Rehearsing different outcomes related to discarding through a method called imagery rescripting has been identified as a promising treatment strategy for individuals struggling with hoarding, according to a study conducted by researchers at UNSW Sydney.
Rehearsing different outcomes of discarding through imagery rescripting has shown to be a promising treatment strategy for individuals with hoarding issues, according to a study by UNSW psychology researchers.
Hoarding disorder is a challenging condition that tends to become more severe with age. Individuals with this disorder develop strong emotional bonds with their belongings, create significant clutter, and face major difficulties when it comes to letting go of possessions, often avoiding treatment altogether.
Mr. Isaac Sabel from the Grisham Research Lab, which focuses on experimental clinical psychology at UNSW Sydney, explains that those who hoard frequently encounter intrusive and distressing mental images in their lives.
“Thoughts about negative outcomes, such as an item deteriorating in a landfill, feelings of regret, or disappointing loved ones, can trigger anxiety and hinder the discarding process. Current treatments based on the best evidence are not yielding the desired results,” says the psychologist and PhD candidate at UNSW.
“While about one in three individuals with hoarding tendencies may see an improvement in their symptoms, less than a third achieve significant clinical change. Moreover, many drop out of treatment or refuse it altogether.”
Imagery rescripting is a technique that is often used in cognitive behavioural therapy (CBT). It allows participants to introduce positive or neutral thoughts to ‘rescript’ negative images, especially those related to worst-case scenarios of discarding items.
“It’s commonly applied to alleviate distress from negative memories, but it’s also effective for other conditions that involve future-focused imagery, such as generalised anxiety and obsessive-compulsive disorder (OCD),” remarks Mr. Sabel.
This research, which involved 176 participants, aimed to see if rescripting an anxiety-inducing narrative around discarding would help those with pronounced hoarding traits. Participants took part in an online program focused on an item they struggled to throw away. They first wrote about their imagined outcome of discarding it and then participated in one of four treatment exercises.
The effectiveness of imagery rescripting was compared with cognitive restructuring (which helps individuals identify and dismiss irrational thoughts); imaginal exposure (which involves confronting anxiety-inducing images to lessen their power over time); and a control treatment that focused on generating positive imagery to uplift mood. Participants were then encouraged to discard the item.
The findings indicated that those who practiced imagery rescripting were more cheerful, motivated, and likely to discard their items. The technique was also more successful at easing feelings of anxiety, sadness, and anger while boosting feelings of happiness and relaxation associated with discarding than imaginal exposure and cognitive restructuring.
The study also revealed that a participant’s visualization skills influenced how effectively imagery rescripting worked. Rescripting participants completed the Vividness of Visual Imagery Questionnaire (VVIQ) to assess the vividness of specific details in imagined scenarios, such as a rising sun or a rainbow. Higher skills in creative visualization correlated with increased readiness and willingness to part with items.
These results were supported by a second upcoming therapist-led study that compares imagery rescripting with thought listing, which has been shown to help individuals with hoarding behaviors discard items effectively.
Preliminary results suggest that rescripting was superior to thought listing regarding motivation to discard and positive attitudes towards the discarding process. These findings are set to be further examined in a clinical trial.
The High Costs and Treatment Challenges of Hoarding
Hoarding disorder affects approximately 2.5 percent of the working-age population in Australia, equating to around 715,000 individuals. Those who hoard typically endure a significantly diminished quality of life, with the psychological distress and social repercussions comparable to living with schizophrenia.
This condition can result in dangerous and unsanitary living environments, social withdrawal, health complications, and an inability to maintain employment. Hoarding may also create risks for fires, housing issues, pests, falls, and various other hazards. Estimates suggest that restoring a hoarder’s home to a livable condition can exceed $87,000.
Clutter often makes everyday tasks—such as eating at a table or sleeping in a bed—difficult, notes Professor Jessica Grisham, who directs the Grisham Research Lab.
“In severe instances, homes become completely unclean due to either an inability to clean or because individuals hoard trash. The burden on families can be immense.”
Stigma associated with hoarding can discourage individuals and their families from seeking help. Frequently, hoarding issues are only addressed once they have escalated. Additionally, those who hoard struggle with regulating and processing negative emotions, which may lead to decreased participation in and increased dropout rates from exposure therapy, she explains.
“There’s significant pressure and often conflict about getting rid of belongings; clients may feel overwhelmed. They might have limited motivation or insight and experience considerable stress and reactivity,” she adds.
“In this initial study, imagery rescripting appears to mitigate that reactivity. Instead of using a direct approach that questions what prevents someone from discarding items and exploring those beliefs, this method fosters a more creative and emotional approach that could benefit individuals with hoarding issues.”
Evidence suggests that individuals who hoard might possess stronger creative inclinations. “Imagery has a powerful impact on emotions. It connects us with the feelings tied to memories and engages the neural processes responsible for these emotional experiences,” she remarks.
Imagery rescripting emphasizes rich sensory details to generate an emotionally engaging and immersive experience, which may be partly responsible for the positive results observed.
The study’s brief online format also holds promise as part of a treatment strategy in rural and remote regions where access to therapy is limited and could serve as an early intervention, she adds.
Why Do People Hoard?
Collecting excessive numbers of items—many of which have little to no value—can be tough to comprehend, according to Professor Grisham. “Yet many of us have attachments to specific belongings, perhaps due to their aesthetic appeal or the nostalgia they evoke. Hoarding involves similar emotional attachments but is characterized by an unhealthy reliance on possessions and difficulty parting with them.”
Though genetics may play a role, hoarding disorder is often the result of various psychological, neurobiological, and social factors. It has been connected to experiences of early trauma, life stressors, and emotional neglect.
“Those who hoard frequently report harsh parenting, challenges in forming relationships, and traumatic childhood experiences. They may come to believe that people are unreliable and that dependence on objects is safer and more comforting,” she explains.
Such experiences can lead individuals to feel that their identity is intertwined with their possessions; if they part with these items, they fear losing a part of themselves, she adds.
Hoarding disorder is also commonly associated with elevated rates of attention deficit and hyperactivity disorder. Struggles with organization, planning, and decision-making can complicate the ability to manage and discard belongings, according to Professor Grisham. “As a result, individuals may avoid these tasks, resulting in overwhelming clutter.”
Imagery rescripting is particularly intriguing because it tackles both the underlying traumas that shape future-focused narratives and the intrusive, distressing images that disrupt the discarding process in the present, she mentions.
“Images can connect our past, present, and future. By rescripting memories that may have contributed to hoarding—addressing those underlying needs—we may be able to improve treatment outcomes and positively impact clients’ lives.”
