A pilot study conducted by Stanford Medicine researchers suggests that virtual reality therapy could be a valuable tool in helping individuals with hoarding disorder overcome their challenges. The findings, published in the Journal of Psychiatric Research, provide initial evidence that virtual reality simulations are a feasible way to help individuals with hoarding disorder declutter their homes.
Hoarding disorder is a mental health condition that affects an estimated 2.5% of the U.S. population. It is characterized by persistent difficulties with discarding possessions, resulting in the accumulation of excessive clutter in living spaces. It goes beyond simply collecting or saving items and often leads to significant distress and impairment in daily functioning. Symptoms of hoarding disorder are more commonly reported among older adults, with individuals aged 55 and above seeking treatment more frequently.
Conventional treatments, such as cognitive behavioral therapy (CBT) and group workshops, have shown some success but are not universally effective. One major challenge is the difficulty of conducting in-home visits due to health risks and logistical constraints. To address this challenge, the researchers sought innovative ways to help hoarding disorder patients learn to discard their possessions.
“Existing treatments for hoarding disorder work somewhat well, but not for everyone, so we wanted to investigate a novel treatment for it,” said study author Hannah Raila, an assistant teaching professor at UC Santa Cruz and adjunct clinical faculty at Stanford University School of Medicine. “One possibility is adding virtual reality (VR) to treatment so that patients can practice virtual discarding of their possessions. The idea is to desensitize to the distress from discarding, which hopefully makes it easier to discard real life objects.”
The pilot study involved nine older adults diagnosed with hoarding disorder. Participants were selected based on specific criteria, including age over 55, a diagnosis of hoarding disorder, clinically significant hoarding symptoms, and clutter in at least one room of their homes. The study also excluded individuals with certain psychiatric and medical conditions.
To create a personalized virtual reality experience, participants were asked to take photos and videos of the most cluttered room in their homes, along with 30 possessions. These visuals were then transformed into custom 3D virtual environments with the help of a virtual reality company and Stanford University engineering students. Participants navigated these virtual environments using VR headsets and handheld controllers.
“We think of virtual discarding as a bridge between imaginal discarding (which we’ve also looked at), where the patient pictures discarding in their mind, and in vivo discarding, where they discard their actual objects,” Raila explained. “Imaginal discarding may not feel real enough for some people, and bringing it to life in the virtual environment may enable it to work more effectively.”
The study consisted of 16 weeks of online facilitated group therapy that incorporated cognitive behavioral skills and peer support for hoarding. Additionally, participants engaged in individual virtual reality sessions guided by a clinician from weeks 7 to 14.
The VR sessions involved several phases, including psychoeducation about the VR approach, familiarization with the virtual home, practicing cognitive skills related to decision-making about possessions, and desensitization to discarding virtual items. During virtual discarding exercises, participants placed virtual objects into bins for trash, recycling, or donation, without the option to keep items. They rated their subjective distress during these exercises on a scale of 0–10 and were assigned to actually discard one of the items they had virtually discarded as homework. The final session included a relapse prevention plan.
The study revealed promising results, with seven out of nine participants reporting improvements in self-reported hoarding symptoms, leading to an average decrease of 25%. Additionally, eight of the nine participants had less clutter in their homes based on visual assessments by clinicians, resulting in an average decrease of 15%. These improvements are comparable to those seen in group therapy alone, suggesting that VR therapy could offer additional benefits.
“VR is a potentially exciting new avenue for treatment for hoarding disorder. Here we established that it’s feasible to create and treat patients using an individualized VR environment that looks like their home with their possessions, and that patients tolerate it well and describe it as useful,” Raila told PsyPost.
“We saw some preliminarily promising symptom improvement. However, much more research is needed. This was just a small pilot trial where everyone got the intervention, so although we saw symptom improvement in people who got the VR intervention, we still don’t know if improvement would be better than existing treatments alone.”
The study also revealed that the VR therapy was well-tolerated by participants. It did not induce significant discomfort or sickness, and participants found the experience to be credible and associated with expected improvements in their condition. Most participants reported that the VR therapy helped them part with possessions in real life, although some found the VR experience unrealistic.
“It surprised us how well our patient sample, who was age 60-73, responded to the VR technology,” Raila said. “They generally did not feel sick, and they experienced the VR intervention as useful.”
While the initial findings are encouraging, it’s important to note that this pilot study had a small sample size and lacked a control group for comparison. Consequently, the results should be interpreted cautiously. Future research should involve larger, randomized controlled trials to determine whether VR therapy significantly enhances treatment outcomes beyond traditional approaches.
“The most important question to address is whether adding the VR improves outcomes significantly more than traditional treatment approaches alone,” Raila told PsyPost. “To determine that, we need to test VR as part of a larger randomized controlled trial.”
Additionally, technology limitations at the time of the study required extensive manual effort to create individualized VR environments for each participant. Future advancements in technology, such as LiDAR scanning and augmented reality, may streamline this process, making VR therapy more accessible and scalable.
“We programmed an individualized world for each patient participant, so that it would like their own home and they could manipulate their own possessions,” Raila explained. “However, programming each world took our student programmers 10-12 hours per world, so at this point it’s not really feasible to adopt this approach in community clinics. That said, this technology is rapidly developing, and it may soon be much more feasible to create individualized worlds in much less time.”
The study, “Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults“, was authored by Hannah Raila, Tatevik Avanesyan, Keara E. Valentine, Brenden Koo, Chloe Huang, Yuri Tsutsumi, Elisabeth Andreeff, Tori Qiu, Paula Andrea Muñoz Rodríguez, Andrea Varias, Maria Filippou-Frye, Peter van Roessel, Kim Bullock, Vyjeyanthi S. Periyakoil, and Carolyn I. Rodríguez.
