This technique proved to be more effective than many other popular treatments.
Hoarding disorder, a debilitating condition often linked to early childhood trauma and prolonged stress, affects about 2.5% of adults. Those with the disorder develop intense emotional attachments to objects, pets, or other possessions, making it difficult to discard these possessions, which can lead to hazardous living conditions, poor health outcomes, and severe social isolation. A new study by researchers from the University of New South Wales has offered a promising new approach, however, to treating the condition using a technique called imagery rescripting.
Imagery rescripting, traditionally used in cognitive behavioral therapy (CBT) for disorders like generalized anxiety and obsessive-compulsive disorder (OCD), allows individuals to “rescript” negative mental imagery by introducing positive or neutral alternatives. In the case of hoarding disorder, individuals often have extreme and unbearable thoughts about discarding items, imagining future regret, the disapproval of loved ones, or the item deteriorating in a landfill. These distressing thoughts hinder their ability to discard things. The study explored whether rescripting these negative future scenarios could help jumpstart the discarding process, alleviating emotional distress.
Researchers conducted an online intervention involving 176 participants with hoarding traits. Participants were asked to select an item they found difficult to get rid of and to imagine a worst-case outcome. They were then assigned to one of four treatment groups, including imagery rescripting, cognitive restructuring (challenging irrational thoughts), imaginal exposure (repeatedly confronting anxiety-provoking thoughts), and positive imagery (to improve mood). The results were especially promising for the imagery rescripting group. Participants who practiced this technique reported feeling happier, more motivated, and more relaxed overall about parting with their items compared to those in the other groups. Imagery rescripting also significantly reduced anxiety, sadness, and anger, all of which are commonly associated with hoarding.
A participant’s ability to visualize played a crucial role in the effectiveness of the intervention. Participants who scored higher on the Vividness of Visual Imagery Questionnaire (VVIQ) (a tool measuring how vividly one can imagine scenarios) were more likely to experience successful outcomes from the rescripting process. These findings suggest that creative visualization abilities could be a key factor in helping individuals with hoarding disorder overcome the emotional barriers to discarding possessions.
The success of imagery rescripting in this study has already been replicated in a second trial led by therapists, which further supports its potential as an effective treatment option for hoarding disorder. Preliminary results from this follow-up study indicate that imagery rescripting outperformed other techniques (different from the first study) like thought listing, enhancing both motivation and positive emotional responses to discarding.
Hoarding disorder can be especially challenging to treat, with high rates of treatment dropout and low rates of clinically meaningful improvement. Many individuals with hoarding disorder struggle with emotional regulation and are reluctant to engage in treatments that trigger anxiety. Imagery rescripting, with its creative and emotionally immersive nature, offers an alternative approach that may be easier to work with for those who struggle with hoarding. By focusing on rescripting distressing imagery rather than directly challenging beliefs (which can induce high levels of anxiety) this technique seems to reduce the emotional reactivity without causing further distress.
Given its online delivery format, imagery rescripting could also be a valuable option for reaching individuals in rural and remote areas who might not have easy access to in-person therapy. Its success in initial trials indicates that it could become an important component of early interventions for hoarding.
While research is ongoing, the potential of imagery rescripting to address both the underlying traumas, and the present-day challenges associated with hoarding disorder marks an exciting development in the treatment of this complex condition. By targeting the distressing mental imagery that drives hoarding behavior, imagery rescripting opens the door to more effective treatment outcomes even for those who have not found success using other interventions.
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Imagery rescripting offers new hope for treating hoarding disorder
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