Non-Immersive Virtual Environments for the Treatment of Hoarding Disorder

Not Applicable

Completed

• Conditions: Hoarding Disorder; Virtual Reality Based Therapy; General Population (no Specific Condition or Disease)

• Registration Number: NCT07160543
• Lead Sponsor: University of Padova

Brief Summary

This experimental trial investigates whether Virtual Reality Exposure (VRe) helps individuals reduce the difficulty of discarding personal possessions. It will also evaluate the psychological state impacts of the intervention. The main questions it aims to answer are:

Does exposure-based intervention (VRe) reduce emotional distress and improve willingness to discard personal items? What psychological reactions (such as anxiety or emotional responses) do participants experience during and after these interventions?

Detailed Description

Researchers will compare the effects of VRe to Imagination exposure (Ie) to determine which method is more effective in reducing discarding-related difficulties. The trial is specifically designed for individuals from the general population who do not meet the criteria for hoarding disorder but experience significant emotional discomfort when trying to part with certain belongings. This subclinical presentation of hoarding-like behavior is common and often unaddressed despite its impact on well-being and living space management.

Participants completed online assessments and screening procedures to determine eligibility. They then participated in a one-time, in-lab exposure session using VRe or Ie techniques. Based on a standardized rating scale, each participant brought a personal object they had previously identified as difficult to discard but not overly emotionally charged. During the session, they engaged in either an immersive visualization of discarding the item (Ie) or a guided interaction with a virtual simulation of discarding the item (VRe). Participants were evaluated on psychological (e.g., state anxiety, positive and negative affect) and behavioral outcomes (e.g., actual discarding behavior) before and after the exposure. At the end of the session, participants reported whether they intended to discard the physical object in real life.

This study follows a single-session randomized controlled trial (RCT) design with partial blinding of outcome assessors. While participants were aware of the intervention type they received due to the nature of the exposure task, the researchers responsible for scoring and analyzing outcome data were blinded to group allocation to minimize bias and expectancy effects. This design enhances the rigor and objectivity of outcome comparisons between groups.

This preliminary RCT adopts an exploratory approach due to the limited empirical research on using non-immersive VR for discarding behaviors, particularly in non-clinical populations. Prior findings suggest that VR-based interventions can simulate real-world behavior and reduce emotional reactivity in anxiety-related contexts. However, existing studies have primarily focused on immersive VR applications and clinical populations, such as individuals with specific phobias or PTSD. The current study aims to fill this gap by assessing the potential of non-immersive, more accessible VR platforms in promoting behavioral change related to possession management.

The specific objectives of the study are:

To investigate whether exposure to a non-immersive VR environment can help individuals discard personally relevant objects more effectively than imagination-based exposure; To assess within- and between-group differences in emotional and behavioral responses-specifically state anxiety, positive and negative affect, and discarding behavior-before and after the intervention.

Given the preliminary nature of this research, the following two hypotheses guide the investigation:

Hypothesis 1: Participants in the VR exposure condition will be more likely to discard their object during or after the session than participants in the imagination-based exposure group. This hypothesis is grounded in preliminary evidence suggesting that non-immersive VR can support emotional regulation and task engagement by providing a structured yet low-pressure simulation of real-world scenarios.

Hypothesis 2: Both groups will show a reduction in state anxiety and negative affect, along with a potential increase in positive affect, from pre- to post-exposure. However, participants in the VR condition may exhibit greater improvements due to the virtual environment's interactive and visually grounded features, which may facilitate emotional processing and cognitive restructuring.

Study Timeline

• Study Start: 2024-01-24
• Primary Completion: 2024-10-31
• Study Completion: 2024-10-31
• Status Verified: 2025-05
• Study First Submitted: 2025-08-21
• Study First Submitted QC: 2025-08-29
• Last Update Submitted: 2025-08-29
• Study First Posted: 2025-09-08
• Last Update Posted: 2025-09-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

Adults individuals from general population.

Exclusion Criteria

• A score of 4 or higher on the self-report item of the Hoarding Rating Scale Self-Report, which assesses difficulty in discarding possessions;
• No evident signs of suicidal ideation, based on the scores of the Beck Depression Inventory-II, nor indications of alcohol or substance abuse, psychotic spectrum disorders, depressive disorders, organic mental disorders, or conditions associated with cognitive impairment;
• Participants must report difficulty in discarding certain objects. Moreover, individuals have to complete online monitoring questionnaires via PC or smartphone.
• Participants had to fill out a custom questionnaire evaluating each object based on two parameters: importance and difficulty in discarding.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Change in State Anxiety as measured by the State-Trait Anxiety Inventory (Y)- State subscale	Baseline (immediately before the intervention) and Post-intervention (immediately after completion of the single experimental session).	State anxiety is a psychological feature focused on how individuals experience at particular times (state anxiety). It will be assessed using the State subscale of the "State-Trait Anxiety Inventory (STAI-Y) State subscale", a validated self-report questionnaire commonly used in clinical and experimental research to measure transient levels of anxiety. Scores range from 20 to 80, with higher scores indicating greater state anxiety.
Change in Positive and Negative Affect as measured by the Positive and Negative Affect Schedule (PANAS)	Baseline (immediately before the intervention) and Post-intervention (immediately after completion of the single experimental session).	Positive and negative affect will be assessed using the Positive and Negative Affect Schedule (PANAS), a validated self-report questionnaire consisting of 20 items. The scale includes two subscales: Positive Affect (10 items; scores range 10-50) and Negative Affect (10 items; scores range 10-50). Higher scores indicate greater intensity of the corresponding affective state.
Frequency of Discarding Behavior (Behavioral Observation)	During the single experimental session (immediately after intervention).	Discarding behavior was assessed through direct behavioral observation during the experimental task. The measure consisted of recording whether participants discarded the personal object (in the imagination condition or in the virtual reality condition) and the frequency of this behavior within the single session.

Trial Locations

Locations (1)

University of Padova; 🇮🇹 Padua, PD, Italy