Evidence-Based Treatment of Trichotillomania and Skin Picking with ACT-Enhanced Behavior Therapy

CE Hours 8.5

About this course

This on-demand training offers six professionally produced modules teaching participants how to effectively treat trichotillomania and skin picking using Acceptance and Commitment Therapy (ACT)-Enhanced Behavior Therapy (A-EBT). A-EBT has been supported in at least 20 outcome studies by multiple research teams from around the world. It has been tested with adults and adolescents when used in person, via video conferencing, or as a web-based treatment. There is a publicly available treatment manual that therapists and clients may follow as they learn to implement A-EBT (Woods and Twohig, 2023).

Participants will learn how to diagnose trichotillomania and be aware of common clinical presentations. They will also learn how to use standard psychological assessments commonly used in the treatment of trichotillomania. The workshop will provide an in-depth understanding of the theoretical basis and principles of Trigger Reduction, Habit Reversal, and Acceptance and Commitment Therapy (ACT). Participants will learn how to apply ACT principles to help clients manage difficult emotions and thoughts that can trigger hair pulling and skin picking behaviors.

The training will also address common clinical issues that occur in the treatment of trichotillomania and skin picking, such as resistance to treatment, relapse, and fluctuating motivation. Participants will learn how to implement strategies to overcome these obstacles and promote long-term recovery. A-EBT is taught via lecture, demonstrations, and recorded therapy sessions. Participants will see Dr. Twohig's expertise in implementation of these skills with one adult with skin picking and one adult with trichotillomania.

Overall, this workshop will equip participants with the knowledge and skills needed to provide effective treatment for trichotillomania and skin picking using Acceptance-Enhanced Behavior Therapy.

Ongoing Consultation:

For the first 6 months after this course launches, Dr. Twohig will host free monthly online group consultation meetings. Anyone who registers during this 6 month period will have access to these live consultations. Please note: consultation meetings are not eligible for CE credit. Register early to maximize the number of sessions you can attend!

Registration Emails:

If you register with a .edu or .org email address, registration emails may go to your spam folder. Please check your spam folder if you are using these types of email addresses.

Learning Objectives

Identify and diagnose trichotillomania and excoriation disorder.
Administer and interpret validated assessment measures for hair pulling and skin picking severity and functional impact.
Construct a case formulation integrating behavioral, emotional, cognitive, and contextual factors contributing to trichotillomania and skin picking based on acceptance and commitment therapy-enhanced behavior therapy (A-EBT).
Establish therapeutic rapport and collaboratively set treatment goals with clients with trichotillomania and skin picking.
Implement stimulus control strategies to reduce exposure to high-risk situations and cues.
Teach and reinforce competing response techniques as part of habit reversal training.
Guide clients in practicing acceptance of uncomfortable internal experiences without engaging in picking or pulling.
Introduce and facilitate defusion exercises to help clients observe thoughts without attachment or judgment.
Demonstrate how to help clients clarify personal values and support clients in making behavioral commitments aligned with their values despite discomfort or urges.
Integrate ACT principles with behavioral strategies to create a cohesive treatment plan for skin picking and hair pulling.

Learning Levels

Beginner
Intermediate

Target Audience

This webinar is intended for behavioral health professionals, including Psychologists, Social Workers, Counselors, and MFT's.

Course Instructor(s)

Michael Twohig, PhD

Professor of Psychology, Utah State University

Michael P. Twohig, Ph.D. is a psychologist in Utah and a Professor of Psychology at Utah State University, where he co-runs the ACT Research Group (with Dr. Levin). He received his B.A. and M.S. from the University of Wisconsin-Milwaukee, his Ph.D. from the University of Nevada, Reno, and completed his clinical internship at the University of British Columbia Hospital. He is past-President of the Association of Contextual Behavioral Science and winner of the 2025 D. Wynn Thorne career research award. His research focuses on the use of ACT across a variety of clinical presentations with an emphasis on obsessive compulsive and related disorders. He has published over 250 peer-reviewed papers, many book chapters, and 13 books, with the most recent being the Anxious Perfectionist (with Ong) and Trichotillomania: An ACT-Enhanced Behavior Therapy Approach (2nd Ed.; with Woods). His research has been funded through multiple sources including the National Institute of Mental Health, IOCDF, and the Misophonia Research Fund. In 2022, 2024, and 2025 he was rated as the most productive author on ACT in the world.

Disclosure

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS CE Learning Systems adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CE activity ― including faculty, planners, reviewers, or others ― are required to disclose all relevant financial relationships with ineligible entities (formerly known as commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. The following relevant financial relationships have been disclosed by this activity’s planners, faculty, and the reviewer: PLANNERS AND REVIEWER The planners of this activity have reported that they have no relevant financial relationships. FACULTY The faculty of this activity receives a portion of the proceeds from this training and sales from the mentioned book.

References

Woolley, M. G., Schwartz, S. E., Morrison, K. L., & Twohig, M. P. (2025). Dissemination trial of provider training of ACT-enhanced behavior therapy for trichotillomania: A waitlist controlled study. Behavior Therapy, 56(3), 648–665. https://doi.org/10.1016/j.beth.2025.01.005
Twohig, M. P., & Capel, L. K. (2025). Acceptance and commitment therapy–enhanced behavior therapy as an intervention for trichotillomania and excoriation disorder (skin picking): A review. Psychiatric Clinics of North America, 48(3), 505–519. https://doi.org/10.1016/j.psc.2025.02.011
Capel, L. K., Woolley, M. G., & Twohig, M. P. (2024). Psychosocial treatment of trichotillomania: A review. Cognitive and Behavioral Practice. Advance online publication. https://doi.org/10.1016/j.cbpra.2024.05.003
Bowers, E. M., Capel, L. K., Woolley, M. G., Barnes, A., Twohig, M. P., & Levin, M. E. (2024). Efficacy and feasibility of web-based ACT-enhanced behavioral treatment for skin picking in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 43, 100909. https://doi.org/10.1016/j.jocrd.2024.100909
Capel, L. K., Bowers, E. M., Becker, M. R., Davis, M. P., Levin, M. E., & Twohig, M. P. (2024). Assessing factors of adherence and efficacy: A randomized controlled trial of a fully automated self-help A-EBT website. Journal of Obsessive-Compulsive and Related Disorders, 43, 100908. https://doi.org/10.1016/j.jocrd.2024.100908

CE Process Info

Content

Welcome and Materials

6 parts
- Use Disclaimer
- How to Access Forms, Worksheets, & Assessments
- Free Live Monthly Group Consultation Meetings with Dr. Twohig
- Links to Accompanying A-EBT Books
- Discount Code Flier for Accompanying A-EBT Books
- Welcome from Dr. Twohig!
Module 1: Understanding Trichotillomania and Skin Picking

11 parts
- How to Diagnose Trichotillomania and Excoriation Disorder
- Information on Trichotillomania and Skin Picking
- Effects of Hair Pulling and Skin Picking
- Contextual Factors of Picking and Pulling
- Assessing and Conceptualizing Pulling and Picking
- Assessing for Psychological Flexibility
- Assessing Severity
- Assessing Contextual Factors
- Case Conceptualization
- Cultural Awareness
- What is ACT-Enhanced Behavior Therapy?
Module 2: Getting Started with Therapy

8 parts
- Getting to Know your Client's Pulling or Picking
- Setting Expectations of Treatment
- Real Play: Lindsay -- Case Description
- Real Play: Lindsay -- Setting Expectations
- Overview of Treatment
- Setting Up Ongoing Assessment
- Real Play: Liz -- Case Description
- Real Play: Liz -- Setting Up Ongoing Assessment
Module 3: Trigger Reduction and Habit Reversal

5 parts
- Trigger Reduction
- Real Play: Liz -- Trigger Reduction
- Habit Reversal
- Teaching Habit Reversal
- Real Play: Lindsay -- Habit Reversal
Module 4: ACT, Values, and Behavioral Commitments

8 parts
- ACT in A-EBT
- Introducing Psychological Flexibility
- Values
- Facilitating Values
- Real Play: Lindsay -- Values
- Behavioral Commitments
- Facilitating Behavioral Commitments
- Real Play: Lindsay -- Behavioral Commitments
Module 5: Acceptance and Defusion

8 parts
- Maintaining Momentum
- Acceptance
- Creative Hopelessness
- Real Play: Liz -- Creative Hopelessness
- Facilitating Acceptance
- Real Play: Lindsay -- Acceptance
- Defusion
- Real Play: Liz -- Defusion
Module 6: Practicing Skills and Ending Therapy

7 parts
- Self-As-Context
- Being Present
- Making Friends with the Urge
- Real Play: Liz -- Making Friends with the Urge
- Wrapping Up with Clients
- Finding Clients
- Thank You!
Reminder: Worksheets, Assessments, and Manual

3 parts
- Reminder: How to access Forms, Worksheets, & Assessments
- Reminder: Links to Accompanying A-EBT Books
- Reminder: Discount Code Flier for Accompanying A-EBT Books

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FAQs

Course Completion

To complete the course, review the course objectives, then review the material, and then pass the exam with a score of 70% or greater and lastly complete an evaluation. Your certificate will be available to download immediately when you pass the course exam and complete the evaluation.
CELS Grievance

If a grievance arises pertaining to continuing education activities or processes, please contact Tyler Gibson via confidential email to tyler@celearningsystems.com as soon as possible, so that the nature of the concern may be addressed in a timely fashion.
Disability Accomodations

ADA accommodations will be made in accordance with the law; please indicate your special needs prior to registering for the course by sending an email to support@ce-go.com or by calling us at 888 498 5578.
Target Audience

This educational activity is intended for behavioral health professionals, including Psychologists, Social Workers, Counselors, and MFT's.
Juniper Mental Health Contact Information

info@junipermh.com 801-251-6688

Evidence-Based Treatment of Trichotillomania and Skin Picking with ACT-Enhanced Behavior Therapy

About this course

Learning Objectives

Learning Levels

Target Audience

Course Instructor(s)

Disclosure

References

CE Process Info

Content

Joint Accreditation (JA)

American Psychological Association (APA)

Association of Social Work Boards (ASWB)

New York State Education Department's State Board for Social Work (NYSEDSW)

New York Education Department Board of Creative Arts Therapy (NYSEDCAT)

New York Education Department for Licensed Mental Health Counselors (NYSEDLMHC)

New York Education Department Board for Licensed Psychoanalysts (NYSEDLP)

New York State Education Department's State Board for Psychology (NYSEDPSY)

New York State Education Department's State Board for Marriage and Family Therapy (NYSEDMFT)

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