Reducing covert self-injurious behavior maintained by automatic reinforcement through a variable momentary DRO procedure.

The team tested a simple schedule called variable momentary DRO. The client earned a small treat if no skin-picking happened at the exact moment the timer beeped.

The behavior was covert, so staff could not see it live. They used hidden video to check each beep moment. No punishment or extinction was used.

Skin picking dropped sharply once the schedule started. The behavior stayed low even though the client still received no other consequences.

The study shows VM-DRO alone can cut automatically reinforced SIB without blocking the body or saying "no."

Kahng et al. (1999) ran the same VM-DRO schedule 13 years earlier. Their clients had social-positive SIB and the schedule still worked. The 2012 paper proves the same rule holds when the reinforcer is automatic, not social.

Lejuez et al. (2001) also used VM-DRO on low-rate aggression. Both studies echo the same lesson: check at random moments, deliver praise or treats, and the problem fades.

Marcell et al. (1988) took a different path. They paired sensory toys with DRI for automatic SIB. Storch et al. (2012) shows you can skip the toys and still win if you stick to momentary checks.

You can now treat hidden skin picking without punishment, blocking, or fancy toys. Set a variable timer, peek at the moment it beeps, and deliver a quick reinforcer if the hands are still. The client stays safe and you stay hands-off.