Introduction
Anxiety, anxiety, hoarding disorders, hoarding, Obsessive-Compulsive, Hoarding disorder, obsessive-compulsive personality disorder, hoarding behaviors, hoarding, cognitive fusion, thirty-nine, pain, OCPD, cognitive defusion, depression, Depression, Hoarding, OCD, obsessive-compulsive disorder
Edited by: Keong Yap, Australian Catholic University, AustraliaReviewed by: Junhui Wu, Institute of Psychology (CAS), China; Hui Zhang, Nanjing Normal University, ChinaThis article was submitted to Public Mental Health, a section of the journal Frontiers in Public HealthHoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. 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. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.Hoarding disorder has been considered a subtype of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) (Research has shown that individuals with higher attachment anxiety often exhibit higher hoarding (Many theoretical models have integrated emotional regulation and emotional responses into the onset and maintenance of psychological symptoms (Hoarding could be influenced by psychological flexibility. As a core component of acceptance and commitment therapy (ACT), psychological flexibility can be divided into six core processes: acceptance, cognitive defusion, engagement with the present moment, self as context, values, and committed action (Most current interventions for hoarding behaviors are less effective or even ineffective, but many kinds of cognitive behavioral therapy (CBT) have shown definite effectiveness in reducing hoarding disorders (Rational Emotive Behavior Therapy (REBT) is one kind of traditional CBT, but there is little empirical evidence on the efficacy of REBT for hoarding. The theoretical basis of REBT is the ABC theory of emotions (According to the cognitive model of hoarding, the manifestation of hoarding (e.g., difficulty discarding, clutter, and acquiring) stems from a variety of avoidance behaviors aiming to avoid distress (Currently, the vast majority of ACT research or psychological flexibility studies have been conducted in Western countries and in English. In addition, contemporary research on hoarding has also focused on Western countries, and there is a lack of research on the effects of ACT on hoarding behaviors in different cultural contexts. Moreover, some studies focusing on mechanisms of change have suggested that the effect of ACT or CBT on outcome variables (e.g., depression, pain interference, and OCD) is mediated by its impact on psychological flexibility or cognitive fusion (According to the aforementioned, hoarding can be accompanied by attachment anxiety, difficulties with emotion regulation, and negative emotions. Therefore, the main purpose of this study was to investigate the efficacy of ACT and REBT on hoarding among Chinese college students and to explore whether psychological flexibility or cognitive fusion mediates the effect of ACT/REBT on the outcome variables (i.e., hoarding behaviors, difficulties in emotion regulation, and attachment anxiety).