Non-immersive virtual environments for the treatment of hoarding disorder: a preliminary randomized controlled trial based on a non-clinical sample

Hoarding Disorder (HD) is characterized by persistent difficulty discarding possessions, leading to excessive accumulation and functional impairment. Traditional treatments, based on cognitive-behavioral therapy (CBT), emphasize motivational enhancement, cognitive restructuring, and exposure-based interventions. However, these methods face challenges, including heightened distress during in vivo exposure and avoidance tendencies. Virtual Reality (VR) has emerged as a promising adjunctive tool, offering immersive, controlled environments for gradual exposure. The current preliminary study investigates the efficacy of non-immersive VR, defined as a computer-generated environment accessed via a standard screen without head mounted displays or motion tracking, in facilitating the discarding of personal belongings compared to imaginative exposure. Eighty participants from non-clinical convenience sample (mean age = 25.98, SD = 9.84) were randomly assigned to Virtual Reality Exposure (VRe) or Imagination Exposure (Ie). A non-immersive VR environment was created using Blender and GODOT software, simulating a non-immersive virtual home where participants interacted with representations of their objects. Psychological constructs, including state anxiety and positive and negative feelings, were measured using validated self-report tools (STAI-Y1, PANAS). Behavioral outcomes focused on object discarding frequency during exposure and in vivo sessions. Results demonstrated a significantly higher proportion of successful discarding in the VR group compared to the imagination group during the experimental exposure session (87.5% vs. 50%; p < .001). VR’s realistic sensory-motor engagement may help circumvent cognitive and emotional barriers to exposure tasks, increasing the ecological validity of these techniques. This preliminary study indicates that non-immersive VR may play a role in bridging the gap between imaginative-based exposure therapy and in vivo HD, that is, real-life exposure to discarding personal items. Although replication in clinical populations and long-term outcome data will be needed, non-immersive VR may provide a cheap, broadly available tool to improve treatment engagement and efficacy. Therefore, future research should analyze the relative advantages of immersive-type VR systems and improve assessment instruments to capture subtle changes over time in psychological constructs. This study was conducted according to the Declaration of Helsinki and was approved by the Ethics Committee of Psychological Research (Area 17), University of Padova (approval number: DD0A28FFB2B4C63CFED6CC9BACC7A530). ClinicalTrials.gov identifier NCT07160543. Retrospectively registered. Approved and published 5 September 2025.