home become a health
hazard or a fire hazard?

Are there areas of your home that
you can’t use because there is
so much stuff piled up in there?

Take a look at the next few slides:
Which number is your space?

Where are you between these
extremes?

Exercise:
 Each person was asked to bring in 2 items:
1. One item from your home that your
family members would treasure and
want to keep after you are gone
2. One item from your home that you
treasure but know that your family
members would not want to keep after
you are gone

Exercise (cont.)
In small groups, discuss what
makes each item special to you
What makes each item something
your children (or other family
members) would either treasure or
want to discard

What is the difference between
hoarding and collecting?
A collection is defined as a group
of treasured objects that one takes
pleasure in collecting and showing
to others.

What is the difference between
hoarding and collecting? (cont.)
Hoarding can be defined as
having so much stuff that one is
unable (or unwilling) to take
pleasure in showing it to others.
 Other definitions for hoarding include:

Other definitions for Hoarding
 Hoarding is usually considered a subtype of Obsessive
Compulsive Disorder (OCD).
 Like other compulsive behaviors, hoarding is an effort to
manage the anxiety raised by obsessive doubts.
 There are varying levels of hoarding behavior. A diagnosis
of OCD of the hoarding type is made when there is
significant distress or disruption to feelings of self-worth,
interpersonal relationships, education, occupation,
housing, finances, legal issues, or health as a result of
hoarding behavior.

What is Hoarding? (cont.)
Symptoms vary from person to person,
but may include:
Saving items seen by most people as
unneeded or worthless, (i.e., not true
collectibles).
Compulsively buying or saving excessive
quantities of items of any kind.

 Treating all saved items as equally valuable--
whether or not the object has sentimental,
financial or functional value.
 Experiencing intense anxiety or distress
when attempting to discard-or even think
about discarding-what most others view as
useless objects.

 Engaging in saving activity to combat anxiety-
provoking thoughts such as:
 What if I run out?
 What if I need to know something and don't have
the information available?
 What if I put it away and can't find it?
 What if the way I organize it isn't the right way?
 What if I throw it away but the day comes when
I really need it?

 Being unable to use furniture, rooms,
or entire homes in standard ways due
to saved items.
 Significant deterioration in
housekeeping due to excessive clutter.

What Causes Hoarding?
 There appears to be a strong genetic
component to Obsessive Compulsive
Disorder of the hoarding type. Modeling
and conditioning may also play a role in the
development of this disorder.
 OCD usually involves over-activity and/or
under-activity of brain regions that
underpin the observed behaviors.

What causes Hoarding (cont.)
 Hoarding worries and behaviors can begin
in childhood, even as young as age five.
 The latest research indicates there may be a
link between hoarding and Attention
Deficit Disorder
 Similar areas of the brain are implicated in
hoarding and executive functioning
problems

OK– I recognize I have a problem,
but how do I change?
1. Psychotherapy
2. Exposure Therapy
3. Medication
4. Working with a professional organizer
to reduce and organize clutter
5. Often a combination of all of the
above works well

Psychotherapy Treatment
Involves exploring the impact of
learning, triggers, worrisome
thoughts, and intense emotions.
Helps you explore acquiring
behaviors (triggers) and how
that impacts your clutter.

Medication Treatment
Medications used to treat anxiety
and OCD (e.g. Paxil, Luvox, etc.)
and to sharpen attention (e.g.
Ritalin) can be helpful.
Co-morbid conditions such as
depression may also need to be
addressed.

Using a Professional Organizer
 Professional organizers help you categorize
and store items so that your space is less
cluttered
 They will also encourage you to discard
unneeded items
 Problem: most lack training in helping you
learn how not to acquire too much new
stuff.

Exposure Therapy Treatment
 Exposure therapy involves practicing new
ways of responding to uncomfortable
thoughts and feelings that arise when
hoarding behavior is challenged.
 It is often conducted in the home with
pragmatic emphasis on both reducing the
clutter and managing the doubt and anxiety
that perpetuate the clutter.

Exposure Therapy Treatment
The key is learning to "allow"
feelings of anxiety to be
present without attempting
to neutralize them by saving
things.

ERP: What is it?
 Exposure and Response Prevention
 The client deliberately exposes him or herself to the
feared situation and deliberately chooses not to engage
in their normal behaviors
 Example: The hoarder walks into his apartment
carrying his mail. Instead of adding the mail to the pile
of unopened mail (the normal clutter response) he
chooses to go through each item right then and there
and discard junk mail WHILE BEING
UNCOMFORTABLE WITH LETTING IT GO

Response prevention
 Confront demoralization and self-contempt
 Learn to tolerate uncertainty

When certainty will finally be obtained!

Response prevention (cont.)
 Change the reaction to symptoms of
arousal from catastrophizing to
acceptance and curiosity
 Change the attitude from avoidance to
approach
 Use practice not testing

Therapy goals:
 Avoid repetitive questioning (e.g., "Why? Why
do I have so much clutter/hoard? Why did I let
this get out of hand?").
 Understand that recovery doesn't require an
answer to "Why?“
 Remember: OCD and/or hoarding are/is not
logical.
 Ask instead: "What is my objective? How can I best
get there?"

Therapy goals (cont.)
 What do I value?
 Is it more important to have a functional
space or to have my stuff around me?
 Are family members refusing to come to my
apartment because of my clutter? – am I
willing to change to see my grandchildren
more often?
 Has my spouse moved out because of my
clutter? Do I want him/her back?

What do you want your space to
look like? This?

Or this – a fully functional room?

Develop the ability to tolerate
intense emotions.
 Rate the intensity of feelings on a scale of 1
to 10.
Observe changes in the intensity of feelings.
Notice that feelings come and go; saving
things is not required to reduce anxiety.

Accept that less than perfect is
"good enough."
 Towels do not have to be folded with military
precision, cans do not have to be arranged in
alphabetical order, etc.
 Take care with items of consequence (e.g., bills,
medicine, safe deposit box keys), but relax with
things of less consequence (e.g., today's
newspaper, "junk" mail, spare toothbrushes).
Correctly making that distinction is often the key
to recovery.

Accept that less than perfect is
"good enough.“ (cont.)
 Practice a "so what" attitude if you make a
mistake. Ask yourself what is the worst that
could happen and how could it be fixed.
 Ask yourself if it is worth the time and effort
to change something you have done or
whether you have better things to do.

One way to avoid clutter
For every item that comes into
your home, at least one item has
to leave your home
 Doing this will very effectively address the
acquiring behavior that is typical of most
people who struggle with clutter

"Only Handle It Once." (OHIO)
 Deal with each item only once.
 Check things only once instead of storing
them to check more thoroughly later.
 Deal with things as soon as they come into
the house.
 Do not retrieve items from the trash when
second thoughts intrude and raise doubt.

OHIO

Keep Discard Donate

Simplify decision making.
 Limit choices, (e.g., keep, recycle, sell,
give away, throw away).
 Make clear decision rules for each
choice, (e.g., keep 10 hole-free plastic
bags, throw away dirty bags, recycle
remaining bags).

Simplify decision making. (cont)
 Use broad categories instead of many
specific ones, (e.g., "gift wrap items"
instead of paper, lace ribbons, small,
medium & large bows).
 Accept that others, including experts,
may do things differently.

OHIO
• How useful is it?
• How often do I really use
this item?
• Have I used it within the
Keep last 6 months? (12
months for seasonal
items)
• Does it have special
sentimental value?

OHIO
• Items that are
broken, chipped, or
soiled.

Discard • Junk mail. That
“special offer” will be
repeated!
• Newspapers at the
end of every day.

OHIO

• Magazines after 1 – 2
weeks. If you haven’t
had time to read it
Discard within that time frame,
chances are that you
will never read it
• Clothing: anything
ripped, torn, or soiled

OHIO

• Leftover food (if it’s been
in the fridge for more than
a week …)

Discard • Containers from food
service places (e.g. Burger
King bags, napkins, salt
sachets, etc.)

OHIO
• Anything that is in
excess. For
example: do I really
need 40 shirts, 20
Donate pairs of shoes, 60
pens, 3 sofas, and 30
coffee mugs?

OHIO

• Ask yourself how
you can help
Donate others by
donating this
item

OHIO

• If you are
internet-savvy,
Donate think about
posting your items
to sell on Ebay.

Organize and file systematically.
 Place like things together in a designated
place, (e.g., place grain products in one
cabinet, bottled and canned goods in
another).
 Use broad headings when filing, (e.g.,
house, cars, medical, insurance, job,
education).
 File only important papers.

Buy and keep "just enough."
 Sales will be repeated.
 If you run out, it is not a disaster.
 Keep items you use--throw out others, (e.g.,
You have five handbags--you use one; one
has a broken handle; one has a hole in the
bottom; one is too small; and, one is a color
you do not like. Keep the one you use; throw
away the damaged ones; and give away the
other two).

Focus on functionality.
 Select a target, (e.g., an area such as the kitchen
or even a corner of a particular room).
 "Excavate" the target by throwing away and
organizing.
 Maintain the clear space.
 Use the cleared space only for its intended
purpose.

Seek assistance or another opinion.
 Individuals who hoard often have a difficult
time determining what is "important vs.
unimportant," "just enough vs. excessive," or
"necessary vs. inconsequential."
 Enlisting the aid of a trusted friend or
professional can provide guidance in
developing appropriate guidelines and
persevering with your goals.

Acceptance Not Control
 No technique, coping skill, behavior therapy
or practice will ultimately work if the patient
remains afraid of and struggling against the
sensations of arousal or the intrusions of
anxious thoughts. This is the basic paradox
to be learned over time.
(Sally Winston, ASDI)

Take home message
 Recovery
occurs when
the symptoms
no longer
matter
(Claire
Weekes)

Levels of recovery
 Significant improvement
 Clutter/Hoarding is under control
 cognitive recovery
 You accept you have a problem with clutter/hoarding
 insight recovery
 The physical symptoms you get when you think
about cleaning your space are information
 existential recovery
 symptoms do not matter – you are able to clean your
clutter anyway!
(Sally Winston, ASDI)

Remember your goals. What do
you want your space to look like?

References
 Freedom from Obsessive Compulsive Disorder, Grayson
 Chapter 13, OCD Workbook. Hyman
 Randy Frost
 Noppinger
 Gail Steketee
 Edna Foa
 The Doubting Disease, Help for Scrupulosity and
Religious Compulsions, Ciarrocchi

Who to call to find help
 ASDI
 Dr. Sally Winston, 410 938 8454
 Sally coordinates services at ASDI & will match you with a
therapist or in vivo specialist trained in helping with clutter

 Maryland Association of Professional
Organizers
 National Association of Professional
Organizers

New Group being formed
 Eve Berkow and I are forming a low-fee
group for clients who struggle with
clutter.
 The group will meet on Tuesdays at
1pm at our ASDI office in Towson,
beginning sometime in 2011

But, I have Medicare, and no one
will take my insurance!
 Eve Berkow at ASDI is able to work with a
limited number of Medicare clients
 In 2011 Eve and I are beginning a group for
clients who struggle with clutter .
 Call Eve at (410) 938-8450 if you are
interested in the group or individual work.

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