A VR simulation of a patient's home can provide “a kind of stepping stone” toward discarding real-life possessions, according to Carolyn Rodriguez. (Image: Rodriguez Lab)

The simulations can help patients practice organizational and decision-making skills learned in cognitive behavioral therapy — currently the standard treatment — and desensitize them to the distress they feel when discarding.

The study was published in the October issue of the Journal of Psychiatric Research.

“Unfortunately, stigma and shame prevent people from seeking help for hoarding disorder,” said Senior Author Dr. Carolyn Rodriguez. “They may also be unwilling to have anyone else enter the home to help.”

In the study, Rodriguez’ team asked nine participants, over the age of 55 and with diagnosed hoarding disorder, to take photos and videos of the most cluttered room in their home along with 30 possessions. Seven of the nine participants improved in self-reported hoarding symptoms, with an average decrease of 25 percent. Eight of nine participants also had less clutter in their homes based on visual assessment by clinicians, with an average decrease of 15 percent. 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.

Here is an exclusive Tech Briefs interview — edited for length and clarity — with Rodriguez.

Tech Briefs: What was the catalyst for this VR therapy?

Rodriguez: Hoarding disorder is common and debilitating, especially in older adults, and novel treatment approaches are needed. Many current treatments emphasize skills related to discarding and decision-making about possessions, which can be practiced in the patient’s home. However, in many cases, in-home visits are unfeasible, or real-life discarding is too difficult.

In some cases, the clutter is stacked so high that it’s dangerous for our team to go inside; yet, practicing letting go of items is such a useful skill that we wanted to create a virtual and safe environment.

Tech Briefs: What were the biggest technical challenges you faced?

Rodriguez: The biggest challenge was how time consuming it was to generate individually customized environments with the individuals’ own objects (15 hours each). However, as we wrote in the paper — technology is rapidly evolving to allow for recreating one’s in vivo surroundings in VR in more automated ways.

For example, the recent addition of LiDAR scanning technology to some smartphones enables people to access user-friendly software to scan and create 3D representations of their surroundings. Or, future interventions may try using augmented reality to allow participants to navigate their home in vivo but with virtual objects overlaid.

Tech Briefs: Can you explain in simple terms how it works?

Rodriguez: We asked participants with diagnosed hoarding disorder to take 360-degree photos and videos of the most cluttered room in their home along with 30 possessions that would be imported into custom 3D virtual environments. They were asked to provide photos of objects of varying levels of difficulty discarding, from easier to part with (e.g., receipts) to more difficult (e.g., souvenirs).

The participants navigated around their rooms and manipulated their possessions using VR headsets and handheld controllers. All participants attended 16 weeks of online facilitated group therapy that provided peer support and cognitive behavioral skills related to hoarding. In weeks 7 to 14, they also received individual VR sessions guided by a clinician. In these one-hour sessions, they learned to better understand their attachment to the objects and practiced placing them in recycling, donation, or trash bins — the latter of which was taken away by a virtual garbage truck. They were then assigned the task of discarding the actual item at home.

Tech Briefs: Do you have any set plans for further developing this therapy?

Rodriguez: Next steps are to enhance digital visual elements and sounds and other sensory stimuli to combine computer generated content and real world. Virtual reality is a promising area to explore for mental health applications. Research trials are needed involving early testing with a focus on feasibility, acceptability, tolerability, and initial clinical efficacy. As a next step for this project, we will need to conduct a larger randomized trial to assess efficacy.

As technology advances, it would be wonderful to explore augmented reality approaches.

Tech Briefs: Was there a reason the nine participants were all over the age of 55? Plans for research with younger test subjects?

Rodriguez: Studies report hoarding disorder is linked with older age, as symptoms are three times more likely to occur in older adults than younger adults. Those who seek treatment are typically age 55 or older, and they report increased hoarding severity with each successive decade of their lives. Funding for the project came from the National Institutes of Aging (NIA). We would like to open this study to adults age 18 and older; indeed, the earlier we can identify hoarding behaviors that may lead to hoarding disorder and offer treatment when individuals meet the diagnostic criteria, the better for their quality of life.

Tech Briefs: Do you have any advice for engineers aiming to bring their ideas to fruition?

Rodriguez: There are many areas of high need in mental health, and interdisciplinary teams will be key to finding new breakthroughs. Reach out to build partnerships and don’t give up.

Tech Briefs: Anything else you’d like to add?

Rodriguez: I often get asked, if someone has hoarding disorder, what should they do?

For individuals with hoarding disorder: There is hope and help available. Get Information and professional help. The best evidence supports cognitive behavior therapy for hoarding disorder.

For friends and family:

  • Get Information and Professional Help
  • Express Empathy and Praise Progress (even if slow)
  • Avoid arguments, negative comments
  • Roll with Resistance
  • Take Care of Your Own Well-Being

Informational Websites with Information on Hoarding Disorder