Biofeedback Therapy and Excoriation Disorder

Tasneem Abrahams
Oct 23rd, 2015

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image: Vitalgate Health

There are many alternative therapies recommended for a variety of conditions. And while these 'new' treatments do not have enough empirical evidence supporting their use with disorders like compulsive skin picking, there are those who have tried various therapies and have reported positive outcomes. Biofeedback is one such treatment. Biofeedback involves using methods that assist the patient to learn to change and control physiological processes and responses of the body such as heart rate and muscle tension, to physical stimuli.

How does Biofeedback work?

Biofeedback works by first monitoring the body's natural reposnse to stimuli such as stress or tension. This is done by using special electrode sensors that record information about specific muscles, brain activity, heart rate etc, and then giving feedback to your body. The idea behind biofeedback is that, by harnessing the power of your mind and becoming aware of what's going on inside your body, you may gain more control over these involuntary processes. There is limited research into the effectiveness of biofeedback, but the hypothesis is that biofeedback promotes relaxation, which can help relieve a number of conditions that are related to stress, such as skin picking.

How is it used with skin picking?

The biofeedback works in essence on a principle of awareness training. The more aware you are of your body's involuntary processes, the more you will be able to control it. In biofeedback therapy, once you have a clear picture of when and how your body reacts under stress, the biofeedback therapist helps you practise relaxation exercises, which you fine-tune to control these different functions. This is not far from the principle of habit reversal training (HRT) used in cognitive behavioural therapy (CBT). During HRT the individual is required to first develop an awareness of their picking behaviour through the use of picking logs. Once they are in tune with the cues to when the urge to pick is likely to arise, the more proactive they can be in terms of controlling the offending stimulus or being ready to employ a competing response to picking. Relaxation techniques would be an example of a stimulus control when the urge to pick is triggered by increased stress or tension. Just as in HRT, you will also be given home assignments to do.

image: Medical News Today

The Approach

Different types of biofeedback measure different bosy parts

Electromyogram (EMG)

This approach looks at feedback on the tension of the muscles in the neck, shoulder, and the head. The behavior to pick at the skin is greater when the muscles of these regions are tensed. This method tries to establish when the muscles are greatly stressed in a bid to reduce tension in these areas. The second aim is to focus more on the head and face muscles and work out ways of relieving stress. This kind of feedback can help the patient to be occupied in a way that he or she does not pick at the skin but is rather preoccupation in dealing with muscle tension in the stated areas.


The body's temperature is monitored. During stress or tension, the body's 'fight or flight' system kicks in causing the internal temperature to increase.

Neurofeedback or electroencephalography (EEG)

This measures brain waves, which helps you identify when you are feeling stressed or anxious as many of us are not even aware when we are feeling these negative emotions.

Other measures include Electrodermal activity (EDA), which measures sweating and Heart rate variability (HRA), which measures heart rate.

Why try it?

Biofeedback appeals to many people because it has some advantages over traditional methods:

  • it can eliminate the need for regular medication.
  • The method is non-invasive.
  • It is safe for pregnant women

A doctor can combine more than one strategy to achieve the kind of response that is desirable or behavior patterns that are desirable. The lack of empirical evidence should however caution againts relying solely on biofeedback. As with any therapy, including CBT, a comprehensive, holistic approach is key.

Tasneem Abrahams

Tasneem is an Occupational Therapist, and a graduate of the TLC foundation for BFRBs professional training institute. Her experience in mental health includes working at Lentegeur Psychiatric hospital forensic unit (South Africa), Kingston Community Adult Learning Disability team (UK), Clinical Specialist for the Oasis Project Spelthorne Community Mental Health team (UK). Tasneem is a member of both the editorial team and the clinical staff on Skinpick, providing online therapy for people who suffer from excoriation (skin picking) disorder.

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