Discussion
anxiety, hoarding, hoarding, cognitive fusion, hoarding behaviors, depression, OCD, obsessive-compulsive disorder
In this study, ACT and REBT were found to reduce hoarding compared to the control group. Specifically, ACT and REBT improved individuals' psychological flexibility and reduced cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Finally, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding behaviors, negative affect, attachment anxiety).ACT has been found to alleviate individuals' OCD (Previous studies have suggested that other therapies can also affect psychological flexibility, including other forms of CBT, such as exposure and response/or ritual prevention (Additionally, some studies focusing on mechanisms of change have suggested that the effect of ACT or CBT on outcome variables is mediated by its impact on psychological flexibility (The present study did not find a mediating role of cognitive fusion. Future research should explore the possible mediating roles of other process variables in the effects of various forms of CBT on psychological and behavioral outcomes related to hoarding. Such process-based research may be better able to distill potent components from ACT and other formats of CBT to develop a coherent intervention framework for hoarding in the service of streamlining treatment development, dissemination, and implementation (There are some limitations in this study. The present study did not carry out follow-up measures to examine the durability of the effects of the intervention study, and there is a lack of follow-up studies on the stability of the intervention effect. Second, this study measured psychological flexibility using the Acceptance and Action Questionnaire II (AAQ-II), which measures only one dimension of psychological flexibility (Overall, current findings provide preliminary support for the efficacy of ACT and REBT for hoarding and associated impairment in China. We found that ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder. Furthermore, this study examined the mediating role of psychological flexibility as a process variable. A test of mediating effects would be helpful in understanding the mechanisms of CBT in non-Western countries and the role of psychological flexibility in individual psychological and behavioral changes.