New Developments in Hoarding Research: A Novel Approach Using Virtual Reality. Hanna McCabe-Bennett, MA PhD Candidate, Clinical Psychology

Transcription

1 New Developments in Hoarding Research: A Novel Approach Using Virtual Reality Hanna McCabe-Bennett, MA PhD Candidate, Clinical Psychology 18 th International Conference on Hoarding and Cluttering Friday March 23, 2018

2 Agenda Overview of the Cognitive-Behavioral Model of Hoarding Current State of the Literature Someone Said Something about Virtual Reality Treatment Implications Take-Home Messages Q & A

3 Cognitive-Behavioral Model of Hoarding

4 Overview of DSM-5 Hoarding Disorder Difficulty Discarding Sentimental, aesthetic, instrumental value Responsibility (objects, environment) Living rooms, kitchens, bedrooms Clutter Excessive Acquiring Buying (clothes, books, gifts) Free things (flyers, plastic bags) Stealing (rare)

5 Emotional Attachment to Possessions Information Processing Deficits Hoarding Beliefs about Possessions Behavioral Avoidance Cognitive-Behavioural Model of Hoarding Disorder (Frost & Steketee, 1998)

6 Emotional Attachment to Possessions Core elements of emotional attachment: Emotional comfort Uniqueness of objects Fear of loss Objects viewed as safety signals, useful for soothing intense emotions But, less effective at using objects for comfort in times of need Emotional attachment to possessions & hoarding symptom severity (r =.79, p <.001 ) Information Processing Deficits Emotional Attachment to Possessions Hoarding Beliefs about Possessions Kyrios et al., 2017; Nedelisky & Steele, 2009; Phung et al., 2015; Steketee et al., 2003 Behavioural Avoidance

7 Beliefs about the Nature of Possessions Catastrophic consequences of discarding Missing or forgetting information would be terrible If my things are violated, then I am violated I must keep it just in case I am responsible for keeping my possessions safe from harm Large correlations with hoarding symptom severity: Sense of responsibility for possessions, r =.69, p <.001 Emotional Attachment to Possessions Fears of losing control over possessions, r =.64, p <.001 Information Processing Deficits Hoarding Beliefs about Possessions Frost & Steketee, 1998; Kyrios et al., 2017 Behavioural Avoidance

8 Behavioral Avoidance Experiential avoidance Loss of a valued possession (discarding) Loss of a bargain or potential opportunity (acquiring) Fewer items discarded in the context of sad moods Increased saving under stressful conditions Organizational systems Fear of forgetting Making mistakes Perfectionism Information Processing Deficits Emotional Attachment to Possessions Hoarding Beliefs about Possessions Frost & Steketee, 1998; Kyrios et al., 2017; Norberg et al., 2015; Shaw & Timpano, 2016 Behavioural Avoidance

9 Information Processing Deficits Attention Higher rates of ADHD Inattention unique predictor of hoarding No impairment in selective attention Possible impairment in sustained attention Memory No unique deficits in verbal memory Mixed findings on visuospatial and working memory Clear deficits in memory confidence Information Processing Deficits Emotional Attachment to Possessions Hoarding Beliefs about Possessions Grisham et al., 2007, 2010; Sumner et al., 2016; Tolin & Villavicencio, 2011 Behavioural Avoidance

10 Information Processing Deficits Excessive β = 0.68 saving β = 1.17 Poor memory confidence Clutter β = 0.83 β = 0.18 Inattention Functional impairment Model accounts for 91% variance F(4,49) = , p <.001 Hallion, Diefenbach, & Tolin, 2015

11 Information Processing Deficits Decision making Complex rule learning, flexibility Slower, more perseverative errors, poorer conceptual functioning Mixed findings regarding planning Higher indecisiveness Fear of decision-making unique predictor of hoarding symptom severity Categorization Underinclusivity Emotional Attachment to Possessions Information Processing Deficits Hoarding Beliefs about Possessions Grisham et al., 2010; Luchian et al., 2007; McMillan et al., 2013; Sumner et al., 2016 Behavioural Avoidance

12 Underinclusivity

13 Current State of the Literature

14 Limitations Nonclinical & Undergrad Samples Ecological Validity Risk of Poor Understanding

15 Panic Disorder

16 Social Anxiety Disorder

17 Specific Phobias

18 Obsessive-Compulsive Disorder

19 Hoarding Disorder? Raines, Timpano, & Schmidt (2014) 34 participants with HD Completed tests of verbal memory and sustained attention No differences But, we know that verbal memory is not impaired and findings are mixed for sustained attention Is this cluttered enough?

20 What to do When Increasing Ecological Validity is Difficult in a Lab Setting?

21 Solving the Ecological Validity Problem with Virtual Reality

22 Solving the Problem with Virtual Reality

23 What is Virtual Reality (VR)? 3-dimensional, computer generated environment Presence, immersion, interactivity Lisewski, 2006; Witmer & Singer, 1998

24 VR Helps to Overcome Barriers in Hoarding Research Eliminates physical risks of extreme clutter Decreases shame and embarrassment Standardization Allows us to ask more nuanced questions How does categorization occur in naturalistic environments? How do people respond to being surrounded by varying degrees of clutter?

25 Applying VR to Hoarding Research Study 1 Perceived and Actual Information Processing Deficits Study 2 Emotional Intensity, Experiential Avoidance, and Hoarding Symptoms Study 3 Differential Experiences of Clutter Information Processing Deficits Emotional Attachment to Possessions Hoarding Beliefs about Possessions Behavioural Avoidance

26 Participants Hoarding Group (n = 36) Nonhoarding Group (n = 40) Age M = 36.14, SD = M = 33.20, SD = Gender Ethnicity Hoarding severity* Saving Inventory- Revised 63.9% Female 30.6% Male 5.6% Other 50.5% White 22.2% Asian 27.8% Other 65.0% Female 35.0% Male 0% Other 37.5% White 42.5% Asian 20.0% Other M = 67.83, SD = 8.79 M = 11.70, SD = 9.37

27 Apparatus Image: Daily Vice

28 Study 1: Perceived and Actual Information Processing Deficits Aims Explore memory and decision making performance Examine state and trait memory confidence Attempt to elicit underinclusivity in VR Emotional Attachment to Possessions Information Processing Deficits Hoarding Beliefs about Possessions Behavioural Avoidance

29 Study 1: Methods Attention ADHD self-report scale Memory Rey-Osterrieth Complex Figure Test VR memory test State (VR) & trait (questionnaire) memory confidence Categorization VR organizing plan Decision making Iowa Gambling Task Time to complete VR categorization task Indecisiveness & perfectionism questionnaires

30

31 VR Memory Test

32

33 ADHD Self-Report Scale Study 1 Results: Attention 16 *** Hoarding Nonhoarding ADHD Symptoms

34 T Scores Accuracy Study 1 Results: Memory 60 Hoarding Nonhoarding 30 Hoarding Nonhoarding 50 ** ** IR DR REC RCFT 0 IR DR REC VR

35 Scores Seconds Study 1 Results: Decision Making Hoarding Nonhoarding Hoarding Nonhoarding 30 * IGT 500 VR

36 Memory Confidence Memory Confidence Study 1 Results: Memory Confidence Hoarding Nonhoarding Hoarding Nonhoarding 90 *** MCCS (Trait) 0 VR (State)

37 Study 1 Results: Categorization Hoarding Nonhoarding Objects 0 Objects/Category * Categories 0 % Categories 1 Object

38 Study 1 Results: Perfectionism * Hoarding Nonhoarding *** CM PS PE PC DA O Frost MPS 80 *** 70 *** Hoarding Nonhoarding Self Other Social Hewitt & Flett MPS

39 Frost Indecisiveness Scale Study 1 Results: Indecisiveness 60 *** Hoarding Nonhoarding Indecisiveness

40 Study 1: Research Implications Attention Provides support for attentional difficulties in hoarding Memory Adds to growing body of literature suggesting no evidence for memory impairments Importance of trait vs. state memory confidence Categorization Uniqueness of objects may lead to underinclusivity Decision making Impairment may only exist in the context of personal objects

41 Study 1: Treatment Implications Attention Importance of pacing according to personal limits Memory Psychoeducation on ability vs. confidence Behavioural experiments to improve global confidence Categorization Developing rules for minimum category size Decision making Practice generalizing intact decision making ability to personal objects

42 Study 2: Emotional Intensity, Experiential Avoidance, and Hoarding Symptoms Aims Examine the effect of negative mood and experiential avoidance on real time acquisition and discarding patterns Attempt to induce virtual object attachment Emotional Attachment to Possessions Information Processing Deficits Hoarding Beliefs about Possessions Behavioural Avoidance

43 Study 2: Methods Negative or neutral mood inductions Virtual shopping trip Imagined discarding of favored object

44 Virtual Shopping Trip

45 Acquisition: Typical Nonhoarding Participant Acquisition rate = 0.03 objects/second; Discarding rate = 0.10 objects/second

46 Acquisition: Typical Hoarding Participant Acquisition rate = 0.05 objects/second; Discarding rate = 0.11 objects/second

47 Maximum Acquisition: Nonhoarding Participant

48 Maximum Acquisition: Hoarding Participant

49 Number of Objects Study 2 Results: Mood-Related Acquisition and Discarding Hoarding Nonhoarding 8 7 ** Neutral: Acquisition Negative: Acquisition Neutral: Discarding Negative: Discarding

50 Experiential Avoidance Number Acquired Study 2 Results: Experiential Avoidance 14 Hoarding Nonhoarding *** 12 Hoarding Nonhoarding ** * Negative Neutral 0 Lab Visit 1 Lab Visit 2

51 Reactivity to Imagined Discarding Study 2 Results: Virtual Object Attachment Hoarding *** Nonhoarding 4 3 Hoarding Nonhoarding * Object Attachment -3 Positive Affect Negative

52 Study 2: Research Implications VR paradigm successfully showed differences in acquisition and discarding patterns between groups Does the type of shop or objects available matter? Importance of experiential avoidance Would acquisition have been the same in both lab visits if there had been no discarding task? Object attachment Phenomenon occurs even with virtual objects

53 Study 2: Treatment Implications Acquisition Speed, and not just number, may need to be addressed Discarding Exposure to discarding when feeling negative emotions Finding alternative coping strategies Object attachment Psychoeducation about tendencies to become quickly attached, even to objects you know you cannot take home Cognitive strategies to challenge anthropomorphism

54 Study 3: Differential Experiences of Clutter Aim Explore differences in experiences of clutter Distress Preferences Emotional Attachment to Possessions Information Processing Deficits Hoarding Beliefs about Possessions Behavioural Avoidance?

55 Study 3: Methods Exposure to progressively increasing clutter levels Monitored subjective and physiological ratings of distress Ascertained subjective preferences for clutter levels Queried claustrophobia symptoms

56 Clutter Image Rating (Frost, Steketee, Tolin, & Renaud, 2008)

57 1

58 2

59 3

60 4

61 5

62 6

63 7

64 8

65 9

66 SUDS Study 3 Results: Discomfort with Clutter BL Room Hoarding Nonhoarding

67 Study 3 Results: Clutter Preferences & Claustrophobia Hoarding Nonhoarding Hoarding Nonhoarding ** *** 0 Preferred Room 0 Claustrophobia

68 Study 3: Research Implications Subjective & physiological distress No group differences with increasing amounts of clutter Is there something unique about being surrounded by one s own clutter (clutter blindness?) Clutter preferences Hoarding group preferred more cluttered room Likely not clinically significant Claustrophobia Realistic fears of restriction & suffocation?

69 Study 3: Treatment Implications Amplify ambivalence to enhance motivation Clutter = Distress Treasures = Joy Collaborative goal setting regarding clutter preferences

70 Could VR be used in Treatment? Use personalized VR to practice categorizing and imagined discarding VR shopping trips to practice non-acquiring Repeated exposure to VR clutter may help shift perspectives

71 VR Limitations Expensive Requires some technical savvy Medical contraindications Novelty factor Drop-outs Simulator sickness

72 Take Home Messages Innovation is key & VR is a viable avenue to pursue Generalize existing decision making skills Collaboratively develop categorization rules Boost memory confidence Slow acquisition Alternative coping strategies to avoidance Amplify ambivalence Client-centred goal setting

73 Acknowledgments Psychology Team: Dr. Martin Antony Dr. Todd Girard Carson Pun Volunteers: Victoria Seguin, Jenn Stevens, Amna Ursani, Julia Tindal Anxiety Treatment and Research Lab VR Team: Dr. Richard Lachman Eric Karnis Joshua See Kristian Howald Rodrigo Borquez Diaz Thank you! Hanna McCabe-Bennett