Decluttering the Mind: Imagery Rescripting Compared to a Verbal-Processing Strategy to Address Difficulty Discarding in Hoarding

Abstract

Mental images associated with possessions may maintain hoarding problems by impeding discarding. We tested whether generating a rescripted image, highlighting a positive outcome of discarding a hoarded object, would facilitate discarding relative to Thought Listing (TL) – a strategy commonly used in hoarding treatment that relies on verbal processing. Participants with hoarding symptoms (N = 103) were invited to a videocall with a psychologist. They selected an object they were having difficulty discarding, identified interfering images connected to this item, and were then randomised into a therapist-guided imagery rescripting (ImRs) or TL exercise before engaging in a discarding task. Whereas both exercises made discarding less aversive, ImRs outperformed TL at post-test by reducing some maladaptive savings beliefs, increasing positive affect, enhancing motivation, and increasing discarding frequency. No effect of condition was found on measures assessing the impact of the original interfering image over time, although participants high in imagery use tendency reported less vividness after rescripting. At 1-week follow-up, both exercises reduced hoarding symptoms, and discarding frequency became equivalent between conditions. Given the advantages that generating rescripted imagery demonstrated on some indices of discarding ease relative to an established approach, this technique may hold clinical utility for individuals with hoarding problems.