Acceptance and Commitment Therapy (ACT) for excoriation disorder

Acceptance and Commitment Therapy (ACT) is a type of cognitive behavioral therapy (CBT) that that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies. ACT  is used in conjunction with mindfulness based techniques, which teaches clients to become present in each moment. The method may seem counter-intuitive to many as it promotes the acceptance of negative thoughts and feelings as part of the human experience. This is termed the Acceptance part of the technique. The indvidual is then encouraged to think of ways to respond to these negative thoughts and emotions in a way that fully embraces personal values and goals.  This is the commitment aspect of ACT as the individual pledges commitment to their identified values and goals. ACT has strong roots in the Relational Frame Theory, which highlights the ways that language reinforces or refutes thoughts and beliefs and how this in turn can be used as a powerful tool to counter the negative thought processes that influence out behaviors. Instead of resisting unwanted thoughts, feelings, memories, and physical sensations through avoidance and other destructive behaviors, clients are taught strategies to change the context of their thoughts and to accept their thoughts rather than oppose them. However the development and insight into the client's unique personal values is crucial to establishing a commitment to behavior change that is congruent with these values.

How does it work?

A key aspect of ACT is being aware of the thoughts and feelings that influences our behavior. If you are not able to identify the reasons you are engaging in undesirable behaviors, you cannot adress these. As such ACT promotes the practice of being present in the moment and developing an awaress of what you are thinking, feeling and experiencing at any given time. ACT then teaches people how to engage with and overcome painful thoughts and feelings not through avoidance but through observing these as experiences rather than tangible facts. ACT is about embracing life and feeling everything it has to offer. There is a thriving research community that examines the basic science underlying ACT and the effectiveness of applying ACT techniques to numerous life problems such as trichotillomania, skin picking, anxiety, depression, PTSD, substance abuse, chronic pain, psychosis, eating problems, and weight management, just to name a few.

ACT and Skin Picking

Excoriation or compulsive skin picking disorder is a behavioral problem, and is often referred to as a habit disorder, but it is important to consider the cognitive and emotional components of the behavior. CBT is seen to be the most effective form of therapy for BFRBs. Behaviour therapy has the greatest empirical support, but the number of mental health providers familiar with excoriation disorder and its treatment is quite small. It is suggested that a blend of traditional behaviour with therapy elements of habit reversal training and stimulus control techniques, with the more contemporary behavioural elements of Acceptance and Commitment Therapy (ACT) is the most holistic approach for excoriation disorder. This is the approach we have taken in developing the online therapy program here at Skinpick.com

Practical Application

In the first phase of the program, clients are taught skills for stopping and preventing their unconscious picking episodes through competing responses and stimulus controls. In the second phase, clients are introduced to ACT. Unlike traditional interventions that aim to change type or frequency of picking-related thoughts or emotions in the hopes of reducing urges to pick, our program uses strategies to change the function of these cognitions. Clients are taught to see urges for what they really are and to accept their picking-related throughts, feelings, and urges without fighting against them. This is accomplished through distancing oneself from your thoughts and changing the context of the thoughts so as to minimize the power of these thoughts. Over the course of approximately 8 weeks, clients learn to be aware of their picking and warning signals, use self-management strategies for stopping and preventing picking, stop fighting against their picking-related urges and thoughts, and work towards increasing their quality of life. Self-monitoring and homework assignments keep clients motivated and engaged throughout. There is a growing amount of empirical evidence indicating that ACT can be very effective in the treatment of body-focussed repetitive behaviors (BFRBs) such as skin picking disorder.