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CDP Presents Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) for Hoarding Disorder: An Overview

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Catherine Ayers, Ph.D |  Tina Mayes, Ph.D
Course Levels:
90 minutes
Media Type:
Access for event date only.



Hoarding Disorder (HD) is a chronic and debilitating psychiatric condition that leads to devastating personal consequences and significant healthcare costs. Epidemiological reports estimate the prevalence of clinically significant hoarding symptoms at 7%, while almost 20% of the US population report difficulty discarding ‘worn out’ or ‘useless’ items. This can be problematic when combined with many of the additional challenges certain populations face, including severe functional impairment, medical and psychiatric comorbidities, and cognitive dysfunction. A growing body of research demonstrates higher rates of mental health challenges for Veterans, including hoarding challenges when compared to the typical populace. Unfortunately, Veterans with HD are chronically underdiagnosed and do not receive evidence-based treatment. In this webinar, we will discuss the challenges associated with identifying, screening for, and ultimately treating hoarding disorder in a veteran population with a focus on Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). CREST is a proven, evidence-based treatment that addresses neurocognitive weaknesses that may contribute to HD while targeting the core symptoms of urges to save and avoidance of discarding that lead to the accumulation of clutter. Participants will be introduced to the specific treatment components of CREST. Modifications that were made in response to COVID to include adapting CREST for virtual delivery will be discussed.


Target Audience: For behavioral health providers who treat military personnel, veterans, and their families. 


Instructional Level: Introductory


Learning Objectives:

Attendees will be able to:

  • Explain current deficiencies in identifying Veterans with Hoarding Disorder (HD).

  • Evaluate modified Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) treatment features and advantages.   



American Psychological Association (APA)

The Center for Deployment Psychology is approved by the American Psychological Association to sponsor continuing education for psychologists. The Center for Deployment Psychology maintains responsibility for this program and its content.


Catherine Ayers, Ph.D's Profile

Catherine Ayers, Ph.D Related Seminars and Products

Catherine Ayers, Ph.D., ABPP is a Section Chief at the VA San Diego Healthcare System (VASDHS), Professor in the University of California San Diego (UCSD) Department of Psychiatry, and faculty member in the San Diego State University (SDSU)/UCSD Joint Doctoral Program in Clinical Psychology. She is the Chair of the San Diego County Older Adult Council. Her research is focused on the characterization, treatment development, and community intervention implementation for older adults with hoarding disorder. She has published over 85 peer-reviewed articles and book chapters on late life hoarding. Her research has been funded by the International OCD Foundation, County of San Diego, and Department of Veterans Affairs. Recently, her research has focused on delivery of personalized treatments, digital delivery, loneliness, and functional interventions for hoarding.

Tina Mayes, Ph.D's Profile

Tina Mayes, Ph.D Related Seminars and Products

Dr. Tina Mayes is an experienced, licensed Mental Health Professional who specializes in affordable online therapy offered through our partner, BetterHelp.


First and foremost, I believe in the power of every individual to be able to make long-lasting change in their life. A person is more than just a mental health problem and I take a whole-person approach in my clinical work. We will focus on what is most relevant to you. I have been described as a compassionate, no-nonsense, strong advocate for the people I work with. Some of the feedback I have received from past clients include "I felt understood and heard" and "I didn't know how to cope before, but I do now."


I earned a M.A. and a Ph.D. in Clinical Psychology from Alliant International University, California School of Professional Psychology in San Diego, California. My undergraduate degree in psychology is from San Diego State University. I am a licensed clinical psychologist (#PSY28926) in the State of California. My basic theoretical approach to therapy is rooted in Cognitive Behavioral Therapy (CBT). This is a philosophy of psychotherapy which looks at the relationship among thoughts, feelings, and behaviors and how they may contribute to problems. I use a variety of techniques in therapy, trying to find what will work best for you. My areas of specialized training and expertise include aging and geriatrics, anxiety disorders (OCD, panic disorder, specific phobia, generalized anxiety disorder ), hoarding disorder, adjustment in the wake of divorce, survivors of trauma, and people in recovery from alcohol and drugs. I have formal training and experience in trauma-focused treatment for childhood abuse, sexual assault, and military/combat trauma and co-occurring substance abuse disorders. Some of the therapies I routinely use for trauma include, but is not limited to, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE).