Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults

Hoarding disorder is common and debilitating, especially in older adults, and novel treatment approaches are needed. Many current treatments emphasize skills related to discarding and decision-making about possessions, which can be practiced in the patient's home. However in many cases, in-home visits are unfeasible, or real-life discarding is too difficult. Virtual reality (VR) offers the ability to create a virtual "home" including 3D scans of the patient's actual possessions that can be moved or discarded. VR discarding is an alternative to in-home visits and an approach that provides a stepping stone to real-life discarding. VR has been successfully utilized to treat many disorders but tested minimally in hoarding disorder. In nine older adults with hoarding disorder, we tested an 8-week VR intervention administered to augment a 16-week Buried in Treasures group treatment. Individualized VR rooms were uniquely modeled after each patient's home. During clinician-administered VR sessions, patients practiced sorting and discarding their virtual possessions. The intervention was feasible to administer. Open-ended participant responses, examined by two independent evaluators, indicated that VR sessions were well-tolerated and that participants found them useful, with nearly all participants noting that VR helped them increase real-life discarding. Self-reported hoarding symptoms decreased from baseline to close, with seven of the nine participants showing reliable improvement in this timeframe and none showing deterioration. Results from this exploratory pilot study suggest that VR is a feasible way to simulate an at-home sorting and discarding experience in a manner that may augment skills acquisition. It remains an open question whether VR discarding practice yields greater improvement than existing treatments. VR for this population merits further clinical investigation.

Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis

This is the first comprehensive meta-analysis in approximately 20 years of all controlled studies of the use of hypnosis for relieving clinical pain. To be included, studies were required to utilize a between-subjects or mixed model design in which a hypnosis intervention was compared with a control condition in alleviating any form of clinical pain. Of 523 records screened, 42 studies incorporating 45 trials of hypnosis met the inclusion criteria. Our most conservative estimates of the impact of hypnosis on pain yielded mean weighted effect sizes of 0.60 (p ≤ .001) for 40 post trials and 0.61 (p ≤ .001) for 9 follow-up trials. These effect sizes fall in the medium range according to Cohen's guideline and suggest the average participant receiving hypnosis reduced pain more than about 73% of control participants. Hypnosis was moderated by the overall methodological quality of trials-the mean weighted effect size of the 19 post trials without high risk ratings on any of the Cochrane Risk of Bias dimensions was 0.77 (p ≤ .001). Hypnosis was also moderated by hypnotic suggestibility, with 6 post trials producing a mean weighted effect size of r = 0.53 (p ≤ .001). Our findings strengthen the assertion that hypnosis is a very efficacious intervention for alleviating clinical pain.

THE EFFICACY OF HYPNOSIS AS A TREATMENT FOR ANXIETY: A META-ANALYSIS

This meta-analysis quantifies the effectiveness of hypnosis in treating anxiety. Included studies were required to utilize a between-subjects or mixed-model design in which a hypnosis intervention was compared with a control condition in alleviating the symptoms of anxiety. Of 399 records screened, 15 studies incorporating 17 trials of hypnosis met the inclusion criteria. At the end of active treatment, 17 trials produced a mean weighted effect size of 0.79 (p ≤ .001), indicating the average participant receiving hypnosis reduced anxiety more than about 79% of control participants. At the longest follow-up, seven trials yielded a mean weighted effect size of 0.99 (p ≤ .001), demonstrating the average participant treated with hypnosis improved more than about 84% of control participants. Hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when used as a stand-alone treatment.

A Meta-Analysis of Hypnotic Interventions for Depression Symptoms: High Hopes for Hypnosis?

This meta-analysis quantifies the effectiveness of hypnosis for treating the symptoms of depression. To be included in the meta-analysis, studies were required to use a between-subjects or mixed-model design in which a hypnotic intervention for depression was compared with a control condition in reducing depression symptoms. Of 197 records screened, 10 studies incorporating 13 trials of hypnosis met the inclusion criteria. The mean weighted effect size for 13 trials of hypnosis at the end of active treatment was 0.71 (p ≤ .001), indicating the average participant receiving hypnosis showed more improvement than about 76% of control participants. The mean weighted effect size for four trials of hypnosis at the longest follow-up was 0.52 (p ≤ .01), indicating the average participant treated with hypnosis showed more improvement than about 51% of control participants. These effect sizes are comparable to those associated with well-known psychological interventions for depression (e.g., Beck's cognitive therapy, interpersonal therapy) and suggest hypnosis is a very effective way of alleviating the symptoms of depression. Clinicians may wish to give serious consideration to hypnosis as a treatment option when working with clients and patients who are depressed.