Written Imaginal Exposure for Hoarding Disorder: A Preliminary Pilot Study

ABSTRACT

Hoarding disorder (HD) is marked by difficulty discarding possessions. Many refuse treatment or drop out, which may be due to treatment's incorporation of in-home decluttering, which is feared and avoided. Thus, strategies to prepare patients for decluttering/discarding are needed. Imaginal exposure (IE), or imagining one's worst fears about discarding, could be one such strategy. This pilot preliminarily tested a short-duration IE intervention compared with a control intervention. Over 3 days, adults diagnosed with HD (n = 32) were randomly assigned to either write about and imagine their worst fears about discarding (IE condition) or a neutral topic (control writing [CW] condition). The IE condition showed significant improvements in HD symptoms from preintervention to 1-week follow-up, with medium to large effects; however, the CW condition did as well. Comparing change scores between conditions, the IE condition's improvements were not significantly different than the CW condition's. Overall, IE was helpful in improving HD symptoms, but this pilot did not indicate that it was more helpful than CW. This raises important questions about possible demand characteristics, placebo effects, or regression to the mean, and it has implications for the design and methodology of other studies assessing IE's utility.

The mindful gaze: trait mindful people under an instructed emotion regulation goal selectively attend to positive stimuli

Trait mindfulness confers emotional benefits and encourages skillful emotion regulation, in part because it helps people more deliberately attend to internal experiences and external surroundings. Such heightened attentional control might help skillfully deploy one's attention towards certain kinds of stimuli, which may in turn help regulate emotions, but this remains unknown. Testing how trait mindful people deploy attention when regulating their emotions could help uncover the specific mechanisms of mindfulness that confer its emotional benefits. The present study aimed to determine whether high trait mindfulness is associated with sustained attention biases to (i.e. longer gaze at) emotional scenes, when all participants are given the emotion regulation goal of staying in a positive mood. To measure this, we used eye tracking to assess selective attention to positive, neutral, and negative photographs. Higher trait mindfulness was associated with both a stronger attention bias for positive (vs. neutral and vs. negative) images, as well as greater success staying in a positive mood during viewing. Surprisingly, this attention bias towards the positive images did not mediate the relationship between mindfulness and maintenance of positive mood. Future work should compare visual attention to other emotion regulation strategies that may maximise positive affect for mindful people.

The influence of interactions with pet dogs on psychological distress

Many people, including nearly half of American households, own a pet dog. Previous work has found that therapy dog interactions reduce distress, but little work to date has empirically established the mood-enhancing effects of interaction with one's own pet dog. In this study, dog owners (N = 73; 86.3% female, 13.7% male; age 25-77 years) underwent a stress-inducing task followed by random assignment to either (a) interacting with their dog (n = 24), (b) an expectancy control (n = 25; "stress-reducing" coloring books), or (c) a waiting control (n = 24). We compared the effects of each condition on affect and state anxiety. Participants assigned to the dog interaction showed greater increases in positive affect, as well as greater reductions in anxiety compared to both expectancy and waiting controls (ds > 0.72, ps < .018). No significant reductions in negative affect were detected. Second, we found that self-reported experiences with animals, attitudes toward animals, or bondedness with their dog did not differentially predict the condition's impact on the owner's mood. Finally, we coded participants' degree of engagement (e.g., time spent playing) with the dog and found that higher engagement predicted reduced negative affect. Overall, interacting with one's own pet dog reduced owners' distress. Such interactions, which occur commonly in daily life, may have the potential to alleviate distress at a large scale. Precisely how this works and for whom it is especially well suited remain intriguing open questions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Seeing red: Distraction influences visual attention for anger but not for other negative emotions

Emotion regulation is a vital skill that improves psychological well-being and overall functioning. Distraction (the purposeful internal disengagement from an emotional stimulus) and cognitive reappraisal (the process of changing one's thoughts about an emotional event/stimulus) are two well-established regulation strategies that can effectively decrease negative affect. Less understood, however, are the attention allocation strategies that occur when engaging in these emotion regulation strategies-specifically, do people visually scan emotional information differently when distracting vs. reappraising? In the current study, community participants were randomly assigned to either distract, reappraise, or view naturally while watching four emotional film clips that each elicited a different negative emotional state: anger, fear, sadness, and disgust. Eye tracking was used to record total time spent gazing ("dwell time") at faces within the emotion-eliciting film clips. An effect of condition was found for anger-eliciting material only: participants in the distraction condition exhibited shorter dwell times compared with reappraisal and natural viewing. Importantly, this effect was moderated by state anxiety, such that it was found at low but not high levels of state anxiety. These results show that emotion regulation strategies differentially affect attention to emotion-eliciting stimuli and points to the role of current affective states in impacting how distraction is used. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does repetitive negative thinking affect attention? Differential effects of worry and rumination on attention to emotional stimuli

Worry and rumination, two cardinal responses to emotional events, are key for maintaining negative emotion and have been implicated in the etiology and maintenance of anxiety and depressive disorders. Though worry and rumination are highly correlated with one another and people who engage in one often engage in both, they may differentially affect emotion. Specifically, previous work suggests that worry helps people avoid (intense) emotion, while rumination provokes it. Examining the ways in which these two forms of repetitive negative thinking (RNT) influence cognitive processing of emotional material may help us better understand the emotional sequelae of worry and rumination. This study examines visual attention to emotional information, since attending to certain types of information opens the door for further processing of it. The current study induced worry and rumination and then used eye tracking to compare how each form of RNT influenced the allocation of attention to emotional scenes. Participants induced to worry, compared with those induced to ruminate, spent less time viewing positive (vs. neutral) scenes and were the only group to preferentially maintain their attention on negative images when they were paired with positive images. These findings suggest that worry, compared with rumination, leads to the relative avoidance of positive information. Implications of these findings for research on mood and anxiety disorders are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Seeing the world through rose-colored glasses: People who are happy and satisfied with life preferentially attend to positive stimuli

Given the many benefits conferred by trait happiness and life satisfaction, a primary goal is to determine how these traits relate to underlying cognitive processes. For example, visual attention acts as a gateway to awareness, raising the question of whether happy and satisfied people attend to (and therefore see) the world differently. Previous work suggests that biases in selective attention are associated with both trait negativity and with positive affect states, but to our knowledge, no previous work has explored whether trait-happy individuals attend to the world differently. Here, we employed eye tracking as a continuous measure of sustained overt attention during passive viewing of displays containing positive and neutral photographs to determine whether selective attention to positive scenes is associated with measures of trait happiness and life satisfaction. Both trait measures were significantly correlated with selective attention for positive (vs. neutral) scenes, and this general pattern was robust across several types of positive stimuli (achievement, social, and primary reward), and not because of positive or negative state affect. Such effects were especially prominent during the later phases of sustained viewing. This suggests that people who are happy and satisfied with life may literally see the world in a more positive light, as if through rose-colored glasses. Future work should investigate the causal relationship between such attention biases and one's happiness and life satisfaction.

Neuroscience and Facial Expressions of Emotion: The Role of Amygdala–Prefrontal Interactions

The aim of this review is to show the fruitfulness of using images of facial expressions as experimental stimuli in order to study how neural systems support biologically relevant learning as it relates to social interactions. Here we consider facial expressions as naturally conditioned stimuli which, when presented in experimental paradigms, evoke activation in amygdala–prefrontal neural circuits that serve to decipher the predictive meaning of the expressions. Facial expressions offer a relatively innocuous strategy with which to investigate these normal variations in affective information processing, as well as the promise of elucidating what role the aberrance of such processing might play in emotional disorders.