Cognitive-behavior therapy for self-injurious skin picking. A case series.
CBT plus habit reversal can slash severe skin-picking damage even when clients also carry mood or anxiety disorders.
01Research in Context
What this study did
Three adults with severe skin picking got a mix of CBT and habit reversal.
Two of them also had depression or anxiety.
Therapists met them once a week over the study period and tracked how much skin damage they caused.
What they found
All three people cut their skin damage by at least half.
One person stopped picking almost completely.
The gains held up three months later, even for the two with extra mental-health issues.
How this fits with other research
Kahng et al. (1999) showed that plain habit reversal fails for clients with intellectual disability unless you add remote prompts and rewards.
Thilo’s study shows the same core package works for adults without ID who have psychiatric comorbidity, so the earlier finding doesn’t apply here.
Sturmey (2009) reviewed many trials and says CBT is solid for depression; this paper adds skin picking to the list of problems CBT can tackle.
Wulfert et al. (2006) used CBT plus motivational interviewing to keep gamblers in treatment; Thilo kept everyone engaged without extra motivation steps, hinting that skin-picking clients may need less front-end work.
Why it matters
If you treat adults who pick until they bleed, you can start with the classic habit-reversal steps and fold in standard CBT mood tools.
No need for fancy tech or extra motivational sessions—just weekly therapy and self-monitoring worked for these severe cases.
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02At a glance
03Original abstract
Self-injurious skin picking is characterized by repetitive, ritualistic, or impulsive skin picking that leads to tissue damage and causes significant distress or impairment in daily functioning. Little is known about effective behavioral or cognitive-behavioral treatments for self-injurious skin picking. As described by Azrin and colleagues, habit reversal is a promising behavioral treatment for modifying nervous habits or tics. To the authors' knowledge, only one case series currently exists in the literature that shows self-injurious skin picking, in the absence of an underlying dermatological condition or without psychiatric comorbidity, can be successfully treated with habit reversal. In the current article, the authors describe the implementation and outcome of cognitive-behavior therapy for three patients with severe self-injurious skin picking, two of which had psychiatric comorbidity.
Behavior modification, 2002 · doi:10.1177/0145445502026003004