From Avoidance to Acceptance: Using ACT to Change Your Relationship with Skin Picking

For someone with skin picking disorder, the urge to pick can feel like an unrelenting force that demands attention, creating a tension that can only be relieved if you give in and pick. But picking is only one part of the experience of this disorder. After the picking comes feelings of shame, frustration and guilt, setting up a vicious cycle that is hard to break. 

You’ve probably been told things like “just stop” or “find something to do you’re your hands” or other acts of resistance. You’ve tried to resist the urge, but it usually wins out. What if breaking free from skin picking lies not in resistance but acceptance?

What Is Acceptance?

Acceptance is one of those often misunderstood terms. Acceptance is often thought of as resignation or of being powerless to do anything. 

On the contrary, acceptance is about choice – your choice about how you handle something and where your boundaries lie. Acceptance allows you to see things as they are and make choices that are right for you. 

Acceptance is also the foundation for a form of therapy known as Acceptance and Commitment Therapy (ACT) that is often used as part of treating skin picking.

What Is Acceptance and Commitment Therapy (ACT)?

Acceptance and Commitment Therapy (ACT) is a powerful, evidence-based approach that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. At its core, the aim of ACT is psychological flexibility, to help a person to face and accept what is out of their control and engage in meaningful activities while uncomfortable thoughts or sensations (such as urges) are present. 

ACT encourages people to accept their thoughts, feelings, and urges rather than fighting them, while committing to actions aligned with their values. Unlike traditional cognitive-behavioral therapy (CBT), which often focuses on changing or eliminating negative thoughts, ACT emphasizes acceptance of what cannot be controlled and purposeful action toward what matters most. For someone with skin picking disorder, ACT offers a framework to reframe their relationship with urges and discomfort, creating space for healing and growth.

Shifting the Focus: From Resistance to Acceptance

Skin picking often stems from an attempt to escape uncomfortable emotions—stress, anxiety, boredom, or even perfectionism. The act of picking might provide temporary relief, but it’s typically followed by guilt and shame, reinforcing a vicious cycle. Conventional wisdom tells us to resist the urge and to fight through it. But this resistance can amplify the urge’s power, turning it into an all-consuming battle.

ACT takes the opposite stance. Instead of viewing the urge to pick as an enemy to defeat, it invites you to accept the urge as a sensation or thought that simply exists – no judgment or the need to act on it. For example, when an urge strikes, you might think, “Ugh, I can’t stand it! I need to make it stop!” An ACT-informed response might be, “Hey I’m noticing an urge to pick right now. That’s ok. It doesn’t control me.” This kind of shift in thinking reduces the emotional intensity of the urge, letting it pass without resistance. 

A Healthier Way of Coping 

ACT has been shown to be quite effective in treating skin picking, alone as well as when combined with other modalities such as Habit Reversal Training (HRT) and exposure therapy, a technique often used for treating OCD.

By accepting discomfort rather than fighting it, ACT fosters resilience. The urge to pick may never fully disappear, but its power diminishes as it becomes just one part of a larger, richer life. Research supports ACT’s effectiveness for skin picking, showing it reduces distressing symptoms and promotes the use of adaptive coping strategies.

If you’re living with skin picking, it’s important to remember, it’s about progress, not perfection. Rather than constantly trying to fight the urge, you can choose to sit with the discomfort, knowing it will pass, and knowing you have the choice to take small, intentional steps towards healing. If you want to learn more about the power of acceptance, a therapist trained in ACT and body focused repetitive behaviors (BFRBs) like skin picking can help you learn to tap into the power of acceptance. You have the power of choice. 

References

1. Utah State University. (n.d.). ACT guide for skin picking. College of Education and Human Services | USU. https://cehs.usu.edu/scce/services/act-guide/act-for-skin-picking

2. Anderson, S., Clarke, V., & Thomas, Z. (2022). The problem with picking: Permittance, escape and shame in problematic skin picking. Psychology and Psychotherapy: Theory, Research and Practice, 96(1), 83-100. https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/papt.12427

3. Flessner, C. A., Busch, A. M., Heideman, P. W., & Woods, D. W. (2008). Acceptance-enhanced behavior therapy (AEBT) for trichotillomania and chronic skin picking: exploring the effects of component sequencing. Behavior modification, 32(5), 579–594. https://pubmed.ncbi.nlm.nih.gov/18334614/