Internet-based Self-Help for Skin Picking: What Does the Research Say?

When you think of treatment for body-focused repetitive behaviors (BFRBs) like skin picking, what probably comes to mind is traditional therapy and working with a therapist using approaches such as Habit Reversal Training (HRT) and cognitive behavioral therapy (CBT). And there’s ample evidence that these treatment modalities are effective. However, for any number of reasons (e.g., cost, stigma, accessibility), the traditional approach to therapy may not be the best fit for everyone. And that’s where self-help can help bridge the gap.

Self-Help for Skin Picking

Evidence suggest that various forms of self-help can be a powerful option for managing a variety of mental health disorders including skin picking. Self-help is, simply put, using your own efforts and resources to cope with life problems. Self-help can take many forms including things like books, support groups, apps, fidgets, and more. More recently, self-help has taken the form of internet-based interventions that offer an alternative to traditional therapy.

Internet-based self-help for skin picking takes some of the most effective modalities for treating skin picking and presents them in user-friendly, self-guided programs. Some of those modalities include:

• Self-guided HRT - Replaces the old automatic behavior through awareness and competing response training
• Decoupling – The behavior is unlearned by disrupting the behavior before it is completed and replacing it with a slightly different behavior.
• Decoupling in-sensu - A variant of decoupling in which the automatic behavior is imagined and replaced by an alternate action. This intervention is especially effective for skin-picking.
• Habit replacement - Replaces the harmful automatic habit (e.g., skin picking) with a harmless, unobtrusive action
• Stepped care – More of a process, this approach involves using less intensive, restrictive, or costly methods first, followed by more structured, intensive ones as needed
• Expressive writing – Similar to journaling, expressive writing is a form of personal and emotional writing sometimes used in both self-help and therapeutic approaches.

These interventions have consistently been shown to improve quality of life for people living with BFRBs like skin picking. There are also a number of websites devoted to BFRBs, including skinpick.com, that offer resources and programs.

But is self-help effective and how does it fit into an overall approach to treatment?

The Benefits of Self-Help

In a review of studies focused on self-guided interventions for BFRBs, researchers take a closer look at the use of internet-guided self-help programs and the role they can play in treatment of BFRBs like skin picking. The review focused on twelve randomized controlled trials (RCTs) that included self-help internet-based interventions for adults with BFRBs. 

The review findings suggest that self-help does indeed play a role in the treatment of BFRBs like skin picking.

• 70% of participants reported positive effects, and users experienced significant improvements in quality of life and reductions in depression symptoms.
• Self-guided HRT, decoupling, and decoupling in-sensu showed significant symptom reduction across multiple studies, with significant positive effects on quality of life.
• Habit replacement was found to be particularly effective for BFRBs.
• The stepped care model was rated high in patient satisfaction and showed positive rates of symptom reduction.
• The popularity of websites devoted to internet-based self-help reflected a high demand for online self-help treatment options including online therapy. 

The researchers noted that online self-help resources offered a number of potential benefits to users, especially for those for whom access to more traditional therapy is limited:

• Online resources minimize barriers associated with stigma or limited geographical access to treatment.
• Online resources reduce financial barriers as many are free or reasonably priced, making them affordable for more people.
• These online interventions may serve as a bridge to in-person care for those who are awaiting therapist-guided treatment.
• Internet-based interventions may also help reduce stigma and encourage individuals to seek treatment who might otherwise feel shame or fear judgment in in-person settings.

Where Self-Help and Therapy Meet

Of course, self-help alone may not be enough for someone with severe BFRB symptoms or other mental health needs that require the support of a therapist. The researchers noted that for some, therapist-guided interventions may provide a more personalized and comprehensive experience, leading to better treatment outcomes than relying on self-help alone.  

If you need more, therapy can be the perfect next step towards healing and recovery. Professional help can give you the additional tools and support you need to make the progress you seek. The good news is that even if you choose therapy, you can still reap the benefits of online interventions. Today’s online therapy can be a convenient and cost-effective alternative to traditional in-office therapy and has been shown to be just as effective. 

If you're wondering whether a structured program or additional support might be the right next step, feel free to reach out to us. We're here to answer any questions you have and help you explore the options available. It could be just the support you need to continue your healing journey.

References

1. Falbe-Hansen, L., Le Huray, C., Phull, B., Shakespeare, C., & Wheatley, J. (2009). Using guided self-help to treat common mental health problems: The Westminster Primary Care Psychology Service. London journal of primary care, 2(1), 61–64. https://pmc.ncbi.nlm.nih.gov/articles/PMC4453713/

2. Moritz, S., Penney, D., Ahmed, K., & Schmotz, S. (2021). A head-to-head comparison of three self-help techniques to reduce body-focused repetitive behaviors. Behavior Modification, 46(4), 894-912. https://journals.sagepub.com/doi/full/10.1177/01454455211010707

3. Murase, E. M., Raygani, S., & Murase, J. E. (2025). Narrative Review of Internet-Based Self-Help Tools for Body-Focused Repetitive Behaviors: Recommendations for Clinical Practice. Dermatology and therapy, 15(4), 811–818. https://pubmed.ncbi.nlm.nih.gov/40102374/