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

An 8.5 CE, on-demand training led by Dr. Michael Twohig
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8.5 CE Hours

Lifetime, on-demand access

Professionally produced

Lectures, demonstrations, and recorded therapy sessions

Evidence-Based

Backed by 20+ research studies on trichotillomania and skin picking

This on-demand training for trichotillomania and skin picking equips behavioral health professionals with research-backed treatment strategies.

Enroll in Course - 1 payment of $295

Why Learn A-EBT?

What is ACT-Enhanced Behavior Therapy?

Read the summary here

These conditions are more common than you think

Trichotillomania affects about 1.7% of people (Grant, Doherty, & Chamberlain, 2020). Excoriation (skin picking) disorder affects 2–5% (Grant & Chamberlain, 2020).

Clients often receive ineffective care

When individuals with these conditions do seek help, they frequently report receiving treatments that don’t work (Woods et al., 2006).

A-EBT is the most effective, research-supported treatment

ACT-Enhanced Behavior Therapy (A-EBT) is the most empirically supported psychosocial approach for trichotillomania and excoriation disorder (Capel, Woolley, & Twohig, 2024; Twohig & Capel, 2025).

Most providers aren’t fully prepared

Few clinicians accurately understand these disorders or how to treat them effectively (Capel, Petersen, et al., 2024; Marcks et al., 2006). Specialized training in A-EBT can change that (Woolley, 2025).

Welcome, from Dr. Twohig

A-EBT integrates Acceptance and Commitment Therapy (ACT) with Habit Reversal Training (HRT) and Trigger Reduction strategies. It has been tested with adults and adolescents in multiple formats, including in-person, video conferencing, and web-based delivery.

Through a mix of lectures, demonstrations, and therapy recordings, participants will:

  • Learn to diagnose trichotillomania and excoriation disorder
  • Use standard assessments for body-focused repetitive behaviors (BFRBs)
  • Gain an in-depth understanding of ACT, HRT, and Trigger Reduction
  • Watch Dr. Twohig demonstrate treatment in real plays

The workshop also covers common clinical challenges, such as resistance to treatment, relapse, and fluctuating motivation—equipping clinicians with strategies to support lasting recovery.

This training provides clinicians with the skills needed to understand and treat trichotillomania (hair pulling) and excoriation disorder (skin picking) using ACT-Enhanced Behavior Therapy (A-EBT).

What You’ll Learn

By completing this continuing education training for trichotillomania and skin picking, you will be able to:

  • Diagnose trichotillomania and excoriation disorder in clinical practice
  • Implement psychological assessments used in BFRB treatment
  • Apply ACT principles to manage difficult urges, emotions, and thoughts
  • Use Trigger Reduction and Habit Reversal strategies effectively
  • Address treatment resistance, relapse prevention, and motivation issues
  • Support long-term recovery with evidence-based techniques

Your Instructor:

Michael Twohig, Ph.D.

Dr. Twohig is a licensed psychologist, researcher, and leading expert in Acceptance and Commitment Therapy (ACT) and the treatment of obsessive-compulsive and related disorders, including trichotillomania and skin picking. He has authored numerous publications, developed treatment manuals, and trained clinicians around the world in evidence-based practices.

Learn more about Dr. Twohig’s professional background

What Participants Are Saying

The ACT-Enhanced Behavior Therapy for Trichotillomania workshop offers a powerful integration of evidence-based principles drawn from Acceptance and Commitment Therapy (ACT) and traditional behavioral interventions for body-focused repetitive behaviors. This training provides clinicians with a clear, practical framework for helping clients reduce hair pulling while cultivating psychological flexibility and values-based living.

Participants can expect a balance of conceptual clarity and clinical depth. The workshop moves beyond symptom reduction to address the broader patterns of avoidance and struggle that often maintain these behaviors. Attendees will leave with concrete tools they can implement in clinical practice—rooted in empirical support and delivered with compassion and precision.

This is an essential training for any clinician seeking to expand their behavioral repertoire and deliver more comprehensive, person-centered care for individuals struggling with trichotillomania and related conditions.

R. Trent Codd, III, Ed.S., BCBA

Finally, a BFRB course that truly delivers both depth and breadth.

This course is a long-awaited resource that brings together a strong foundation in both diagnosis and treatment of BFRBs. For clinicians working with trichotillomania and skin picking, it is genuinely a treasure. It strengthens both your clinical understanding and your practical skills in a way that is rare to find in a single training.

I have worked with BFRBs for many years and specialize in this area. For me, this was the first time I had access to such a comprehensive and well-structured training presented by Dr Michael Twohig. Whether you are new to the field, experienced, or already an expert, this course offers a complete and research grounded approach that is easy to apply in real clinical work.

What I appreciated most was how clear and accessible the course is. Advanced methods and concepts are presented in a way that feels engaging and easy to follow. It makes the whole experience surprisingly enjoyable, and you quickly find yourself wanting to continue.

I can strongly recommend this course to anyone who wants to develop their skills in the BFRB field.

Johannes Cannán-Magnusson

Unit Manager and Psychotherapist, OCD-Clinic Lerum/Sweden

I cannot say enough wonderful things about this course! Come for the amazing overview of BFRBs and A-EBT, and stay for a fantastic dive into ACT with an expert! Dr Twohig is an amazing resource on both ACT and this treatment for BFRBs, and I will be recommending this course to any colleagues who want to learn about how to treat this important presenting concern. I really like how it is broken down into a few sections made of short videos, which helps to make it digestible and effective. The real plays are so helpful to see the treatment in action, and Dr Twohig’s overviews, examples, and clinical work are very inspiring and effective. I have definitely made note of some additional metaphors and strategies to use in my work!
 
This course is an excellent entry point for clinicians wanting to learn about BFRBs and evidence-based treatments for working with them, as well as experienced clinicians who want to hone their A-EBT skills, or need a refresher. It’s an exceptional resource, and I hope it helps to get more needed specialists into the field!
Lisa Conway

Exposure Therapy Chicago

Very useful content, both for understanding and integration of ACT, as well as BFRBs. Very good supplement to my COM-B training.

Jessica Vornbrock

I learned techniques that I was able to immediately use with clients.

Kristin Kalning

Course Curriculum

Welcome and Materials

How to Access Forms, Worksheets, & Assessments

Free Live Monthly Group Consultation Meetings with Dr. Twohig

Links to Accompanying A-EBT Books

Welcome from Dr. Twohig!

Module 1: Understanding Trichotillomania and Skin Picking

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

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

Trigger Reduction

Real Play: Liz — Trigger Reduction

Habit Reversal

Teaching Habit Reversal

Real Play: Lindsay — Habit Reversal

Module 4: ACT, Values, and Behavioral Commitments

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

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

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!

CE Information

Advance your clinical expertise with this

evidence-based training for trichotillomania and skin picking treatment.

Enroll Now - 1 payment of $295

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References

Capel, L. K., Petersen, J. M., Woods, D. W., Marcks, B. A., & Twohig, M. P. (2024). Mental health providers’ knowledge of trichotillomania and skin picking disorder, and their treatment. Cognitive Therapy and Research, 48(1), 30–38. https://doi.org/10.1007/s10608-023-10381-w

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

Grant, J. E., & Chamberlain, S. R. (2020). Prevalence of skin picking (excoriation) disorder. Journal of Psychiatric Research, 130, 57–60. https://doi.org/10.1016/j.jpsychires.2020.06.033

Grant, J. E., Dougherty, D. D., & Chamberlain, S. R. (2020). Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Research, 288, 112948. https://doi.org/10.1016/j.psychres.2020.112948

Marcks, B. A., Wetterneck, C. T., & Woods, D. W. (2006). Investigating healthcare providers’ knowledge of trichotillomania and its treatment. Cognitive Behaviour Therapy, 35(1), 19–27. https://doi.org/10.1080/16506070510010657

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, 505–520. https://doi.org/10.1016/j.psc.2025.04.002

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

Woods, D. W., Flessner, C. A., Franklin, M. E., Wetterneck, C. T., Walther, M. R., Anderson, E. R., & Cardona, D. (2006). Understanding and treating trichotillomania: What we know and what we don’t know. Psychiatric Clinics of North America, 29(2), 487–501. https://doi.org/10.1016/j.psc.2006.02.009

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