Re:Compulsive Skin Picking + CBT

Since the problem sounds quite similar to trichotillomania (compulsive hair-pulling) and I'd think in terms of using Habit Reversal Training. This approach, developed by Nate Azrin in the 1970s consists of several steps:

1. Start with a good evaluation, of course, and deal with any co-occuring problems which need to be treated first.

2. Use self-monitoring to collect information and increase the client's awareness(have the client record each episode of skin picking: when it occurred,where it occurred, duration, strength of urge, what they were doing at the time, emotional state, automatic thoughts, etc.).

3. Teach the client progressive relaxation and diaghramatic breathing.

4. Identify a competing response which involves muscle tension and which is at least partially incompatible with skin picking, such as making a fist.

5. Combine steps 3, 4, and 5. When the urge to pick occurs, have the client relax, engage in deep breathing, and use the competing response instead of picking. Have them do this patiently and persistently knowing that the habit of skin picking won't fade quickly.

6. Use coping self-statements to encourage persistence. Address beliefs and attitudes which interfere.

7. Wearing gloves, finger splints, etc. can be used initially to make it easier for the client to face high-risk situations without picking.

8. Finish with work on relapse prevention:

* Identify high-risk situations and plan how to handle them

* Be prepared for slip-ups, deal with them promptly

* Accept that slip-ups happen and deal with them rather than over-reacting or giving up

* Try to live a balanced life, reduce stress insofar as possible

Note that addressing beliefs and assumptions is only a small part of dealing with this type of problem. Explicitly working for behavior change is essential.

I agree with Carl that the Trichotillomania Learning Center (http://www.trich.org/) can be a useful source of information.

Replies:

Re:Compulsive Skin Picking + CBT, by , 02/24/04

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