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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.

Keywords

hoarding disorder imagery imagery rescripting thought listing cognitive behavioural therapy

Introduction

Hoarding disorder (HD) is a psychological disorder characterised by a strong attachment to objects, leading to difficulty discarding and the accumulation of clutter that compromises living areas (American Psychiatric Association, 2022). It afflicts up to 2.5% of the population (Postlethwaite et al., 2019). When left untreated, hoarding has a chronic course and becomes more burdensome over time (Cath et al., 2017). Individuals with HD often live in homes that become unusable because of clutter and susceptible to health and sanitation concerns, including pestilence, falls risk, and fire hazard (Dozier & Porter, 2020). They also report psychosocial difficulties, including high levels of unemployment, conflict with cohabitating family members and neighbours, and high rates of mental and physical health comorbidities (Spittlehouse et al., 2016). Overall, hoarding is estimated to contribute to a worsened quality of life greater than other leading causes of disability worldwide, including diabetes, heart-disease and substance use disorders (Nutley et al., 2022).

The treatment with the highest evidence base for HD is cognitive behavioural therapy (CBT; Rodgers et al., 2021), which targets factors considered to maintain hoarding specified in Frost and Hartl’s (1996) model. Although this therapy results in symptom improvement with large effect sizes that sustain at follow-up, only a third of individuals show clinically significant change (David et al., 2022). This may be because CBT fails to address some prominent clinical features of the disorder that remain unspecified in dominant hoarding models. Further, many clients refuse CBT or drop out prematurely due to motivational concerns or because the (rightful) emphasis on discarding in this therapy is experienced as too aversive (David et al., 2022). As such, there is scope to improve HD treatment by targeting unexamined clinical features of the disorder and addressing motivational and emotional blocks to discarding.

Mental Imagery in Hoarding

Emerging evidence suggests targeting mental imagery may be a promising avenue for refining HD treatment (Stewart et al., 2020). Mental images are internally generated sensory-perceptual experiences occurring without afferent input (‘seeing with the mind’s eye’; Kosslyn et al., 2001, p. 635). They can take the form of memories, dreams or mental forecasts of future events, and can be voluntarily evoked (e.g. fantasizing about a holiday) or involuntarily triggered (e.g. post-traumatic flashbacks). While imagery is an important part of mental life for most people, including healthy individuals, growing evidence suggests abnormalities in mental imagery processes play a transdiagnostic role in psychopathology (Brewin et al., 2010), including hoarding.

Research in clinical HD samples has revealed individuals who hoard experience more frequent, intrusive and aversive mental images in daily life compared to community controls, and these images cause life-interference and promote avoidance behaviour (Stewart et al., 2020). They also report saving possessions to preserve mental images, such as important memories linked to items, and worry about losing access to these images by discarding (Hartl et al., 2004; Steketee et al., 2003). Moreover, individuals with HD experience intrusive images, such as resurfacing memories and images featuring feared discarding outcomes, when attempting to part with possessions that disrupt this process (Stewart et al., 2020). As such, images appear to be important psychological phenomena in HD maintaining the disorder, especially by contributing to problematic saving behaviour and difficulty discarding.

Imagery Rescripting

One strategy to address problematic images in HD suggested by previous researchers is imagery rescripting (ImRs; Sabel et al., 2025; Stewart et al., 2020). ImRs is an emotion-focused therapeutic technique where problematic images are reshaped or replaced by positive ones to reduce negative impacts of the original trace (Kip et al., 2023). The most common version follows Arntz’s (2012) protocol, which involves modifying schemas associated with traumatic memories by envisioning a different outcome to the memory or the satisfaction of an unmet emotional need, usually via the imagined intervention of an attachment figure. Other prominent ImRs variants include the Holmes et al. (2019) method (also termed ‘Imagery Modification’), where a mental image associated with distress or a maladaptive implicit meaning is first evoked, and then the individual is guided to imagine an alternative, competing image that carries a more adaptive meaning. Newer protocols where prospective images are rescripted instead of aversive memories are also emerging, often emphasising positive re-imagined future outcomes or adaptive coping with feared events (Cooper et al., 2023; Stavropoulos et al., 2025).

ImRs demonstrates strong effects reducing symptoms of psychopathology in various meta-analyses (Kip et al., 2023; Kroener et al., 2023; Morina et al., 2017), including disorders sharing transdiagnostic processes with hoarding, such as anxiety and other obsessive compulsive related disorders (Strachan et al., 2020). While most empirical research focuses on the rescripting of aversive memories (Kip et al., 2023; Morina et al., 2017), rescripting prospective images also appears to result in promising shifts, such as reductions in anxiety, improved coping, and greater receptivity to exposure (Kroener et al., 2023). Although often studied as a component of larger treatment packages (ten Napel-Schutz et al., 2011), ImRs can exist as a standalone intervention, with single sessions demonstrating remarkable effectiveness (Kroener et al., 2023). Although the mechanism is still contested, and may differ across rescripting protocols, theoretical models propose ImRs either updates the meaning of the pre-existing problematic image (Arntz, 2012), or creates a better elaborated, alternative image that outcompetes the original during retrieval (Brewin, 2006).

Recently, Sabel and colleagues (2024) found a novel, future-oriented, written ImRs technique showed promise addressing difficulties discarding in an online analogue HD sample. In their paradigm, participants were guided to imagine a feared outcome of discarding a hoarded object and then rescripted this into an image highlighting an alternative, positive discarding outcome. Results revealed promising effects, favouring rescripting, with regard to motivating discarding, making it less aversive, and promoting discarding frequency, relative to other cognitive behavioural strategies (i.e. imaginal exposure, cognitive restructuring, positive imagery). Moreover, individuals with higher baseline imagining ability appeared to derive more benefit, reporting greater discarding motivation and readiness after rescripting. The authors conclude ImRs may hold promise as a clinical technique to facilitate discarding and be a useful addition/adjunct to hoarding treatment.

However, before ImRs is promoted clinically, the technique requires replication and extension. Sabel and colleagues (2024) utilised an online, self-guided, written ImRs task. It is yet to be determined whether these promising effects translate to face-to-face settings with a therapist guiding rescripting, which may have greater emotional impacts than written, self-guided variations. The authors also rescripted deliberately generated imagery of a feared discarding outcome. Individuals with HD experience other types of images that interfere with discarding, including positive memories linked to their items (Stewart et al., 2020), so it is uncertain whether pre-existing idiopathic images inhibiting discarding (regardless of their temporal orientation or valence) can be successfully rescripted.

Although Sabel and colleagues (2024) used multiple measures to assess for effectiveness, the authors failed to examine change in certain cognitive and experiential factors possibly responsible for ImRs’ promising effects. ImRs can induce belief change, as well as alter the properties (i.e. vividness) of the original trace (Kroener et al., 2023). The authors also did not include a follow-up, nor verify discarding had taken place beyond participants’ self-report. These are important oversights to address given hoarding’s chronicity and the tendency of individuals with HD to ‘churn’ items (i.e. merely moving objects around when discarding, without getting rid of them; Muroff et al., 2014).

Summary

The current study was designed to address these gaps. Drawing on elements from established rescripting methods (Arntz, 2012; Holmes et al., 2019), and newer protocols suggesting ImRs can be future-oriented (Kroener et al., 2023), we piloted a single-session rescripting task, focused on helping participants with hoarding tendencies rehearse positive outcomes of discarding a difficult item through imagery to compete with any pre-existing idiopathic images inhibiting discarding (Stewart et al., 2020). We had psychologists guiding rescripting in a setting intended to resemble therapeutic conditions, and compared ImRs to an active Thought Listing (TL) control exercise – a verbal/linguistic ‘distancing strategy’ commonly used in hoarding treatment to facilitate the discarding of difficult items that has outperformed cognitive restructuring in previous experimental trials (Frost et al., 2016). Change was assessed on a triad of emotional, cognitive and behavioural discarding-related primary outcome variables (e.g. motivation and emotions associated with discarding, savings beliefs, discarding ease and frequency). We also assessed for shifts on several secondary imagery-related indices, such as the effect of ImRS on the vividness, urge to suppress, and valence of participants’ imagery inhibiting discarding, the content/themes within these images, and whether imagining ability moderated intervention effectiveness.

In line with research suggesting imagery is an ‘emotional and motivational amplifier’ compared to verbal processing (Holmes & Mathews, 2010), we expected to see greater reductions in discarding-related distress, maladaptive savings beliefs, and aversive imagery-characteristics in ImRs compared to TL, and greater increases in discarding motivation, readiness and frequency. However, as individuals who experience imagery more frequently and vividly appear to benefit more from rescripting (Liu et al., 2025; Sabel et al., 2024), we hypothesised these effects may be more marked among participants with a greater baseline tendency to use imagery in daily life.

Method

Participants

Participants with elevated hoarding tendencies were recruited from the university and surrounding community through the home institution’s undergraduate (SONA-1) and paid (SONA-P) research participation systems (https://www.sona-systems.com/). The SONA-1 participant pool consists of enrolled psychology undergraduate students who participate in research opportunities for course credit, whereas the SONA-P participant pools is comprised of individuals from the university and surrounding community who agree to participate in exchange for monetary renumeration. The use of non-clinical analogue samples in HD research is appropriate as hoarding tendencies are dimensional in severity and frequency within the population (Timpano et al., 2013), and sufficiently prevalent in student and community groups (Kajitani et al., 2019; Samuels et al., 2008).

Previous research has indicated ImRS produces medium-to-large effects on discarding-related outcomes relative to other cognitive-behavioural strategies (Sabel et al., 2024). A power analysis using G*Power, Version 3 (Faul et al., 2007) was performed using this input, and revealed to detect an effect of this size with 80% power and significance set at 0.05 for a repeated measures MANOVA with a between-within subjects’ interaction, 90 participants were required. However, to account for attrition, we planned to collect data from 100 participants.

We used a cut-off score of 33 on the Savings Inventory Revised (Frost et al., 2004) to screen individuals into the study with clinically significant hoarding or subclinical/probable HD (Kellman-McFarlane et al., 2019; Spittlehouse et al., 2016). Additional inclusion criteria involved having sufficient proficiency in English, and access to video-conferencing technology. From the 1633 people who completed the screening, 152 met inclusion criteria and were invited to participate. One hundred and eight participants accepted this invitation and completed the study. Participants were subsequently excluded if they were given an extremely low effort rating on a clinician administered scale (n = 2), failed to adhere to task instructions (n = 1), or were suspected of impersonation (i.e. attempting to participate twice under different aliases; n = 2). The remaining sample included 103 participants (SONA-1: n = 43, SONA-P: n = 60). Importantly, there was an equal distribution of SONA-1 and SONA-P participants in each condition (p > .05). See Figure 1.

Figure 1.

Flow of the protocol from initial screening through to randomisation and analysis

Participants ranged from 17 to 43, with a mean age of 22.32 (SD = 4.69). Fifty-two participants identified as male, 50 as female, and one as non-binary. Participants identified their ethnicity as East Asian (n = 33), South Asian (n = 18), Caucasian (n = 11), South-East Asian (n = 7), African (n = 7), Middle Eastern (n = 5), South American (n = 3), Pacific Islander (n = (2) and Aboriginal or Torres Strait Islander (n = 2), or mixed race (n = 15). Most participants were studying (n = 66) and/or working (n = 56) in a full or part-time capacity and had completed some tertiary education or higher (n = 61). Fifty-eight participants lived in suburban areas, 41 in urban areas, and four in rural settings.

Materials and Measures

Primary Discarding Related Outcome Measures

We included the Saving Inventory Revised (SI-R; Frost et al., 2004), a widely used 23-item self-report questionnaire assessing the major features of hoarding (i.e. clutter, difficulty discarding, and excessive acquisition), to screen participants into the study and measure their difficulty discarding at 1-week follow up. The SI-R has good psychometric properties (Kellman-McFarlane et al., 2019), including the ability to reliably distinguish hoarding cases from other clinical and community groups (Frost et al., 2004). The SI-r had sound internal consistency in the present study at baseline for the total score (α = .89), and difficulty discarding subscale (α = .69).

We used the Savings Cognition Inventory (SCI; Steketee et al., 2003), a 24-item self-report questionnaire assessing maladaptive beliefs about possessions (i.e. emotional attachment, control, excessive responsibility, and memory concerns), to assess for change in participant’s cognitions about their object(s) over time. The SCI subscales have demonstrated strong reliability (Steketee et al., 2003), and had acceptable-to-excellent internal consistency at baseline for the control (α = .58), memory (α = .70), responsibility (α = .82), and emotional attachment (α = .95) subscales.

We also included the Object Attachment Questionnaire (OAQ; Grisham et al., 2009), a 13-item self-report questionnaire that assesses the strength of attachment towards a specific object, as another pre-to-post cognitive measure. The OAQ has excellent reliability and validity (Grisham et al., 2009) and had high internal consistency at baseline in the present study (α = .93).

We used the Discrete Emotions Questionnaire (DEQ; Harmon-Jones et al., 2016), a 32-item instrument sensitive to eight distinct state emotions (i.e. anger, disgust, fear, anxiety, sadness, happiness, relaxation, and yearning/desire), to assess for change in participant’s emotional experiences about discarding over time. The eight emotion factors have high reliability (Harmon-Jones et al., 2016), and fell within the excellent range at baseline for anger (α = .90), disgust (α = .91), fear (α = .92), anxiety (α = .88), sadness (α = .88), happiness (α = .83), relaxation (α = .87), and yearning/desire (α = .81).

Single item ratings of participants’ motivation and readiness to discard, made on a 7-point Likert scale (not at all ready/motivated to extremely ready/motivated), were used as additional pre-to-post dependent measures. We opted for these brief ratings over other motivational measures to reduce duration and minimise participant burden.

A single item behavioural index of participants’ decision to save or discard a hoarded object was used as a final dependent measure. Participants were asked to indicate whether they (a) discarded their object (placed it in the trash or a donation bin etc.), (b) made steps towards discarding (discarded part of their item etc.), (c) decided to discard later (made a plan to discard etc.), or (4) opted against discarding. This index was constructed by Sabel and colleagues (2024) by applying the stages of change model (Prochaska & Velicer, 1997) to a hoarding-specific discarding scenario (i.e. precontemplation: no discarding, contemplation: decided to discard later, preparation: taking steps towards discarding, and action: discarding). Participants who discarded were asked to provide photo-verification of this.

Secondary Imagery Related Outcome Measures

We used the Adapted Imagery Interview for Discarding Scenarios, developed by Stewart and colleagues (2020), to assess whether any images came to mind when participants considered discarding their object(s). Participants provided a one sentence description of any image identified and were asked to comment on the connection they perceived (if any) between this imagery and their hoarding problem/difficulty discarding. Participants who identified an image provided ratings of the vividness, valence, and their urge to suppress the image on single-item 0-100 visual analogue scales, used as additional pre-to-post dependent measures.

We also included the Spontaneous Use of Imagery Scale (SUIS; Reisberg et al., 2003), a 12-item self-report measure assessing the tendency to experience visual imagery in daily life as a potential moderator. Previous research has indicated acceptable reliability and convergent validity of the SUIS with other imagery measures (Nelis et al., 2014). In the current study, internal consistency was high (α = . 80).

Exercises

Participants were randomised to either a ImRs or a TL exercise, guided by one of two doctoral level psychologists (i.e. IS or LS). As per standard rescripting protocols, the exercises lasted for 15–20 min.

In the rescripting condition, participants were guided to imagine an alternative image to compete with their idiopathic imagery and/or thoughts and feelings inhibiting discarding. This rescripted image was required to feature a positive, future outcome of discarding their item(s) that meant something positive to them. Participants were lead from the beginning of the image as they prepared to discard, to the end of the scene where they discarded their item(s) and this resulted a positive outcome. To maximise experiential processing, participants were instructed speak aloud in the first-person present tense, to focus on their sensory-perceptual experiences (what they could see, hear, touch etc.), to report on their thoughts and emotional reactions, and to dwell on any positive meanings the new image represented about themselves, others or the world. Any content to make the outcome of discarding most desirable for participants was permitted in the imagery, for example, by including attachment figures or spiritual/fantasy elements. Our method of rescripting is therefore best categorized as a hybrid approach, recombining elements from more established rescripting procedures (i.e. the creation of a competing image with an ‘antidote meaning’ as in Holmes et al. (2019), including attachment figures and/or fantasy elements, as in Arntz (2012)), with newer variations of the technique that are future oriented, emphasising mastery over feared events and adaptive coping (e.g. Landkroon et al., 2022; Stavropoulos et al., 2025). See Table 1.

Table 1.

An example item, image, and rescript for a sample of three participants

Item	Original image linked to hoarded object	Summary of rescripted image
An old hoodie	No image, but a sense of needing the hoodie in the future and not having it, thereby losing a source of comfort and security.	The exercise began with the participant visualizing himself before his wardrobe, experiencing frustration from the lack of order. He then reassured himself that parting with some of his clothing would reflect a positive shift towards minimalism, and he acknowledged that he had too many clothes, including items that he rarely wore. He envisioned placing several garments, including his old hoodie, into a bag and delivering them to a local charity for donation. He then visualized other people purchasing and wearing his clothes, giving them a ‘new life’. Finally, he pictured returning to his room, observing the orderly space around his wardrobe, which now contained only a few essential items. This image gave him a sense of greater control over his relationship with his possessions.
A box of birthday cards with messages inside	An image of her close friends being hurt and disappointed in her if she discarded the birthday cards.	The rescript began with the participant envisioning herself in her room on a sunny day, feeling happy and relaxed. She then visualized leaving her room to dispose of birthday cards in the recycling bin, reassuring herself that any pain experienced from discarding would be temporary and subside within a few hours. After discarding, she envisioned returning to her room and observed the space created by their removal. This gave her a sense of satisfaction, and she felt as if a ‘weight had been lifted’. She then imagined enjoying a pleasant lunch with her family, followed by a trip to a nearby beach with friends. Contrary to her concern that they might be upset about the discarded birthday cards, she was pleasantly surprised to learn they were indifferent to the matter and happy for her as they were aware she usually struggled with discarding.
An old dress	The dress evoked memories of her late grandmother	The rescript involved the participant imagining selecting an old dress from her wardrobe and then walking to her friend’s house nearby. Upon arrival, she imagined being greeted warmly by her friend’s mother, who hugged her, and invited her inside. She then imagined entering her friend’s room and gifting them the dress. Her friend expressed delight at this gift and began ‘jumping with joy’ as the dress fit them perfectly. This new imagery fostered a sense of generosity and happiness in the participant, and she observed that the memory of her grandmother had become less vivid.

In the TL condition, participants were instructed to speak aloud their thoughts and feelings about whether to discard their item(s) for 5-min. The researcher spent the remaining time reflecting back participants’ thoughts and emotions and prompted them to elaborate on reasons verbalized in favour of discarding. If participants found it difficult to speak continuously for 5 min, gentle prompts or words of encouragement were used (i.e. ‘Keep going if you can’, ‘Can you tell me more about that thought?’). This procedure was taken from Muroff and colleagues’ (2014) CBT manual for HD, although the exercise was lengthened to match the rescripting condition.

Procedure and Design

Study procedures were approved by the university’s human research ethics committee (HREC File no. HC220235). Following ethics approval, participants were screened for hoarding from the university and surrounding community via the institution’s research participation systems. The study was advertised as an investigation determining whether imagery could help people make decisions about possessions. For SONA-1 participants, the SI-R was included within a battery of pre-screening measures completed by all enrolled psychology undergraduates, as per course requirements; and the study listing was only visible to participants who scored above our clinical threshold value. For SONA-P participants, the SI-R was included as a hyperlink within the study advertisement, and interested individuals scoring above this value were provided with an invitation code to participate.

Eligible participants were then invited to an hour-long Microsoft Teams call with a psychologist and were asked to bring in an item (or a cluster of related items e.g. a three-book trilogy) they were having difficulty discarding. To ensure participants chose items representative of conventionally hoarded objects used in discarding exposures, participants were instructed to bring in items they felt they should be able to part with, that were inexpensive/low in monetary value, and that other people would have little trouble discarding. These parameters have been used in previous research (e.g. Yap & Grisham, 2020), and several example objects were provided to guide item selection (e.g. old books, clothes, paper items; see Table 1).

The study used a mixed between and within-subjects design. After consenting to the study, participants completed the demographics items, baseline study measures, and the imagery interview – where their idiopathic images inhibiting discarding were elicited. For cases where participants did not report an image (n = 6), the clinician-experimenter explored what thoughts and feelings inhibited discarding for that participant and used this idiopathic mental representation as the basis for rescripting; consistent with contemporary approaches suggesting that a pre-existing image is not necessarily a prerequisite for rescripting (e.g. Landkroon et al., 2022; Stavropoulos et al., 2025). Participants were then randomised into either a 15–20-minute therapist-guided ImRs or TL task. After the exercises, participants recompleted the measures and underwent a 5-minute discarding exposure, where they were instructed to attempt to discard their item(s), and rate whether they were able to on the discarding decision-making index. Participants who discarded were prompted to upload a photograph verifying this. To minimize the impact of demand characteristics, all participants were reassured that they would be granted renumeration irrespective of whether they discarded their item(s). Moreover, the video-call ended just prior to the discarding exposure to limit the impact of perceived pressure/coercion from the experimenter. All participants were then debriefed via a written statement and granted course credit renumeration or a $15 e-gift voucher.

One week later, participants were emailed a follow-up survey, which was completed by the majority of participants (n = 87/103, 84.47%). In this survey, all participants re-completed the SI-R difficulty-discarding subscale and rated whether they had discarded their item(s) since the videocall. Participants who indicated that they still had not discarded (n = 41) were then re-presented with the study measures to determine if there was any shift in how they felt about their object(s). Those who had discarded did not recomplete the full battery of measures to prevent priming attachment to the already-discarded item(s), thereby inadvertently encouraging them to seek out that item. To incentivise follow-up survey completion, participants were granted additional course credit or a $5 e-gift voucher.

Data Analytic Strategy

Inferential statistics were run in SPSS v.29 (IBM Corp, 2022). Changes in continuous outcomes were assessed through 2 (Condition: ImRs, TL) by 2 (Time: pre-test to post-test) mixed-model MANOVAS and ANOVAS, whereas shifts on categorical outcomes (e.g. the frequency of participant’s discarding outcomes) were examined via Chi-square and McNemar tests. The moderating effects of baseline imagery use tendency was assessed using a series of regression analyses using the PROCESS Macro Extension V4.3 for SPSS (Hayes, 2022), model 1, on participant’s time-2 data, controlling for their time-1 ratings, with condition as the predictor and the SUIS as the theoretically proposed moderator. Qualitative coding of the themes within participant images was conducted by two authors (i.e. IS and BG) using content analysis (Forman & Damschroder, 2007). This was achieved through an iterative process, where the two authors first familiarised themselves with the data, searched for themes and generated initial codes. They then corresponded several times to resolve discrepancies in coding, before applying the final codes to the dataset to generate a tallied shortlist.

Preliminary assumption testing was performed prior to analyses. To ensure randomisation, Chi-square and independent-samples t-tests were used to compare the different measures at baseline between the two conditions, and no significant differences were found for any measures or demographic items (all ps >. 05). Examination of Boxplot and Mahalanobis distance calculations revealed one non-extreme univariate and one multivariate outlier, which were retained as outcomes did not change when re-run with outliers excluded. While a matrix of scatterplots revealed the assumption of linearity was satisfied, Shapiro Wilk normality tests revealed some dependent variables were non-normal (e.g. participant ratings of their readiness and motivation to discard, all imagery ratings, p > 0.05). However, this test is sensitive to departures from normality when sample size exceeds 50 (N = 103; Le Boedec, 2016), and inspection of quantile-quantile plots did not indicate significant deviations. Box’s MTest of Equality of Covariance Matrices was significant for some multivariate analyses, violating homogeneity of variance-covariance assumptions, so Pillar’s trace was used as the omnibus test-statistic. Available case analysis was used for tests affected by missing data from follow-up survey attrition, as Little’s MCAR test was not significant, χ² (1, 103) = 0.098, p = .75, and a comparison of participants who did and did not complete the follow-up survey on the demographics items and hoarding baseline measures did not significantly differ; suggesting missingness completely at random (all ps >. 05; Okpara et al., 2022). Partial eta-squared (η_p²) and Crammer’s V effect sizes were interpreted in accordance with guidelines by Cohen (1988), and the risk of type-1 error was controlled for through a familywise Bonferroni correction strategy. Adjusted p-values are reported where these corrections have been applied.

Results

Descriptive Statistics

Descriptive statistics between conditions over time are presented in Table 2. Notably, across conditions, participants had mean scores on the SI-R of 47.43 (11.75), which is above the general cut-off of 39 and the more stringent cut-off of 43 amongst younger adults to detect clinically significant hoarding (Kellman-McFarlane et al., 2019). This indicates the screening process successfully enlisted individuals with elevated hoarding tendencies.

Table 2.

Mean and standard deviation scores for the study outcomes between conditions

Measure	ImRs (n = 50)	TL (n = 53)
SUIS	41.16 (8.05)	40.64 (7.72)
SI-R total score	47.18 (12.19)	47.66 (11.44)
SI-R difficulty discarding
T1	15.51 (3.92)	16.54 (3.49)
T3	11.85 (3.89)	14.37 (3.87)
SCI – M
T1	20.88 (6.53)	19.98 (6.05)
T2	16.42 (6.93)	19.98 (6.21)
SCI - C
T1	14.08 (3.54)	14.08 (3.52)
T2	11.54 (4.57)	13.05 (3.92)
SCI-R
T1	26.24 (9.01)	25.77 (7.75)
T2	21.26 (10.25)	23.91 (8.71)
SCI-EA
T1	38.86 (17.19)	40.36 (15.03)
T2	31.56 (17.49)	39.43 (16.60)
OAQ
T1	59.22 (16.82)	58.62 (16.91)
T2	50.16 (18.30)	56.60 (17.36)
DEQ - anger
T1	8.38 (5.32)	8.28 (5.61)
T2	6.84 (4.79)	7.30 (5.52)
DEQ – disgust
T1	9.28 (6.69)	9.21 (6.35)
T2	8.10 (5.51)	8.51 (6.18)
DEQ – fear
T1	7.72 (5.35)	9.11 (5.66)
T2	6.54 (4.60)	7.45 (5.61)
DEQ – Anxiety
T1	19.90 (9.23)	21.40 (10.14)
T2	14.56 (8.92)	17.77 (10.67)
DEQ – sadness
T1	15.26 (6.61)	16.87 (7.01)
T2	10.70 (5.78)	14.34 (8.02)
DEQ – Desire/Yearning
T1	13.60 (5.68)	14.34 (5.87)
T2	9.92 (5.18)	11.25 (5.99)
DEQ – Happiness
T1	8.16 (4.36)	8.34 (4.57)
T2	13.46 (5.54)	9.09 (5.69)
DEQ – Relaxation
T1	9.39 (4.97)	9.54 (5.14)
T2	13.74 (5.17)	9.60 (5.71)
Motivation to discard
T1	1.36 (1.30)	1.32 (1.22)
T2	2.68 (1.39)	1.83 (1.54)
Readiness to discard
T1	1.30 (1.32)	1.00 (0.96)
T2	2.48 (1.)	1.64 (1.65)
Imagery vividness
T1	67.26 (23.82)	67.28 (24.34)
T2	61.16 (21.35)	66.43 (26.81)
Imagery valence – Positivity
T1	65.16 (28.39)	67.87 (27.95)
T2	64.68 (23.89)	68.34 (26.90)
Imagery valence – Negativity
T1	32.36 (30.64)	31.75 (28.12)
T2	29.02 (24.46)	25.66 (24.15)
Urge to suppress image
T1	41.06 (29.42)	41.13 (30.88)
T2	42.04 (27.69)	38.94 (32.27)

Note. SUIS = Spontaneous Use of Imagery Scale, SI-R = Savings Inventory Revised, SCI – M = Savings Cognition Inventory Memory Subscale, SCI-C = Savings Cognition Inventory Control Subscale, SCI – EA = Savings Cognition Inventory Emotional Attachment Subscale, SCI-R = Savings Cognitions Inventory Responsibility Subscale, OAQ = Object Attachment Questionnaire, DEQ – Discrete Emotions Questionnaire, T1 = Pre-test, T2 = Post-test, T3 = Follow-up.

Primary Discarding Related Outcomes

Negative and Positive Emotions About Discarding

Participants’ negative emotions about discarding (i.e. anger, disgust, anxiety, fear, sadness, and desire/yearning ratings) significantly reduced from pre-to post-exercise, F (1, 101) = 67.51, p<. 001, η_p² = .40, but contrary to predictions these reductions were comparable across conditions, F (1, 101) = 1.79, p = . 18, η_p² = .02. Contrastingly, participants’ positive emotions about discarding (i.e. happiness and relaxation ratings), increased from pre-to post-exercise as hypothesised, F (1, 101) = 31.17, p < .001, η_p² = .24, and significantly more so for participants in rescripting, F (1, 101) = 22.27, p < .001, η_p² = .18. When we examined the positive emotion indices separately, findings confirmed participants in ImRs reported greater increases from pre-to post-exercise in feelings of both happiness, F (1, 101) = 19.14, p adjusted <.001, η_p² = .16, and relaxation about discarding, F (1, 101) = 20.03, p adjusted<. 001, η_p² = .17, than those in TL.

Motivation and Readiness to Discard

As hypothesised, participants’ discarding motivation and readiness significantly increased from pre-to post-exercise, F (1, 101) = 67.74, p < .001, η_p² = .40, and these increases appeared more marked for participants who underwent rescripting, F (1, 101) = 4.38, p = .04, η_p² = .08. However, when we examined participant ratings of their readiness and motivation to discard separately, findings revealed that while participants in ImRs reported greater increases in their motivation to discard than those in TL, F (1, 101) = 10.04, p adjusted<.01, η_p² = .09, both conditions equivalently increased their discarding readiness from pre-to post-exercise, F (1, 101) = 4.97, p adjusted = .06, η_p² = .05.

Saving Cognitions

Consistent with predictions, participants’ maladaptive savings cognitions decreased from pre-to post-exercise, F (1,101) = 20.89, p < .001, η_p² = .17, and these reductions appeared to be more marked for participants in rescripting, F (1,101) = 10.49, p < .01, η_p² = .09. When we examined the subscales of the SCI and the OAQ separately, findings confirmed that participants in ImRs reported greater reductions than those in TL in their object attachment on the SCI-EA, F (1,101) = 7.33, p adjusted = .04, η_p² = .07, and on the OAQ, F (1,101) = 8.71, p adjusted = .02, η_p² = .08, as well as greater reductions in memory-concerns, F (1,101) = 11.44, p adjusted <.01, η_p² = .10, from pre-to post-exercise. However, both conditions equivalently reduced participants’ need for control, F (1,101) = 4.20, p adjusted = .20, η_p² = .04, and sense of responsibility over their item(s), F (1,101) = 6.59, p adjusted = .06, η_p² = .06, from pre- to post-exercise.

Discarding Frequency

As predicted, participants’ discarding outcomes at post-test differed significantly between conditions, χ² (3, 103) = 8.46, p = .04, Crammer’s V = .29, with participants in TL being significantly more likely to choose to ‘not discard’ their item(s) compared to participants in rescripting (p adjusted = .01). However, the frequency distributions of participants’ discarding outcomes changed between post-test and 1-week follow-up, χ² (6, 87) = 26.38, p < .001, Crammer’s V = .48. By 1-week follow up, participants’ discarding outcomes no longer significantly differed between conditions, χ² (3, 87) = 7.01, p = .07, Crammer’s V = .28.

Exploratory analyses were used to understand whether these changes were due to any delayed effects of the exercises overtime. Pairwise comparisons identified there was a significant proportion of participants in rescripting who had ‘planned to discard later’ at post-test who then followed through and ‘discarded’ at 1-week follow-up (p adjusted = .05; see Table 3), whereas all other comparisons were non-significant (all ps > 0.05).

Table 3.

Frequency of discarding decisions over time by condition

Group	Discarding decision
Group	Did not discard	Planned to discard later	Took steps towards discarding	Discarded
Post-test (T2)
ImRs (N = 50)	6 (5.83%)	18 (17.48%)	7 (6.80%)	19 (18.45%)
TL (N = 53)	17 (16.50%)	13 (12.62%)	11 (10.68%)	12 (11.65%)
Follow up (T3)
ImRs (N = 41)	9 (10.34%)	2 (2.30%)	6 (6.9%)	24 (27.59%)
TL (N = 46)	13 (14.94%)	9 (10.34%)	2 (2.30%)	22 (25.29%)

Note. ImRs = Imagery Rescripting, TL = Thought Listing.

Discarding Ease

Participants’ self-reported difficulty discarding reduced from pre-test to 1-week follow-up with a large effect size, F (1,85) = 31.72, p adjusted<.001, η_p² = .27, but there was no significant difference between conditions, F (1,85) = 2.07, p adjusted = .16, η_p² = .02, suggesting both exercises equally reduced participants’ symptoms of discarding difficulty overtime.

Subgroup Analysis: Non-discarding Participants

To understand whether participants who had not discarded their item at follow-up (n = 41; 17 x ImRs, 24 x TL) nevertheless experienced any continuing positive cognitive, emotional, or motivational shifts from the exercises, we examined changes between post-test and 1 week follow-up on this subgroup of participants. We found non-discarding participants’ beliefs about needing to exert control over their item(s) significantly reduced from post-test to follow-up, F (1, 39) = 15.37, p adjusted<.001, η_p² = .23, and these reductions were more marked for those who underwent rescripting, F (1, 39) = 7.40, p adjusted = .05, ηp² = .16. We also found non-discarding participants’ attachment to their item(s) on the OAQ significantly reduced from post-test to follow-up, F (1, 39) = 7.61, p adjusted = .05, η_p² = .16, but these reductions were equivalent between conditions, F (1, 39) = 1.07, p adjusted = 1.00, η_p² = .03. All other comparisons were non-significant (all other DVs ps > .05).

Secondary Imagery Outcomes

Imagery Content and Characteristics

As hypothesised, the majority of participants (i.e. 94.17%, n = 97/103) reported an image came to mind when considering parting with their hoarded object(s). All these participants perceived at least some connection between this imagery and their difficulty discarding/hoarding problem. These images tended to take the form of positive memories featuring attachment figures (n = 26), positive memories of using the item(s) in the past (n = 9), positive memories of acquiring (n = 8), positive memories of different times/places (n = 8), mixed-valence memories featuring important life experiences/transitions (n = 5), negative prospective images of discarding outcomes (n = 13), positive prospective images of using the item(s) in the future (n = 10), or neutral images of interacting with the item(s) (n = 5). The remaining participants reported emotions or verbal thoughts were the main deterrents for discarding (n = 6) or provided descriptions that were unable to be properly coded (n = 17, e.g., describing image properties rather than their content; see Table 4).

Table 4.

Examples images linked to participants’ hoarded object(s)

Theme	Temporal orientation	Valence	n	Example image
Attachment	Past	Positive	26	‘I remember...my grandfather…. Every time I hold it, I feel his smell, his voice and how he looked every day when we spoke’
Using the object(s) in the past	Past	Positive	9	‘[A memory of] being upset and the toy relaxing me as I would rub the material against my fingers
Acquiring the object(s)	Past	Positive	8	‘[A memory of] buying it at the zoo with all my family, I have never got a toy from the zoo before, so this was special’
Different times and places	Past	Positive	8	‘[A memory of] sitting at a park bench and eating chocolates, sunny day, birds are chirping’
Important life experiences or transitions	Past	Mixed	5	‘The objects are a great reminder of how my life took a big turn immediately [after] I joined high school and how my experience was all through’
Feared outcomes of discarding	Future	Negative	13	‘It will end up in landfill…I am hurting the planet and shouldn’t have gotten it in the first place’
Needing the item(s) again in the future	Future	Positive	10	‘[I’m] imagining possible future scenarios of wanting to lend it to a friend or to read it again’
Interacting with the item(s)	N/A	Neutral	5	‘Third-person perspective, looking at myself in bed lying down, while I’m on my phone...’
No image	N/A	Mixed	6	‘None; I have poor vivid imagery; however, I do have emotions with the object’
Unable to be coded	N/A	N/A	17	‘The mental [image] is very clear’

Imagery Ratings

Contrary to predictions, there were no significant changes from pre- to post-exercise, nor any differential effects of condition on participant ratings of the vividness (Time: F (1,101) = 2.64, p adjusted = .43, η_p² = .03, Interaction: F (1, 101) = 1.541, p adjusted = .89, η_p² = .02), positivity (Time: F (1, 101) = .00, p adjusted = 1.00, η_p² = . 00, Interaction: F (1, 101) = .03, p adjusted = 1.00, η_p² = .00), negativity (Time: F (1, 101) = 3.17, p adjusted = .32, η_p² = . 03, Interaction: F (1, 101) = .0.27, p adjusted = 1.00, η_p² = .00), or urge to suppress (Time: F (1, 101) = .05, p adjusted = 1.00, η_p² = .00; interaction F (1, 101) = .32, p adjusted = 1.00, η_p² = .00) their original image interfering with discarding.

Imagery Use Tendency as a Moderator

We found participant’s baseline imagery use tendency moderated the effect of rescripting on their vividness ratings of their original interfering image only (B = −1.53, SE = .49, p adjusted <.01, all other DVs ps > .05). Simple slopes analysis revealed the effect of rescripting on participants’ imagery vividness ratings was non-significant one SD below the mean (B = 6.76. P = 0.21), non-significant at the mean (B = −5.23, p = 0.16), but significant one SD above the mean (B = −17.24, p < .01). As shown in Figure 2, as imagery use tendency increased, an effect of ImRs on reducing participants’ vividness ratings of their original image became apparent. The opposite trend emerged for participants in TL, with those higher in imagery use tendency reporting greater vividness of the original image linked to their hoarded object(s) after the exercise.

Figure 2.

Imagery use tendency as a moderator between ImRS and the vividness of participants’ imagery impeding discarding

Discussion

This study investigated whether a single session of therapist-guided rescripting, focused on helping individuals with elevated hoarding tendencies rehearse positive outcomes of parting with a challenging object through imagery, facilitated the ease and frequency of discarding compared to TL – a widely used technique in HD treatment that relies on verbal-processing (Frost et al., 2016). While both conditions made discarding less aversive and equally reduced hoarding symptoms at follow up, we found some promising differential effects of rescripting on our primary emotional, cognitive, and behavioural discarding-related outcomes, such as increasing positive affect and motivation to discard, reducing some savings beliefs, and increasing discarding frequency at post-test. Contrary to predictions, neither exercise had any effect on our secondary imagery-related outcomes, although participants higher in imagery use tendency reported less vividness of their original image after rescripting. Differences in discarding frequency, apparent at post-test, also became equivalent between conditions by 1-week post-exercise. These results have interesting implications for the utility of imagery-based interventions in hoarding, as well as suggesting avenues for future research.

Emotions and Motivation

The finding that ImRs was equivalent or superior to TL on our affective and motivational discarding-related outcomes is broadly consistent with research demonstrating imagery acts as an ‘emotional and motivational amplifier’ relative to strategies relying on verbal processing (Holmes & Mathews, 2010). Pending replication and extension in a clinically diagnosed sample, ImRs may be a therefore be a valuable tool to employ in HD treatment (perhaps prior to in-vivo discarding exposures) as an alternative to verbal-persuasive methods for individuals who are reluctant to part with items due to anxiety or other affective blocks, or for those who are struggling with the motivation to initiate decluttering.

The affective and motivational benefits observed in ImRs may be due to ability of imagery to generate rewarding ‘pre-experiences’. Research on episodic future imagining, such as envisioning consuming sugar or nicotine, suggests imagery can elicit rewarding sensory-perceptual experiences and positive affective states, such as relief, pleasant tastes, and relaxation, while also highlighting the current absence of these rewards, motivating approach seeking behaviour (May et al., 2015). Perhaps by instructing participants to simulate a positive outcome of discarding via rescripting we allowed them to ‘pre-experience’ benefits discarding might result in (reduced clutter volume, stress relief, improved relationships etc.), thereby inducing positive affect and increasing motivation to partake in this often-avoided activity.

Savings Beliefs

We also found ImRs was equivalent or superior to TL at inducing belief change, particularly for cognitions pertaining to object attachment and memory concerns. Furthermore, even amongst those who chose not to discard, ImRs appeared to make these participants less controlling over their item(s) by follow-up, relative to those who underwent TL. One potential explanation for this differential effect on cognitive change may depend on the techniques’ contrasting mechanisms of action. TL is considered to facilitate the process of distancing or ‘defusing’ from automatic thoughts in order to reduce distress associated with believing or ‘fusing’ with them (Frost et al., 2016), whereas ImRs is thought to alter cognition at a deeper level of underlying core beliefs and maladaptive schemata (Arntz, 2012). Perhaps some saving beliefs we observed differential effects on are particularly amenable to techniques like rescripting that facilitate shifts at a deeper level of semantic memory and schematic beliefs. Pending replication in a clinically diagnosed sample, ImRs may therefore be a particularly useful strategy to facilitate discarding of more difficult ‘cherished’ items that have a stronger personal meaning and value as part of moving up a discarding exposure hierarchy during treatment.

Discarding Outcomes

Consistent with hypotheses, we found ImRs made participants more likely to discard their item(s) at post-exercise. Although this difference disappeared at follow up, nevertheless, the effects of rescripting were not short-lived as exploratory analyses allowed us to isolate that there was a significant proportion of contemplative participants in ImRs at post-test who followed through with discarding by follow-up. As difficulty discarding is the cardinal symptom of HD, and leads to some of the most negative consequences in terms of health, safety, and quality of life outcomes (American Psychiatric Association, 2022), these findings were promising; especially as we were able to confirm self-reported discarding took place through photo-verification methods. These results suggest ImRs may be a useful tool to encourage adaptive behavioural change, alongside inciting positive emotional and cognitive shifts.

We also found both exercises reduced trait difficulty discarding from baseline to 1-week follow-up with a large effect size. Given the chronicity of hoarding, this was a surprising finding as we did not expect to observe symptom change following brief (i.e. 15–20 minute) therapeutic exercises. Although we caution against drawing strong conclusions from this result as we cannot rule out non-specific effects, and did not perform clinical benchmarking, this may suggest practicing strategies to facilitate discarding on difficult possessions under guidance of a psychologist generalise to the ability to discard other items. Moreover, it suggests ImRs may warrant further investigation as a clinical strategy for addressing difficulty discarding in HD as it appears at least as effective as an established TL method in producing symptom change over time.

The positive effects of ImRs on participants’ discarding outcomes may be explained by the ability for imagery to simulate action rehearsal. Research suggests merely visualizing performing specific behaviours can increase follow-through and subsequent performance outcomes in a range of domains, from voting behaviour to surgical skills (Arora et al., 2011; Libby et al., 2007). Alternatively, perhaps, through rescripting we capitalized on the benefits imagining confers on planning and decision-making processes. Generating imagery of episodic future events allows individuals to ‘try out’ different behaviours ahead of time (Zaleskiewicz et al., 2023), and influences the perceived likelihood of imagined outcomes (Sobkow et al., 2016). Perhaps, through rescripting we prompted participants to consider more reasons in favour of discarding, and made these benefits appear more plausible – assisting them in the discarding decision-making process. Pending clinical replication, rescripting may therefore be particularly helpful during HD treatment when the patient is experiencing decisional difficulties during decluttering efforts.

Imagery Outcomes

In keeping with previous research (Stewart et al., 2020), a high proportion of our sample experienced interfering imagery when contemplating discarding their item(s). These images tended to take the form of positive memories, although prospective images (e.g. of feared discarding outcomes) were also reported. This finding further affirms images are important mental events in hoarding that play a role in problematic saving behaviour and difficulty discarding; perhaps via positive (e.g. dwelling on positive images associated with objects), and/or negative reinforcement contingencies (e.g. avoiding distress associated with ‘losing’ a memory by saving).

However, neither condition had any effects on the vivacity, urge to suppress or emotional valence of this interfering image over time, despite ImRs being predicted to target these mechanisms. One explanation is that the version of ImRS used in our study, which aligns with variants of rescripting that leave the original trace unaltered (e.g. Holmes et al., 2019), may change the impact of the idiopathic image on an implicational level (i.e. meaning) only while leaving its visual properties largely intact. Future research may therefore seek to compare different ImRs protocols that alter the outcome or narrative of idiopathic imagery directly (Arntz, 2012), with variants that work on generating ‘competing’ imagery (Holmes et al., 2019) on imagery related outcomes. Alternatively, perhaps a larger sample size was required to detect subtler, differential shifts on these imagery-related indices; although we note that previous meta-analyses suggest rescripting tends to produce large reductions in aversive imagery characteristics, such as vividness and image-related distress (Kroener et al., 2023).

Nevertheless, individuals who used imagery more habitually in daily life did report less vividness of their original image inhibiting discarding after rescripting; suggesting that an effect on imagery related outcomes may still occur following ImRs for this subgroup of participants. Interestingly, the opposite trend emerged for participants in TL, with those reporting greater baseline imagery use tendency describing greater vividness of their original interfering image after the exercise. This suggests that greater access or awareness of intrusive images may be one iatrogenic effect of standard TL procedures, as currently used in HD treatment (Muroff et al., 2014), although further research is required to confirm this finding. As we did not find a moderating effect of our ‘trait’ mental imagery measure on any primary outcomes, unlike Sabel et al. (2024), future research may also seek to compare the moderating effects of various mental imagery measures on the potency of ImRs. For example, comparing instruments such as the VVIQ (as used in Sabel et al., 2024) that require individuals to generate different imaginal stimuli and report on their vividness, with self-report measures like the SUIS that assess the frequency of mental imagery use.

Limitations

Several limitations are noteworthy. Firstly, we used a non-clinical analogue sample. While all participants had scores on a hoarding symptom measure above a threshold value indicating clinically significant or subclinical/probable HD (Spittlehouse et al., 2016), formally diagnosing HD requires a structured clinical interview, so it is uncertain how many participants met criteria. Although the SI-R is the industry standard measure and can reliably differentiate hoarding from other clinical and community groups (Frost et al., 2004), relying on a symptom measure in the absence of certifying a formal HD diagnosis means that we are unable to rule out that individuals with hoarding-like behaviours resulting from other psychopathology (e.g. eating disorders, dementia, psychosis; Novara et al., 2016) were not inadvertently recruited. Results should therefore be interpreted with some degree of caution and future research should seek to replicate our methodology in a clinically diagnosed sample, applying more rigorous inclusion and exclusion criteria.

Secondly, our sample consisted mostly of young adults from the university and surrounding community. This limits generalizability, especially as individuals with HD tend to present for treatment later in life compared to other clinical groups (Cath et al., 2017). However, as hoarding tendencies are dimensional in the population (Timpano et al., 2013), sufficiently prevalent in student and community groups (Kajitani et al., 2019; Samuels et al., 2008), and young adulthood is the time of symptom emergence (Cath et al., 2017), early detection and intervention could markedly reduce hoarding’s lifetime toll. Nevertheless, future research should test our protocol in a sample of participants with a greater age range, especially as imagining ability worsens across the lifespan (Gulyás et al., 2022).

Thirdly, future research may seek to compare ImRs to an alternative matched comparison condition. TL was selected as our active control given its widespread use in HD treatment (Muroff et al., 2014) and strong performance in previous experimental trials in facilitating discarding; having previously outperformed cognitive restructuring (Frost et al., 2016). However, this technique differs from ImRs in multiple ways (modality, hypothesised mechanism of action etc.). Future studies may therefore seek to compare ImRs to other controls to delineate the mechanisms driving change. For instance, comparing ImRs against an imagery ‘defusion’ technique (e.g. Wang et al., 2022) or a general positive imagery condition (Schubert et al., 2020) to ascertain whether it is the mere utilisation of imagery, or how imagery is used to facilitate meaning or schema change, that is the more critical factor. Future research may also seek to compare ImRs against waitlist, placebo or alternative, ‘passive’ controls, such as supportive counselling, to account for non-specific effects (expectancy, regression to the mean, the therapeutic relationship etc.) and estimate the magnitude of ImRs’ effects compared to no intervention.

Although we found some promising differential effects of rescripting, another limitation is that the intervention was single-session, and our follow up period was short (i.e. 1-week post-intervention). Given hoarding’s chronicity, future research should examine the use of repeated rescripting sessions, using alternative research designs. Furthermore, although we attempted to certify discarding took place by using photo-verification, it is possible that participants may have later retrieved their object(s), which is a limitation of conducting the study via videoconferencing. Although this allowed us to assess individuals in their naturalistic home environment and ensured easy access to an item(s) for the discarding exposure, future research may seek to assess participants in the laboratory where greater certainty can be exercised over behavioural outcomes or find other more reliable methods to ensure discarding has taken place. Finally, although all hypotheses were theoretically derived, we did not pre-register our study or analytic plan. To support replicability, future studies should seek to address these issues prior to data collection.

Concluding Remarks

This study aimed to replicate and extend a novel application of ImRs for hoarding (Sabel et al., 2024). We achieved this by comparing a therapist guided rescripting exercise to TL – an established verbal-linguistic technique widely used in hoarding treatment – on the ease and frequency of discarding in a hoarding sample. Results revealed ImRs was equivalent or superior to TL on a range of discarding-related emotional, cognitive and behavioural primary outcomes at post-test, and at 1-week follow-up. Pending future research in a clinically diagnosed sample, these findings provide further support for the important role of mental imagery in hoarding (Stewart et al., 2020) and suggest rescripting, with its ability to engender adaptive emotional, cognitive, and behavioural change, may be a promising avenue to facilitate discarding in hoarding treatment.

Footnotes

ORCID iDs

Isaac Sabel

Bidhu Ghosh

Ethical Considerations

All study procedures were reviewed and approved by the University of New South Wales Human Research Ethics Committee (HREC File no. HC220235, approval date 20/03/2023), which applies human research ethics principles in accordance with the Declaration of Helsinki.

Consent to Participate

Written Informed consent was obtained from all participations prior to data collection.

Consent for Publication

Participants were informed before providing consent that study findings would be submitted to a journal for publication.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the by an Australian Government Research Training Program Scholarship (RTP) awarded to Isaac Sabel by the University of New South Wales (UNSW). This project will contribute towards a doctoral degree award for the first author.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data is available upon request from the authors.*

Author Biographies

Isaac Sabel is a Psychologist and PhD Candidate in the School of Psychology at the University of New South Wales, Sydney Australia. His research focuses on the role of mental imagery in hoarding disorder

Dr Lauren Stavropoulos is a Clinical Psychologist and Clinical Research Officer. Her research focuses on the role of mental imagery in generalized anxiety disorder.

Bidhu Ghosh is a Provisional Psychologist and PhD Candidate at the University of New South Wales , Sydney Australia. His research focuses on the role of mental imagery in hoarding disorder.

Yanik Weerasekera is a psychology honours graduate and research assistant in the School of Psychology at the University of New South Wales, Sydney Australia.

Professor Jessica Grisham is a professor and academic clinical psychologist in the School of Psychology at the University of New South Wales, Sydney Australia. She and her students conduct research on the phenomenology and treatment of obsessive-compulsive disorder (OCD) and OC spectrum disorders, such as hoarding disorder. She is an international authority on hoarding disorder and has extensive clinical experience assessing and treating OCD and hoarding clients.

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

Abstract

Keywords

Introduction

Mental Imagery in Hoarding

Imagery Rescripting

Summary

Method

Participants

Materials and Measures

Primary Discarding Related Outcome Measures

Secondary Imagery Related Outcome Measures

Exercises

Procedure and Design

Data Analytic Strategy

Results

Descriptive Statistics

Primary Discarding Related Outcomes

Negative and Positive Emotions About Discarding

Motivation and Readiness to Discard

Saving Cognitions

Discarding Frequency

Discarding Ease

Subgroup Analysis: Non-discarding Participants

Secondary Imagery Outcomes

Imagery Content and Characteristics

Imagery Ratings

Imagery Use Tendency as a Moderator

Discussion

Emotions and Motivation

Savings Beliefs

Discarding Outcomes

Imagery Outcomes

Limitations

Concluding Remarks

Footnotes

ORCID iDs

Ethical Considerations

Consent to Participate

Consent for Publication

Funding

Declaration of Conflicting Interests

Data Availability Statement

Author Biographies

References