Paula Muñoz Rodríguez

All Publications

• Exploring the effects of cognitive behavioral therapy on cognitive control circuit and behavioral task performance in hoarding disorder. Journal of psychiatric research Muñoz Rodríguez, P. A., Pines, A., Zhang, X., van Roessel, P. J., Mukunda, P., McCarthy, E., Williams, L. M., Rodríguez, C. I. 2025; 186: 423-433

  Abstract

  Hoarding disorder (HD) is characterized by difficulty discarding or parting with possessions and clutter, which causes distress or impairment in important areas of functioning. Cognitive behavioral therapy (CBT) for HD has shown promise; however, little is known about the brain mechanisms underlying symptom reduction. We previously reported the robust clinical effects of the Buried in Treasures workshop (BIT)-a skills-based group which incorporates CBT principles-augmented with uncluttering home visits (BIT+), in a waitlist-controlled trial involving adults with HD. This study examined neural activity within a network of regions associated with cognitive control in a subset of HD participants (n = 19) before and after 18 weeks of BIT+ sessions using task-based fMRI during a response inhibition task. We used a comparison group of healthy controls (HC; n = 49). Our behavioral results show that participants in the HD group made more errors of omission while performing the task but did not differ from HCs in their errors of commission. The neuroimaging findings indicated a correlation between improvements in hoarding symptoms and blood-oxygen-level-dependent (BOLD) signal during errors of commission in the right insula and anterior cingulate cortex of post-treatment HD participants, suggesting that changes in this region may be associated with the effectiveness of BIT+ treatment. This is the first study exploring neural activity changes associated with symptom-neutral inhibitory control before and after BIT+ treatment in a HD population.

  View details for DOI 10.1016/j.jpsychires.2025.04.010

  View details for PubMedID 40315751

• Randomized waitlist-controlled trial of buried in treasures facilitated support groups and in-home uncluttering (BIT+) for hoarding disorder. Journal of psychiatric research Wheaton, M. G., Varias, A. D., Sandhu, T., Munoz Rodriguez, P. A., Mukunda, P., Filippou-Frye, M., Millen, A., Lombardi, A., van Roessel, P., Raila, H., Anderson, K., Linkovski, O., Mahnke, A., Sanchez, C., McCarthy, E., Wright, B., Mibenge, C., Rico, Y., Righi, S., Halsey, C., Torio, L., Asgari, S., Qiu, T., Garcia, G., Jo, B., Belofsky, B., Shuer, L. J., Frost, R. O., Rodriguez, C. I. 2024; 176: 58-67

  Abstract

  OBJECTIVE: The Buried in Treasures (BIT) workshop is a promising treatment for hoarding disorder (HD), though many participants struggle with home uncluttering. This randomized waitlist-controlled trial investigated the efficacy of a version of BIT, augmented with in-home uncluttering practice (BIT+).METHOD: Adults (N=41) with hoarding disorder were recruited from the community and randomly assigned to BIT+or waitlist. BIT+consisted of 16 sessions of the BIT workshop and 10 uncluttering home visits over 18 weeks. Outcome measures included the Saving Inventory-Revised (self-report) and the Clutter Image Rating Scale (self and independent evaluator rated). Between group repeated measures analyses using general linear modeling examined the effect of BIT+vs waitlist control on hoarding symptoms after 18 weeks. Within group analyses examined pre-post effects for all BIT+participants combined after 18 weeks.RESULTS: After 18 weeks, BIT+participants benefited significantly more than waitlist controls on hoarding severity with large effect size (Cohen's d=1.5, p<.001). BIT+ was also associated with improvement reductions in hoarding symptoms, clutter, and functional impairment.CONCLUSIONS: The BIT+intervention offers promise as a treatment option for hoarding. Adding in-home uncluttering practice may incrementally improve discarding practices. Future controlled trials are warranted.

  View details for DOI 10.1016/j.jpsychires.2024.05.055

  View details for PubMedID 38843580

• Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults. Journal of psychiatric research Raila, H., Avanesyan, T., Valentine, K. E., Koo, B., Huang, C., Tsutsumi, Y., Andreeff, E., Qiu, T., Muñoz Rodríguez, P. A., Varias, A., Filippou-Frye, M., van Roessel, P., Bullock, K., Periyakoil, V. S., Rodríguez, C. I. 2023; 166: 25-31

  Abstract

  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.

  View details for DOI 10.1016/j.jpsychires.2023.08.002

  View details for PubMedID 37716272

• Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults Raila, H. 2023

  View details for DOI 10.1016/j.jpsychires.2023.08.002