ACT Researchers Offer Remote Therapy for Decluttering and Trichotillomania Disorders

ACT Guide, a self-guided online therapy program designed by researchers at USU, is adding two specialized programs for individuals who struggle with a decluttering disorder and trichotillomania (hair pulling disorder).

ACT Guide is an online program based on Acceptance and Commitment Therapy, an effective approach to mental health that is used to treat a range of concerns such as anxiety, depression and stress. ACT Guide can be completed entirely online and at an individual’s own pace, providing an evidence-based self-help option for individuals with limited access to mental health care and others who need support on their own schedule.

The two new service lines were developed by researchers and graduate students in the Utah State University ACT Research Group to address specific disorders and challenges using the principles of Acceptance and Commitment Therapy:

• ACT Guide for Decluttering is designed to help individuals dealing with symptoms of hoarding disorder.
• ACT Guide for Trichotillomania is aimed at individuals experiencing trichotillomania, a disorder that causes recurrent urges to pull out scalp or body hair.

“The USU ACT Research Group is a leading lab for evaluating ACT for obsessive-compulsive-related disorders, including trichotillomania and hoarding disorder,” said Michael Levin, psychology professor and co-director of the USU ACT Research Group. “As part of our lab mission, we aim to make the programs we develop and evaluate available to the wider public. We are excited to now be offering ACT Guide for Trichotillomania and ACT Guide for Decluttering as part of our suite of self-help programs available to the public.”

ACT Guide’s suite of self-guided mental health programs include the original ACT Guide for general audiences and USU students, ACT Guide for Adolescents, and ACT Guide Lite, an abbreviated version of the program for those who want to try it out or refresh the skills they learned from one of the full programs.

Levin and his research team are also currently working on specific programs for individuals with chronic pain, caregivers of individuals with dementia, autistic adults and individuals with compulsive skin picking.

Continue reading for a Q&A with two of the researchers involved in the development of the new programs.

Jennifer Krafft is an assistant professor in clinical psychology at Mississippi State University. Krafft developed a web-based version of ACT for people with hoarding-related problems for her dissertation in the Combined Clinical/Counseling Psychology program at USU.

Doctoral student Leila Capel is in her fourth year of study in the combined clinical/counseling program at USU. Her research focuses broadly on acceptance-based treatment of obsessive-compulsive and anxiety disorders.

Q: Who is ACT Guide for Decluttering for?

JK: This program is a good fit for people who feel like they have a lot of belongings — especially those who feel that it’s hard for them to let go of belongings, even though they may feel like the level of stuff they have doesn’t work well in their life.

It’s tailored to the kinds of problems that are especially relevant to hoarding disorder: It helps people practice behavioral skills like discarding belongings, it helps people overcome the negative perceptions and stigma around hoarding, and it helps people overcome feelings of shame to live more in line with their personal values.

Q: How is ACT Guide for Decluttering different from the original version of ACT Guide?

JK: We added some sections that are specifically focused on when people feel self-judgement or shame to help them come up with ways to be more accepting, mindful and flexible with those feelings. We also added a session focused on identities. Sometimes our belongings are really related to our identity, so we added in exercises that focus on being flexible with your identity so it doesn’t feel like it rests so much on your belongings.

Q: What was the motivation behind creating a version of ACT Guide to address hoarding specifically?

JK: I was especially excited about releasing a hoarding version of ACT Guide because there’s just not that many resources for it out there, especially in the self-help world. It felt to me like an area where there’s an especially big gap and a big need for this type of accessible program.

Addressing hoarding tends to be a long-term process. If you go through the program, it’s likely that you’ll make a difference in the amount of clutter you have in your home, but it will take some time and practice applying those skills. Our main goal is to help people develop skills to feel like they can make decisions about their belongings with more flexibility — that they can make those decisions mindfully and with their personal values in mind.

Q: How does hoarding disorder impact lives?

JK: There’s a lot of variability in how severe it is from person to person, but hoarding disorder is surprisingly common. It affects an estimated 2.5% of people, and it affects a lot of domains of life. It tends to go along with people feeling more stress, anxiety and depression, but it also affects people’s social lives in profound ways, making it hard to invite over friends or connect with family.

Q: How can ACT Guide for Decluttering help people who are facing hoarding challenges?

JK: We all have belongings we care about. We all have reasons that we want to hold onto belongings, and those reasons can come from really understandable places, whether it’s sentimental attachment or not wanting to see things go to waste. Hoarding problems don’t come out of nowhere; they make sense, and there are ways to improve them so they don’t control your behavior so much.

ACT Guide focuses on teaching people a range of skills that focus on things like mindfulness to help people be more aware of their emotions and thoughts and how those might influence them. It focuses on emotional acceptance; in the program, we help people practice experiencing the distress of letting go of belongings in a non-judgmental and open way so that they are still able to proceed with decluttering if that is consistent with their personal goals.

Q: What’s the background behind creating the ACT Guide for Trichotillomania?

LC: Finding treatment for trichotillomania is very difficult for many reasons, but a big reason is that providers do not know what it is or how to treat it. ACT Guide for Trichotillomania was designed to help make treatment more available.

Q: What is trichotillomania? How common is it?

LC: Trichotillomania is a disorder that involves repetitive hair pulling that leads to visible hair loss. Pulling can happen on any body part but the most common place is the scalp. The pulling is distressing and often leads to people avoiding many important activities or responsibilities (e.g., social events; work). Often, people describe impacts in their social, romantic and school/work obligations which make quality of life much worse.

Trichotillomania is common (around 1.7% of the population). It typically starts in early adolescence. Often the symptoms fluctuate and change over time. For example, someone may pull the hair on the scalp and then stop pulling from the scalp but the pulling moves to eyelashes or eyebrows. It also may fluctuate, for example, someone may pull a lot for several months and then pull very little for weeks/months/ years before the pulling increases again.

Q: How can ACT Guide for trichotillomania help?

LC: ACT Guide for Trichotillomania provides two types of interventions, habit reversal training and acceptance and commitment therapy, to help manage urges to pull. These skills range from making a fist when feeling the urge to pull to more cognitive strategies like riding out the urge to pull. At the end of ACT Guide for trichotillomania, you have many different types of skills to help when you have the urge to pull.

Q: How is it different from the regular ACT Guide and the practices taught there?

LC: ACT Guide for trichotillomania provides specific skills to help with pulling and the different emotions that go along with pulling (both habit reversal training skills, and acceptance and commitment therapy skills). Regular ACT Guide teaches some of the same skills but focuses only on acceptance and commitment therapy. So, some skills that may be key to helping decrease pulling (but would be less useful for anxiety) are not addressed in regular ACT Guide.

For more information on the ACT Guide, please visit the website.