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Habit Reversal

Skin Picking Disorder


Also known has Dermatillomania or excoriation disorder, it is listed in the ICD diagnostic manual as a body-focused repetitive behaviour. 

Treating Skin Picking

The treatments for skin picking are very similar to those for OCD, with the treatment found to be the most effective being a talking therapy called Cognitive Behavioural Therapy (CBT). Some people find they also need the additional support of anti-depressant medications to help them through the therapy which will usually be a form of anti-depressant SSRI (Selective Serotonin Re-uptake Inhibitor) medications.

With skin picking an additional element of therapy may be introduced, a technique called habit reversal training. Habit reversal training works by helping the person recognise and be more aware of their skin picking and what is triggering it and sometimes help a person replace skin picking with a less harmful behaviour. This means repeatedly learning to tolerate the resulting discomfort.

Habit Reversal

Habit reversal training (HRT) is an evidence-based highly effective behavioural therapy for people with unwanted repetitive behaviours or habits. HRT works on behaviours such as: tics, hair pulling, nail biting, and skin picking to name a few, and is appropriate for people at any age. Often we don’t really understand what is driving our behaviours (like relief from urges or feelings) until we look for them with the help of a professional.

Habit Reversal Training is made up of five parts:

  1. Awareness training: brings attention to the behaviour so the person can gain better self-control and awareness. In this stage you will work to notice when you are performing the behaviour, identify the earliest warning that a behaviour is about to take place, and identify the situations where the behaviour occurs.

  2. Competing response training: you will work with your therapist to come up with a different behaviour to replace the old unwanted behaviour and practice performing this new behaviour.

  3. Motivation and compliance: you may make a list of all the problems that were caused by the behaviour to remind you of the importance of sticking with it. Parents and friends may be asked to offer praise and encouragement for the person’s progress, support of family and friends can increase your chances of kicking an unwanted behaviour.

  4. Relaxation training: habits or tics can be common when a person is under stress, it can be helpful to learn relaxation skills such as deep breathing, mental imaging, mindfulness, and progressive muscle relaxation to keep urges at bay.

  5. Generalisation training: you will practice your new skills in a number of different situations so the new behaviour becomes automatic.

Habit reversal training has also be used in treatment for depression, smoking, gambling problems, anxiety, procrastination, obsessive-compulsive disorders, and other behavioural problems.

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