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 LETTER TO THE EDITOR

Compulsive buying treated with motivational interviewing and imaginal desensitization

Christopher B. Donahue, PhD

Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA

Brian L. Odlaug, BA

Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA

Jon E. Grant, JD, MD, MPH

Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA

KEYWORDS: compulsive buying, motivational interviewing, impulse control disorders, imaginal desensitization, treatment

ANNALS OF CLINICAL PSYCHIATRY 2011;23(3):226–227

TO THE EDITOR:

Compulsive buying is defined as excessive spending that causes marked distress, financial difficulties, and significant interference with social or occupational functioning.1 Although a recent study suggests the lifetime prevalence of compulsive buying in the United States is 5.8%,2 there is no standard treatment. Preliminary research suggests cognitive-behavioral therapy (CBT) may help treat compulsive buying,3,4 but research is limited and other treatment options are needed. We present a case of a patient successfully treated using imaginal desensitization, motivational interviewing, and naltrexone.

Sonja, age 30, is a married, college-educated female with no children. She presents for psychiatric evaluation for out-of-control spending. Sonja spent >$12,000 over 2 years on clothing and personal effects and was $20,000 in debt and considering bankruptcy. Searching for “deals” and having the “newest” items are her central triggers. She endorses a childhood history of attention-deficit/hyperactivity disorder, alcohol abuse in late adolescence, compulsive stealing, and pathological gambling. Sonja had been abstinent from other impulse control problems, other than shopping for the last 4 years.

She begins a trial of naltrexone (50 mg/d) for 6 weeks and shows partial response in urge control but still presents as severely symptomatic. The CBT program is initiated after 6 weeks of naltrexone, and includes a novel treatment for impulse control disorders (ICD), “imaginal exposure,” which adds to the emerging literature on CBT for compulsive buying. Sonja undergoes weekly CBT, which includes motivational interviewing, imaginal exposures, financial planning, leisure planning, and cognitive restructuring. The 6-session therapy is a modification of a manualized treatment for pathological gambling, a related impulse control disorder.5 Session 1 includes psychoeducation and a motivational enhancement intervention. Session 2 focuses on functional analysis and behavioral strategies for managing compulsive buying and increasing healthy activities (eg, financial management, leisure skills). Session 3 introduces cognitive strategies for coping with urges to shop and changing irrational thinking. Session 4 includes imaginal desensitization. This session involves creating a script and audio taping a typical spending scenario in order to induce an urge to spend and then reduce that urge through review of negative consequences. Session 5 covers relapse prevention and includes preparing for future triggers and practicing asserting her needs with others. Session 6 includes family involvement, education, and therapy.

After 6, 1-hour, weekly therapy sessions, Sonja reports feeling in control of her buying behavior. She reports her urges to shop are substantially reduced and she will not go to a shopping venue without her husband or a friend until she feels comfortable going alone. Sonja has maintained her improvement for 6 months after the acute treatment. She reports that she continues to use the imaginal desensitization tapes approximately once a week. These 6 months have been her longest period of abstinence since her compulsive buying became a problem.

DISCLOSURES: Dr. Grant has received research grants from Forest Pharmaceuticals, GlaxoSmithKline, the National Institute on Drug Abuse, and Psyadon Pharmaceuticals and has received honoraria from Oxford University Press and Current Medicine Group, LLC. Dr. Grant also has been a consultant to Somaxon Pharmaceuticals and for law offices as an expert in pathological gambling. Mr. Odlaug has received honoraria from Oxford University Press and Current Medicine Group, LLC. Dr. Donahue reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products. The authors alone are responsible for the content and writing of the paper.

    REFERENCES

  1. McElroy SL, Keck PE, Pope HG Jr, et al.  Compulsive buying: a report of 20 cases.  J Clin Psychiatry. 1994;55:242–248.
  2. Koran LM, Faber RJ, Aboujaoude E, et al. Estimated prevalence of compulsive buying behavior in the United States. Am J Psychiatry. 2006;163:1806–1812.
  3. Mitchell JE, Burgard M, Faber R, et al. Cognitive behavioral therapy for compulsive buying disorder. Behav Res Ther. 2006;44:1859–1865.
  4. Mueller A, Mueller U, Silbermann A, et al A randomized, controlled trial of group cognitive-behavioral therapy for compulsive buying disorder: posttreatment and 6-month follow-up results. J Clin Pschiatry. 2008;69:1131–1138.
  5. Grant JE, Donahue CB, Odlaug BL, et al Imaginal desensitization plus motivational interviewing in the treatment of pathological gambling: a randomized controlled trial. Br J Psychiatry. 2009;195:266–267.

CORRESPONDENCE: Jon E. Grant, JD, MD, MPH, Department of Psychiatry, University of Minnesota School of Medicine, 2450 Riverside Avenue, Minneapolis, MN 55454 USA, E-MAIL: grant045@umn.edu