How to use ERP for Skin Picking
Exposure and Response Prevention (ERP) is a widely used and effective therapeutic approach for treating conditions like Dermatillomania (skin picking disorder). ERP involves exposing individuals to situations or stimuli that trigger their compulsive skin picking behavior and then preventing them from engaging in the picking ritual. Here are some exposure exercises that an OCD therapist might use to help someone with skin picking:
Mirror Exposure: The person is asked to sit in front of a mirror, preferably a magnifying mirror, and resist the urge to pick at their skin. This exposure helps them confront their triggers directly.
Texture Exposure: The therapist may provide objects with different textures that mimic the sensation of touching or picking at the skin. The person is encouraged to hold these objects when they feel the urge to pick instead of picking their skin.
Visual Exposure: The individual may be shown images or videos of skin conditions or skin picking behaviors to trigger their urges. This can help them learn to tolerate the distress without engaging in picking. Youtube has a plentiful array of skin care videos that do not include extraction.
Recording Triggers: The individual keeps a detailed record of their skin picking episodes, noting the triggers, thoughts, and emotions associated with each episode. This can help them identify patterns and develop coping strategies. The client is then encouraged to face these triggers in session, when there is social pressure not to pick.
Social Exposure: Engaging in social situations where the person may feel self-conscious about their skin, without covering up or hiding the affected areas. This can help reduce social avoidance behaviors related to skin picking. However, due to the potential for traumatic or damaging experiences with others due to exposed picking, the client is also encouraged to make sure the environment is supportive. Many skin picking clients choose to come to group therapy without covering affected areas.
Delayed Response: The person practices delaying their response to the urge to pick, gradually increasing the delay over time until the urge subsides without them engaging in the behavior.
Reduced Ritual Exposure: The therapist may encourage the individual to pick less frequently or pick only specific areas for a limited time, helping to reduce the intensity of the compulsion.
It's crucial that these exposure exercises are tailored to the individual's specific triggers and compulsions and are conducted under the guidance of a qualified therapist experienced in treating skin picking disorder. The therapist's role is to help the person resist the urge to pick and gradually reduce the frequency and intensity of the behavior.
Over time, ERP can help individuals with skin picking disorder gain better control over their urges and develop healthier coping strategies to manage stress and anxiety without resorting to skin picking.
