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Symposium

Obsessive Compulsive and Related Disorders

Broadening the Reach of CBT for Hoarding and OCD: Engagement, Equity, and Sustainable Care

1 - (SYM 37) Does Process Imagery Promote Discarding?

Saturday, June 27, 2026
11:06 AM - 11:27 AM PDT
Location: Yerba Buena Salon 5, B3 Level
Keywords: Hoarding, Motivation, Treatment Development
Abstract Body
Hoarding disorder is a condition characterized by treatment ambivalence and inadequate clinical outcomes. Recent studies have used mental imagery techniques to help people with hoarding difficulties by “rescripting” outcomes of past events to create new meaning. We recently applied another novel imagery technique, known as process imagery, to help people with hoarding problems plan for future discarding scenarios. Imagery is used to envision sorting possessions, completing positive activities that address values which drive ambivalence to discard, and the act of discarding. This technique helps rehearse steps for future actions and highlights the positive outcomes of discarding which may enhance motivation to discard.

The current study assessed if a telehealth-delivered process imagery intervention could promote discarding in individuals with hoarding difficulties. Individuals screened for elevated hoarding tendencies joined a videoconference from their homes and chose personal possessions that they were ambivalent about discarding. They were then guided through either a positive imagery (imagining a walk across a beach and forest) or a process imagery task. Participants rated how much they endorsed appraisals related to discarding before and after completing the imagery task and then sorted their personal possessions into keep or discard piles.

Individuals in the process imagery condition placed more items in the discard pile than those the positive imagery condition (t(48.4) = 2.74, p = .01) despite reporting equal discomfort during the sorting task (F(2, 114) = 1.00). The endorsement of approach-related appraisals (motivation, readiness, and self-efficacy) increased more in the process imagery condition than the positive imagery condition (F(1, 53) = 12.58, p < 0.001). Endorsement of avoidance-related appraisals (anxiety, unhappiness, and uncertainty) reduced marginally more in the process imagery condition than the positive imagery condition (F(1, 53) = 4.07, p < 0.05).

These preliminary data suggest that process imagery may be a brief and efficacious intervention to help those at risk for developing hoarding disorder discard their personal possessions. Although participants experienced similar discomfort, decisions to discard and relevant appraisals toward discarding were improved by process imagery relative to a control condition. Thus, planning actions and pre-experiencing positive future outcomes with imagery may modify attitudes to improve individuals’ distress tolerance when sorting and discarding.