Online Therapy for Skin Picking: What To Know and What to Expect

Therapy is generally the first-line treatment for skin picking disorder, clinically known as excoriation disorder or dermatillomania. Traditionally, therapy has been delivered in an in-person, in-office setting. While therapy is effective, the in-office setting hasn’t always been as accessible or as practical for some people. Things like geographical distance, juggling schedules, cost, and even being uncomfortable about going to a therapy office have been barriers to people getting help. Online therapy has challenged those barriers and has made getting care more accessible than ever. 

Communicating electronically has become part of our everyday life. So, it is no surprise that seeing a therapist or healthcare provider online would make sense for a lot of people. Still, the idea of seeing your therapist online can be unsettling. What’s it like to see your therapist via a screen? What about confidentiality? Is online therapy as effective as in-office therapy? 

If you’re new to this way of delivering therapy, this article is for you. Let’s pull back the curtain on internet-based therapy for skin picking and answer those questions.

What Happens During Online Therapy?

When you meet with your therapist online, you will use a secure video-based platform. These platforms are designed to be secure in order to protect your privacy. While the process may vary a bit, your sessions will proceed much like in-office sessions would: 

Initial Assessment – The process usually starts with a comprehensive assessment. Your therapist will ask a lot of questions about your history as well as specifically about your skin picking and how it impacts your life. Understanding your experiences, patterns, strengths and struggles helps to tailor your treatment to meet your unique needs.  

Education – Part of the therapy process is learning about the disorder and how it can affect you. Sometimes people are very surprised by what they think they know about their disorder and the information they learn in the therapeutic process. 

Evidence-Based Approaches – Therapy is not a one-size-fits-all. Your therapist will choose evidence-based strategies that fit your treatment needs. Evidence-based means that these approaches are backed by science. Some of the most common approaches to treating skin picking include: 

• Cognitive Behavioral Therapy (CBT)
• Habit Reversal Training (HRT)
• Acceptance and Commitment Therapy (ACT) 

These approaches build awareness of triggers, teach alternative ways of responding, and address underlying thoughts and feelings that drive picking. Your therapist may give you tasks to complete between sessions like keeping a log or trying a new strategy.

Ongoing Support – Therapy is one part of your larger support system. You’ll probably see your therapist weekly. Depending on the online therapy program you choose, you may have support options that include self-help resources and tools, discussion forums, and even chat options as needed. 

Every therapy program is different so be sure to ask lots of questions and choose the setting that is right for you. 

Are Online Programs Effective?

This is the question most people want answered. According to research, the answer is a resounding yes!

Numerous studies have found that online therapy, especially cognitive behavioral therapies, is as effective, and in some cases more effective, than in-person therapy for many psychiatric and somatic disorders, including skin picking. 

A newly published study found that online therapy for skin picking was effective in reducing picking behaviors. What’s even more encouraging is that these treatment gains were sustained over time and were still evident at a 6-month follow-up. These results are similar to other studies that have found support for the effectiveness of online therapy in treating skin picking and other BFRBs.

The Takeaway

Therapy is an important part of managing skin picking. Online therapy offers an accessible and effective option to seeking care. It’s important to explore options and find the program that is just right for you. 

The SkinPick program has a team of therapists experienced in treating skin picking and other body-focused repetitive behaviors (BFRBs). Our treatment is rooted in science and validated by the largest peer-reviewed study ever conducted on skin picking treatment. If you’re wondering if online therapy is right for you, reach out. Our treatment experts are ready to help. 

References

1. Asplund, M., Lenhard, F., Rück, C., Andersson, E., Grimlund, T., Nilsson, M., Sarachu-Nilsson, M., Sundh, L., & Ivanov, V. Z. (2025). Therapist-guided internet-delivered acceptance-enhanced behavior therapy for skin-picking disorder: A randomized controlled trial. Behavior Therapy, 56(1), 70-82. https://www.sciencedirect.com/science/article/pii/S0005789424000558

2. Petersen, J. M., Barney, J. L., Fruge, J., Lee, E. B., Levin, M. E., & Twohig, M. P. (2022). Longitudinal outcomes from a pilot randomized controlled trial of Telehealth acceptance-enhanced behavior therapy for adolescents with trichotillomania. Journal of Obsessive-Compulsive and Related Disorders, 33, 100725. https://www.sciencedirect.com/science/article/abs/pii/S2211364922000185

3. Gallinat, C., Moessner, M., Haenssle, H. A., Winkler, J. K., Backenstrass, M., & Bauer, S. (2019). An Internet-Based Self-Help Intervention for Skin Picking (SaveMySkin): Pilot Randomized Controlled Trial. Journal of medical Internet research, 21(9), e15011. https://pmc.ncbi.nlm.nih.gov/articles/PMC6779027/

4. Dar, R., Schonbach, M., & Wenzler, S. (2023). Efficacy of internet-based, therapist-assisted treatment programs for hair pulling and skin picking: Preliminary results. Cognitive Therapy and Research, 48(1), 66-74. https://link.springer.com/article/10.1007/s10608-023-10446-w