A novel treatment strategy for hoarding disorder has demonstrated its potential in a pre-clinical study.
Rehearsing alternative outcomes of discarding through imagery rescripting shows promise as a treatment strategy for people who hoard, a study by UNSW psychology researchers has shown.
Hoarding disorder is a highly debilitating condition that worsens with age. People who hoard form intense emotional attachments to objects, accumulate excessive clutter, and have difficulty discarding possessions. Many avoid treatment.
People who hoard also experience more frequent, intrusive and distressing mental images in their daily lives, says Mr Isaac Sabel from the Grisham Research Lab, an experimental clinical psychology research group at UNSW Sydney.
"Negative memories and feared outcomes, such as an item rotting in landfill, catastrophic regret or the disappointment of a loved one, can induce anxiety and block the discarding process. Our best evidence-based treatments aren't getting the outcomes we'd like," says the psychologist and PhD candidate at UNSW.
"While one in three people who hoard may experience symptom improvement, less than a third of people experience clinically meaningful change. Additionally, there are high rates of dropout and treatment refusal."
Imagery rescripting is an experiential technique, often used in cognitive behavioural therapy (CBT), where participants introduce positive or benign information to 'rescript' the outcomes of negative mental imagery, in this instance worst-case scenarios of discarding.
"It's typically used to reduce distress associated with negative memories, however, it's had success with other disorders characterised by future-focused mental imagery, such as generalised anxiety and obsessive-compulsive disorder (OCD)," Mr Sabel says.
Images can link our past, present and future. Rescripting memories that may have triggered hoarding - going back and meeting those needs - may open up the doorway for greater treatment outcomes and greater positive impact on clients' lives.
This study in 176 people aimed to determine whether rescripting a negative future-focused narrative of discarding helped people with high hoarding traits discard. Participants took part in an online intervention using an item they'd had difficulty discarding. They wrote down their imagined outcome of throwing it away and then completed an exercise based on one of four treatments.
The response to imagery rescripting was compared with cognitive restructuring (learning to identify and disregard irrational, harmful thoughts); imaginal exposure (engaging with anxiety-provoking images/narratives to reduce their impact over time); and dwelling on positive mental imagery to improve their mood (as a control). Participants were then asked to discard their item.
The study found that participants who engaged in imagery rescripting were happier, more motivated and more likely to discard their items. Imagery rescripting was also more effective at reducing anxiety, sadness and anger and increasing feelings of happiness and relaxation around discarding, relative to imaginal exposure and cognitive restructuring.
A participant's ability to visualise impacted how well imagery rescripting worked, the study found. Rescripting participants completed the Vividness of Visual Imagery Questionnaire (VVIQ), self-rating the vividness of elements within prescribed scenarios, such as a rising sun or a rainbow. Higher creative visualisation abilities were associated with greater readiness and motivation to discard.
These results have been replicated in a second therapist-led study, yet to be published, that compares imagery rescripting with thought listing, a technique found to be effective in facilitating discarding in people with hoarding problems.
Preliminary findings show rescripting outperformed thought listing in key areas, with participants more motivated to discard and more positive about the discarding experience. These findings will now be tested in a clinical trial.
