Virtual reality (VR) has showed potential in assisting those suffering from hoarding problem to practice decluttering in a safe and supportive environment. Hoarding disorder is a mental health disease defined by an abnormal accumulation of belongings, which frequently causes severe distress and impairs functioning.
Many people who aspire to have an orderly, clutter-free home like Marie Kondo struggle with deciding what to keep and what to let go. However, for those suffering from hoarding problem, which affects an estimated 2.5% of the US population, the inability to let go can be dangerous and debilitating.
A pilot study conducted by Stanford Medicine researchers reveals that allowing persons with hoarding behavior to practice abandoning items in a replica of their own house could help them declutter in real life. The simulations can assist patients practice organizing and decision-making skills taught in cognitive behavioral therapy, which is presently the conventional treatment, as well as desensitize them to the anguish they experience while discarding.
The study was published in the Journal of Psychiatric Research in October.
Some people are in desperate need, but we are unable to enter their homes. The clutter is piled so high that it’s dangerous for our team to enter. Yet, practicing letting go of items is such a useful skill that we wanted to create a virtual and safe environment.
Carolyn Rodriguez
A hidden problem
Hoarding disorder is an under-recognized and under-treated illness that has just recently been added as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5. People with the disease, who are typically older, have a persistent problem parting with goods, resulting in an accumulation of clutter that interferes with their relationships, job, and even their safety.
“Unfortunately, stigma and shame prevent people from seeking help for hoarding disorder,” said Carolyn Rodriguez, MD, PhD, senior author of the study and professor of psychiatry and behavioral sciences. “They may also be unwilling to have anyone else enter the home to help.”
Rodriguez explained that the problem is sometimes revealed due to cluttered backgrounds on Zoom calls or, tragically, when firefighters attend to a fire. Precarious heaps of goods not only keep people from resting in their beds or cooking in their kitchens, but they can also attract pests, obstruct fire escapes, and collapse on inhabitants, first responders, and physicians providing care.
Clinicians like Rodriguez conduct house visits on occasion to assist patients practice giving up goods, but certain homes are off limits.
“Some people are in desperate need, but we are unable to enter their homes. The clutter is piled so high that it’s dangerous for our team to enter,” Rodriguez explained. “Yet, practicing letting go of items is such a useful skill that we wanted to create a virtual and safe environment.”
Virtual stepping stone
Rodriguez’s team invited nine participants in the study, all of whom were over the age of 55 and had been diagnosed with hoarding disease, to take images and videos of the most cluttered room in their house, as well as 30 possessions. The photographs and films were converted into unique 3D virtual settings with the assistance of a VR business and Stanford University engineering students. Using VR headgear and portable controllers, the participants navigated their rooms and manipulated their belongings.
All participants took part in 16 weeks of online facilitated group therapy that provided peer support and hoarding-related cognitive behavioral skills. They also had individual VR sessions directed by a physician from weeks 7 to 14. During these one-hour sessions, individuals gained a greater understanding of their attachment to the artifacts and practiced placing them in recycling, donation, or trash bins, the latter of which was removed by a virtual garbage truck. They were then tasked with disposing of the actual object at home.
The reasons of hoarding disorder, like many other mental health diseases, are unknown, according to Rodriguez, but could include difficulties processing information, making decisions, maintaining attention, or controlling emotions. People suffering from the condition may be afraid of losing their security or identity if they give up their prized belongings.
Rodriguez described the virtual event as “a kind of stepping stone,” a less intense version of real-life discarding. “It’s nice to be able to titrate in a virtual space for people who experience considerable distress even attempting to part with possessions.”
Seven of the nine participants improved in self-reported hoarding symptoms, with an average decrease of 25%. Eight of nine participants also had less clutter in their homes based on visual assessment by clinicians, with an average decrease of 15%. These improvements are comparable to those from group therapy alone, so it’s still unclear whether VR therapy can add value, Rodriguez said. But importantly, this small initial trial demonstrated that VR therapy for hoarding disorder is feasible and well-tolerated, even in older patients.
“I actually thought it might not work because these were older patients and maybe they would not like the technology or they would be dizzy — but they thought it was fun,” she told me.
Although some participants found the VR experience implausible, the majority indicated it helped them part with goods in real life. The researchers anticipate that improved technology may improve the VR experience and, possibly, enable augmented reality, in which virtual objects are superimposed over the patient’s actual house.
“People tend to have a lot of biases against hoarding disorder and see it as a personal limitation instead of a neurobiological entity,” Rodriguez went on to say. “We just really want to get the word out that there’s hope and treatment for people who suffer from this. They don’t have to go it alone.”
