Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking.

Researchers sent an online survey to 92 adults who said they pick their skin. The survey asked how often and how hard they pick, how sad or nervous they feel, and how much they try to avoid upsetting thoughts.

They wanted to see if ‘experiential avoidance’ helps explain why skin picking and emotional pain often show up together.

The worse the picking, the higher the scores for depression and anxiety. Experiential avoidance sat in the middle: it partly carried the link between picking severity and emotional distress.

In plain words, people who work hard to push away uncomfortable thoughts and feelings report both more picking and more mood trouble.

Casanova (2023) tested an ACT-based exposure add-on to habit reversal. HRT cut picking the most, but the ACT piece gave a small extra gain. That trial builds on the 2006 survey: if avoidance is a key driver, then ACT moves that fit perfectly.

Richman (2008) argues that avoidance turns ordinary sadness into clinical depression. The skin-picker data line up: avoidance scores partly explain why picking and mood symptoms travel together.

Sairanen et al. (2015) show that psychological flexibility helps overweight adults eat intuitively. The same flexibility construct (low avoidance) predicts better mental health across very different body-focused habits.

During intake, add a brief measure of experiential avoidance (e.g., AAQ-II). A high score signals that standard sensory or habit blocks may not be enough. You can weave in values work, mindfulness, or ACT-based exposure to target the avoidance itself, not just the picking topography.