The Rothbaum Model of CBT Shows Promise for Treatment of Skin Picking Disorder

One of the challenges of treating compulsive skin picking is that it often co-occurs with other mental health issues such as anxiety, depression, and other body-focused repetitive behaviors. Sometimes, people with skin picking disorder will present to therapy for other issues and can be missed. Originally, the Rothbaum model of cognitive-behavioral therapy was developed to treat trichotillomania that co-occurs with anxiety and depression. A new study shows that it can be adapted and used successfully for skin picking disorder as well.

What is the Rothbaum Model?

This therapy protocol uses cognitive-behavioral techniques with habit reversal training that targets not only skin picking disorder but also anxiety and depression. In this study, the treatment lasted 8 weeks with 45-minute sessions each week for individual therapy and 90 minutes for group therapy.

The treatment protocol begins with psychoeducation about skin picking disorder, identifying triggers, and learning self-monitoring. Then, the treatment moves into habit changing strategies and coping skills as well as thought-stopping and cognitive restructuring. The last part of the protocol involves changing internal dialog, creating positive reinforcement, and role-playing different scenarios. The therapy ends by developing a relapse prevention plan.

Research results

The study that was conducted in Brazil used the Rothbaum model of treatment for people with skin picking disorder in an individual and a group format. The number of participants in each was not exceptionally large, but the results showed they all experienced improvement in skin picking, anxiety, and depression symptoms. Both the individual and group format showed an improvement, but the individual improvements were larger than the group.

Although each person experiences skin picking behaviors differently, the more options available for treatment, the better. This study also shows that treatment interventions need to account for all mental health issues a person experiences and not solely on skin picking. 

Xavier, Alice C.M., de Souza, Camila M.B., Flores, Luís H.F., Bermudez, Mariane B., Silva, Renata M.F., de Oliveira, Ariadne C., & Dreher, Carolina B.. (2020). Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol: a randomized clinical trial. Brazilian Journal of Psychiatry, Epub May 11, 2020.https://dx.doi.org/10.1590/1516-4446-2019-0636