Cognitive Behavioral Therapy (CBT) techniques are the most widely recognized treatment for Excoriation Disorder although the specific duration of treatment is unknown at this time and likely varies from patient to patient. Early CBT treatment studies provide preliminary evidence for skin picking reduction with habit reversal or acceptance-enhanced behavior therapy.
Habit Reversal Therapy (HRT) is a first-line treatment and focuses on awareness training (encouraging awareness of situations that can precede picking episodes); relaxation training (since anxiety and stress are commonly reported triggers for skin picking episodes); competing response training (encouraging unwanted picking behaviors to be replaced with a less conspicuous action—e.g., clenching fists or squeezing a stress ball antagonistic to the picking action); social support (someone who can point out the person’s behavior to help him or her become more aware and to remind the patient to practice the competing response); motivation procedures (designed to improve how acceptable HRT is to patients and their families); and generalization training (rehearsing trigger situations and the sequence of starting the picking episode, quelling it, and undertaking a competing response). There is evidence that a short course of HRT (3-6 sessions) may be beneficial.
Stress reduction training, in conjunction with habit reversal techniques, are also beneficial in helping patients to reduce picking and deal with emotion regulation difficulties. Depending on the triggers of the patient, learning how to reduce stress may alleviate some of the intensity of picking urges and behavior. For example, if the patient reports that high levels of work stress generally trigger a picking episode in the car on the way home from the office, the clinician can suggest ideas to manage the stress without picking (such as going for a vigorous walk immediately after work prior to getting in the car).
Acceptance and Commitment Therapy (ACT) is a therapy technique in which patients are asked to experience urges to pick and accept the urge without acting on it. The negative emotions involved with picking are also engaged but not acted upon. The idea is that understanding, feeling, and experiencing the fact that the individuals do not have to respond to an urge or emotion can help the patient to feel more in control of their picking. ACT has generally involved 8 sessions to treat Excoriation Disorder although a shorter or longer duration of therapy sessions may be indicated based upon patient symptoms and preference.
Online Therapy. Online therapeutic tools have also been developed by expert clinicians with a substantial amount of experience treating skin picking, including at www.stoppicking.com. The behavioral therapy offered online seeks to help the patient to identify situations or triggers prompting skin picking and subsequently strategize ways in which the patient can address and change those behaviors. Online therapy has been reported as particularly useful for individuals living in rural communities, those with a hectic schedule, or for those who prefer to engage in therapy without leaving their home (due to, for example, embarrassment or shame from lesions or scars resulting from where skin picking has occurred).