Healthcare (Commonwealth Union) – A new approach to treating hoarding disorder has shown potential in an early-stage study.
Using imagery rescripting to practice alternative scenarios for discarding possessions appears to be a promising method for treating individuals with hoarding tendencies, according to research conducted by UNSW psychology experts.
Researchers of the study indicated that hoarding disorder is a severely disabling condition that tends to worsen over time. Those affected often develop strong emotional bonds with their belongings, accumulate large amounts of clutter, and struggle to let go of items. Many also shy away from seeking treatment.
Additionally, people who hoard frequently experience distressing, intrusive mental images, as stated by Isaac Sabel from the Grisham Research Lab, an experimental psychology research group at UNSW Sydney.
Sabel, a psychologist and PhD candidate at UNSW indicated that negative memories and feared consequences—like imagining an object decaying in a landfill, feeling overwhelming regret, or fearing the disappointment of a loved one—can heighten anxiety and hinder the ability to discard.
Sabel further indicated that their current, evidence-based treatments are not achieving the desired results.
“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 a hands-on technique commonly used in cognitive behavioral therapy (CBT), where individuals modify negative mental images by introducing positive or neutral outcomes. In this context, the technique is applied to alter worst-case scenarios related to discarding possessions.
Isaac Sabel indicated that it is usually employed to alleviate distress linked to negative memories, but it has also been successful in treating other conditions marked by future-oriented mental imagery, such as generalized anxiety and obsessive-compulsive disorder (OCD).
This study, involving 176 participants, aimed to assess whether altering negative, future-focused thoughts about discarding could help individuals with strong hoarding tendencies let go of items. Participants took part in an online intervention using a possession they had difficulty parting with. They wrote down their imagined outcome of discarding the item, followed by completing an exercise based on one of four therapeutic approaches.
Imagery rescripting was compared to cognitive restructuring (where participants learn to recognize and dismiss irrational, harmful thoughts); imaginal exposure (where they engage with anxiety-triggering images or narratives to lessen their impact over time); and focusing on positive mental images to improve mood (used as a control). Afterward, participants were asked to discard their selected item.
The study revealed that participants who practiced imagery rescripting were more satisfied, motivated, and more likely to let go of their possessions. Imagery rescripting proved to be more effective in reducing feelings of anxiety, sadness, and anger, while also increasing happiness and relaxation around the discarding process, compared to imaginal exposure and cognitive restructuring.
The effectiveness of imagery rescripting was influenced by participants’ ability to visualize. Those in the rescripting group completed the Vividness of Visual Imagery Questionnaire (VVIQ), where they rated the clarity of specific visual elements like a rising sun or a rainbow. Stronger visualization skills were linked to greater motivation and willingness to discard.
These findings were carried out again in a second therapist-led study, still awaiting publication, which compared imagery rescripting with thought listing—a technique shown to help people with hoarding issues discard items.
Preliminary results show that rescripting outperformed thought listing in key areas, with participants feeling more motivated and positive about the discarding process. These findings will now be further evaluated in a clinical trial.
Professor Jessica Grisham who leads the Grisham Research Lab stated that clutter can make it hard to do things most of us take for granted, such as eating at the table or sleeping in bed.
The living conditions of individuals with hoarding could be severely impacted with positive outcomes from the research.
