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Written Imaginal Exposure for Hoarding Disorder: A Preliminary Pilot Study.

Katie Fracalanza1, Hannah Raila, Tatevik Avanesyan1

  • 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.

The Journal of Nervous and Mental Disease
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Summary

Imaginal exposure (IE) therapy shows promise for hoarding disorder (HD) by helping patients confront discarding fears. However, this pilot study found IE was not significantly more effective than a control writing intervention for improving HD symptoms.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Behavioral Therapy

Background:

  • Hoarding disorder (HD) is characterized by persistent difficulty discarding possessions.
  • Treatment refusal or dropout is common in HD, often linked to the feared in-home decluttering component.
  • Novel strategies are needed to prepare patients for the challenges of discarding and decluttering.

Purpose of the Study:

  • To preliminarily test a short-duration imaginal exposure (IE) intervention for hoarding disorder.
  • To compare the efficacy of IE with a control writing (CW) intervention in reducing HD symptoms.
  • To explore potential mechanisms and methodological considerations for IE in HD treatment.

Main Methods:

  • A pilot study involving 32 adults diagnosed with hoarding disorder.
  • Random assignment to either an imaginal exposure (IE) condition or a control writing (CW) condition over 3 days.
  • Assessment of HD symptoms before and 1-week after the intervention.

Main Results:

  • Both the IE and CW conditions demonstrated significant improvements in hoarding disorder symptoms from preintervention to follow-up.
  • Effect sizes for symptom improvement in the IE group were medium to large.
  • No significant differences were found in symptom improvement between the IE and CW conditions when comparing change scores.

Conclusions:

  • Imaginal exposure (IE) appears to be a potentially helpful intervention for improving hoarding disorder symptoms.
  • This pilot study did not provide evidence that IE is superior to a control writing intervention.
  • Further research is warranted to investigate potential demand characteristics, placebo effects, and regression to the mean, and to refine IE study methodologies.