A new study finds that incorporating virtual reality technology into hoarding disorder treatment, allowing people to deal with clutter virtually, can reduce symptoms and increase the number of real-life discards. This study shows that virtual reality technology can be effective in treating hoarding disorder.
Hoarding is a common, debilitating mental illness characterized by difficulty discarding or letting go of items due to a perceived need to keep them, regardless of their value. Hoarding is more common in people over 60 and can cause problems with relationships, social and work activities.
Little is known about the causes of hoarding disorder. Hoarding disorder was previously considered a subtype of obsessive-compulsive disorder (OCD) and was only recently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. It is also often underdiagnosed.
While the first line of treatment is cognitive behavioral therapy (CBT), a significant number of people continue to suffer from hoarding symptoms after receiving treatment. Now, a new study from Stanford University School of Medicine examines the effectiveness of integrating virtual reality (VR) into treatment for people with hoarding disorder.
"There are people who are in desperate need, but we can't get into their homes," said Carolyn Rodriguez, senior author of the study. "The clutter is piled high and it's dangerous for our team to get in. However, practicing putting things down is a very useful skill, so we wanted to create a virtual safe environment."
Nine participants aged 55 and older who had been diagnosed with hoarding disorder took photos and videos of the most cluttered room in their home and 30 items. These photos and videos are converted into custom navigable 3D virtual environments where participants can play with their belongings.
All participants participated in a 16-week online facilitated group therapy course that provided peer support and cognitive behavioral skills related to hoarding. From weeks 7 to 14, they also received individual clinician-led VR sessions in which they practiced putting their "stuff" into recycling bins, donation bins or trash bins - the latter being picked up by a virtual garbage truck.
Researchers say using VR technology allowed participants to better understand their attachment to hoarded items and demonstrate less threatening discarding behaviors in real life.
"It would be nice to be able to titrate in a virtual space for people who find it quite painful even when trying to throw away items," Rodriguez said.
Seven of the nine participants self-reported improvements in hoarding symptoms, with an average reduction of 25%. Visual inspection by clinicians showed that the clutter in eight of the people's homes had also been reduced, by an average of 15%. The researchers said that while the results were comparable to those who did not receive VR group therapy, this small preliminary trial shows that incorporating VR therapy is feasible even for older adults.
"Realistically, I think it might not work because these are older patients and maybe they don't like the technology or they get dizzy, but they think it's fun," Rodriguez said.
Most participants said VR helped them get rid of their belongings in real life, but some found the experience unrealistic. Researchers hope that newer technology will improve the VR experience and perhaps lead to the use of augmented reality (AR) technology, where virtual items are overlaid in patients' actual homes.
Regardless, the researchers say their study goes some way to removing the stigma associated with hoarding.
"People tend to have a lot of stereotypes about hoarding, thinking it's a personal limitation rather than a neurobiological entity," Rodriguez said. "We just want people to know that there is hope and it can be treated for people with hoarding. They don't have to go through this alone."
The study was published in the Journal of Psychiatric Research.