An interventional study of Imaginal Exposure Writing and Neutral Writing in Hoarding Disorder, sponsored by Stanford University. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-05-29.
Sponsored by Stanford University · Not applicable, Interventional, and Basic science
The present study will test a potential new treatment strategy, imaginal exposure, for hoarding disorder. Although cognitive behavioral therapy often reduces hoarding, some people do not want to start, or cannot handle, that option. To help such individuals, the present study will provide imaginal exposure therapy to people with hoarding disorder, wherein they imagine discarding possessions as a way of becoming acclimated to the idea. We predict that imaginal exposure will improve hoarding symptoms as well as two psychological experiences linked to the condition: intolerance of uncertainty and emotional avoidance.
Hoarding disorder is a common mental illness characterized by difficulty parting with possessions and by clutter that makes living spaces unusable. Cognitive behavioral therapy (CBT) is an effective treatment for hoarding disorder, but new approaches are needed to engage those who are reluctant to start or cannot tolerate CBT. Both intolerance of uncertainty and emotional avoidance are linked to hoarding disorder and may interfere with treatment engagement. Imaginal exposure, a therapeutic technique which involves repeatedly imagining feared scenarios and experiencing the evoked emotions, effectively targets both intolerance of uncertainty and emotional avoidance. The present study is the first to test whether imagining discarding possessions can improve hoarding symptoms more than does a control exercise. We hypothesize that compared to a control exercise, imaginal exposure will improve hoarding symptoms, intolerance of uncertainty and emotional avoidance.
32 studies on the registry are indexed under Hoarding Disorder; 5 are open to participants now.
This study's enrollment of 32 is below the median of 37 across 28 interventional studies indexed under Hoarding Disorder.
Browse Hoarding Disorder studies →Stanford University is the lead sponsor of 2,168 studies on the registry; 431 are open to participants now.
Of its 267 completed or terminated interventional studies of FDA-regulated products, 207 (78%) have results posted.
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Exclusion Criteria:
People with hoarding disorder will write for 20 minutes on each of 3 consecutive days about their worst-case scenario regarding discarding a possession (i.e., imaginal exposure).
Behavioral: Imaginal Exposure Writing
People with hoarding disorder will write for 20 minutes on each of 3 consecutive days about what they would do if they had a day off work or school.
Other: Neutral Writing
Imaginal exposure is a psychotherapy strategy that has been studied and shown to be helpful in the improvement of symptoms (e.g., anxiety, worry) for other psychiatric conditions, including excessive worry and obsessive-compulsive disorder symptoms.
Used in prior research as a control condition for imaginal exposure. Neutral writing will involve writing about what one would do on a day off work or school.
Savings Inventory Revised (Frost, Steketee & Grisham, 2004; Tolin, Meunier, Frost & Steketee, 2011)
Gold-standard 23-item self-report measure of hoarding disorder symptoms. Scale scores range from 0 to 92, with higher scores indicating more severe hoarding symptoms. More severe hoarding symptoms are considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
Compulsive Acquisitions Scale (Frost et al. 2002)
Self-report 18-item measure of behaviors associated with hoarding disorder (i.e., acquiring).Scale scores range from 18 to 126, with higher scores indicating more severe hoarding behaviors. More severe hoarding behaviors are considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
Intolerance of Uncertainty Scale (Buhr & Dugas, 2002)
Self-report 27-item measure of a cognitive process related to hoarding called intolerance of uncertainty. Scale scores range from 27 to 135 (some items are reverse scored), with higher scores indicating more severe intolerance of uncertainty. More severe intolerance of uncertainty is considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
Acceptance and Action Questionnaire - II (Hayes, Luoma, Bond, Masuda and Lillis, 2006)
Self-report 7-item measure of a cognitive process related to hoarding called experiential avoidance. Scale scores range from 7 to 49, with higher scores indicating more severe experiential avoidance. More severe hoarding behaviors are considered a worse outcome.
Time frame: Baseline (Pre Writing) and Follow Up (week 1)
| Milestone | Imaginal Exposure Writing | Neutral Writing |
|---|---|---|
| Started | 17 | 15 |
| Completed | 17 | 15 |
| Not completed | 0 | 0 |
Gold-standard 23-item self-report measure of hoarding disorder symptoms. Scale scores range from 0 to 92, with higher scores indicating more severe hoarding symptoms. More severe hoarding symptoms are considered a worse outcome.
| score on a scale | Imaginal Exposure Writing | Neutral Writing |
|---|---|---|
| Pre Writing | 62.41 ± 13.22 | 62.60 ± 11.97 |
| Follow Up | 53.41 ± 16.87 | 52.00 ± 14.05 |
Self-report 18-item measure of behaviors associated with hoarding disorder (i.e., acquiring).Scale scores range from 18 to 126, with higher scores indicating more severe hoarding behaviors. More severe hoarding behaviors are considered a worse outcome.
| score on a scale | Imaginal Exposure Writing | Neutral Writing |
|---|---|---|
| Pre Writing | 62.88 ± 29.59 | 57.93 ± 27.68 |
| Follow Up | 56.76 ± 30.47 | 47.47 ± 23.52 |
Self-report 27-item measure of a cognitive process related to hoarding called intolerance of uncertainty. Scale scores range from 27 to 135 (some items are reverse scored), with higher scores indicating more severe intolerance of uncertainty. More severe intolerance of uncertainty is considered a worse outcome.
| score on a scale | Imaginal Exposure Writing | Neutral Writing |
|---|---|---|
| Pre Writing | 68.47 ± 31.63 | 72.27 ± 28.86 |
| Follow Up | 65.06 ± 33.27 | 65.47 ± 30.21 |
Self-report 7-item measure of a cognitive process related to hoarding called experiential avoidance. Scale scores range from 7 to 49, with higher scores indicating more severe experiential avoidance. More severe hoarding behaviors are considered a worse outcome.
| score on a scale | Imaginal Exposure Writing | Neutral Writing |
|---|---|---|
| Pre Writing | 24.94 ± 12.40 | 28.33 ± 10.93 |
| Follow Up | 22.06 ± 12.47 | 22.13 ± 11.87 |
Collected over Adverse events were followed for 1 week for each participant.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Imaginal Exposure Writing | 0/17 (0%) | 0/17 (0%) | 0/17 (0%) |
| Neutral Writing | 0/15 (0%) | 0/15 (0%) | 0/15 (0%) |
| Age, Continuous(years) | Imaginal Exposure Writing | Neutral Writing | Total |
|---|---|---|---|
| Mean | 56.94 ± 10.74 | 48.33 ± 15.71 | 52.91 ± 13.79 |
| Sex: Female, Male(Participants) | Imaginal Exposure Writing | Neutral Writing | Total |
|---|---|---|---|
| Female | 14 | 14 | 28 |
| Male | 3 | 1 | 4 |
| Race/Ethnicity, Customized(Participants) | Imaginal Exposure Writing | Neutral Writing | Total |
|---|---|---|---|
| White | 8 | 10 | 18 |
| Black | 0 | 0 | 0 |
| East Asian | 4 | 4 | 8 |
| Southeast Asian | 0 | 0 | 0 |
| Latin American | 3 | 0 | 3 |
| Mixed Race | 2 | 0 | 2 |
| Other ethnicity | 0 | 1 | 1 |
| Employment Status(Participants) | Imaginal Exposure Writing | Neutral Writing | Total |
|---|---|---|---|
| Not working (including student) | 5 | 2 | 7 |
| Employed (full or part-time) | 9 | 9 | 18 |
| Retired | 3 | 4 | 7 |
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