Exposure Therapy for Hoarding

There are two methods to support making behavioural change towards clearing out your clutter. The first is called facing my fears, or exposure therapy, and involves establishing a hierarchy, or list, of easiest items to discard, to hardest items to discard, and gradually moving up your hierarchy or list, item by item. The second method can be used alone, or in combination with the first method. This method involves developing a behavioural experiment, to test out beliefs that might be preventing you from discarding an item for fear of the consequences, even though feared consequences are not guaranteed. These methods are outlined here:

Method 1: Exposure-Discarding and non-acquisition practice

Begin by creating a list of the items you want to discard but are having trouble doing. We advise creating multiple lists, for example, by room or by category. This will allow you to focus on one area at a time and reduce feeling overwhelmed or giving up. Once you have your lists, pick a first list and rank order each item from 0-10. Assign a 0 for the item that is the least scary or difficult to discard, to 10 for the item that is the most scary or difficult to discard. For example, if you have developed a toiletries list, wrappers may be a 1/10 on your ladder, whereas a hand held mirror from your aunt may be an 8/10 or 9/10. See Examples of Fear Ladders for some ideas about building your fear ladder.

Climbing the fear ladder. Once you have built a fear ladder, you are ready to face your fears by putting yourself in situations that bring on your fear or discomfort (exposure). In this example, you are exposing yourself to the act of discarding your items. Feeling anxious when you try these exercises is a sign that you are on the right track. 

  1. Bottom up. Start with the easiest item on the fear ladder first (i.e., fear=2/10) and work your way up.
  2. Track progress. Track your anxiety level throughout the exposure exercise in order to see the gradual decline in your fear or discomfort of a particular situation. Use the Facing Fears Form to help you do this.
  3. Don't avoid. During exposure, try not to engage in subtle avoidance (e.g., thinking about other things, talking to someone, planning to get an item back or to replace it.). Avoidance actually makes it harder to get over your fears in the long term.
  4. Don't rush. It's important to try to do one item at a time and not take on too many to feel overwhelmed. People can sometimes feel a sense of relief once the item is gone - the anxiety peaks during the discarding process and can decrease quite quickly once the item is gone.  
  1. Feeling anxious when you are facing each fear is a sign that you are on the right track. If you’re not anxious you might be too low on your ladder, and if you are feeling flooded with excessive anxiety, chances are you started too high up on the ladder. Remember that regardless of how intense your fear is, it will peak and then level off. What goes up must come down! Even if you do nothing about it the fear will eventually go away on its own.
  2. Stick with it! Do the exposure exercises as often as you can. You are trying to build up positive experiences to replace previous ones where you felt defeated by your hoarding. Too long a gap between exercises makes this more difficult.
  3. Recruit help! Enlist the help of family and friends. It can help to find someone to work with who can talk to you calmly and positively while you are doing the steps. Make sure the helper you recruit is not over-sympathizing or endlessly asking how bad you are feeling. This will make it harder for you to focus on the steps and to stay positive.

How to move on. Once you experience mild anxiety or discomfort when getting rid of items on a specific step of the ladder (e.g., 4/10), you can move on to the next step (e.g., 5/10). For example, after discarding all the empty shampoo and related containers from the bathroom (2/10), you might feel very little anxiety and feel calm. You can then challenge yourself to tackle the rest of the bottles that contain small amounts of product, but aren’t being used (3/10). Again, engage in this practice until your anxiety drops and the process seems easier or more manageable. This is a good guide to know when to go to the next step on the ladder.

Exposure for Non-acquisition Practice: You also can develop a hierarchy, and engage in exposure, for non-acquisition of items in addition to discarding items. In this scenario you will engage in the same steps outlined above, except the items on your list will not be items to discard, but items/situations to expose yourself to, with a plan NOT to obtain them. For example, it may be relatively easy to drive past an expensive store and not go in and buy something (2/10), medium hard or uncomfortable to go to a book drive and not purchase or acquire (5/10), and most hard/uncomfortable to decline a gift from a friend (9/10). 

*For more information on How to do Exposure (see Facing your Fears: Exposure)

Method #2 - Behavioural Experiments

This method involves creating an experiment to test out beliefs about discarding or non-acquisition. Many individuals with hoarding have developed beliefs that are inconsistent with their values. For example, “my stuff is what makes me happy”, yet valuing social engagement with others, which is prevented due to excessive clutter in the home. Following this example, an experiment might involve having the individual gradually remove clutter from the back porch, and then inviting a friend over for a backyard BBQ. Predictions about what might happen would be made, as well as discomfort ratings generated for discarding the bikes.

The following questions can help design your experiment:

  1. My experiment (What I will do): Discard broken bikes from back porch
  2. What I predict will happen (What I am afraid of?): Porch will feel naked and I will miss the bikes. Sadness will make it impossible to enjoy the space.
  3. How strongly do I believe this will happen (0-100%): 75%
  4. My initial discomfort (0-100): 85%
  5. What actually happened? After a few hours my # dropped to 40%. After a few days I started to like the openness of the space and use it to sit and have coffee in the morning. I rearranged the space to showcase my grill and had a friend over for a BBQ. That felt really good.
  6. My final discomfort (0-100):    5%.
  7. Did my prediction come true?    Not really. I still occasionally miss the bikes, but the space is totally worth it and I love entertaining.

After doing a few of these experiments, two important things may happen. The first is that you may notice that your worst fears were not confirmed, and that in fact nothing bad actually happened. Once this occurs a few times, it can provide a boost of confidence that helps you to create and engage in more experiments, which over time allows you to progress with your de-cluttering plan. However, on occasion, for some people, their fears do happen. For example, in the above scenario, perhaps the individual finds that the open space does make the home appear “naked,” and it highlights the peeling paint along the wall resulting in complaints from the strata. Yet, for most individuals when feared outcomes occur, there is often a surprising side effect- the individual learns they can cope. In this scenario, the individual may decide to repaint their home, or build a covered porch allowing them to sit “inside” and enjoy the view no matter the weather. Although their feared outcome “a naked porch” did happen, they were able to find a solution that eliminated the “naked porch” feeling and allowed them to remove the bikes.