Table 1.

CREST Modules, Target Domains, and Manual Content

Module	Session/Homework Content
CCT (target domain)
Session 1. Introduction to CCT and psychoeducation about the link between brain functioning and HD	Discussion of patient’s experienced consequences of HD, barriers to treatment adherence and possible solutions, and treatment goals and expectations
Session 2. Calendar use (prospective memory)	Discussion of current/past calendar system; goal setting of where to keep calendar and when to use it; practicing use of calendar with “real-world” type scenario; using linking tasks and automatic places to help with daily activities
Session 3. Linking tasks, using a “to-do” list (prospective memory)	Review of calendar use and linking tasks; using “to-do” lists along with calendar; determination of to do categories and frequencies; short-term prospective memory strategies (eg, “can’t miss reminders”)
Sessions 4–5. Problem solving	Brainstorming practice exercises (therapist- and patient-provided examples); 6-step problem solving method; practice evaluating solutions for feasibility
Session 6. Thinking flexibly and planning (cognitive flexibility)	Self-talk and self-monitoring; brainstorming steps to meet a goal; practicing setting time lines for long-term goals.
Session 7. Home visit and organizational preparation (cognitive flexibility)	Creating a plan for organizing home (ie, where types of items should be stored); brainstorm “to-do” list for organization; rules of organizing; home maintenance system (current and proposed rules)
ET
Session 8. Exposure preparation	Discussion of expectations, decision making, habituation, and avoidance; rules of discarding; motivational interviewing about willingness to change; acquisition hierarchy; fear of discarding hierarchy
Session 9. Introduction to exposure therapy	Review of organizational plan, rules of organizing, maintenance system, and rules of discarding; introduction to Subjective Units of Distress (SUDS) Ratings; discarding exposure
Sessions 10–22. Exposure to discarding and acquiring	Evaluation of progress; discarding exposure; discussion of reasons for saving and strategies for making discarding choices; introduction to advanced exposure (eg, discussion of rules, preparing for sorting for a longer time, and use of outside help); review of treatment goals
Sessions 23–24. Advanced exposure	Longer exposure time (2–4 hours) with outside help; evaluation of progress; discussion of reasons for saving and strategies for making discarding choices; review of treatment goals
Sessions 25–26. Relapse prevention and maintenance	Review of progress in therapy; discussion of everyday uses for cognitive strategies (eg, calendar use, “to do” lists, problem solving); exposure review; planning for the future

Abbreviations: CCT = compensatory cognitive training, ET = exposure therapy, HD = hoarding disorder.