Emotional Avoidance and Skin Picking

Dr. Dawn Ferrara
Aug 24th, 2021

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We all avoid things. It’s our go-to when something is unpleasant, or we just don’t want to deal with something. But there’s avoidance and then there’s avoidance – the kind that can create emotional distress. In this SkinPick.com webinar, Dr. Vladimir Miletic talks about emotional avoidance and how avoiding difficult emotions and memories may lead to skin picking behavior.

What Avoidance Is and Why We Do It

According to Steven Hayes, the Father of Acceptance and Commitment Therapy, experiential avoidance occurs when a person is unwilling to remain connected to particular private experiences such as body sensations, emotions, or thoughts and takes steps to alter the form or frequency of these events and the contexts in which they occur. Dr. Miletic frames this behavior as the things a person is willing to do to minimize or change their experience so they don’t have to deal with it.

We use avoidance behaviors all the time. Some are relatively benign. Others, like skin picking, can have significant, often unintended, consequences. So, the question is, why do we avoid if we know that it causes problems?

As he often does, Dr. Miletic turns to George Kelly’s personal construct theory and choice corollary for answers. When faced with something difficult, people find themselves at a crossroads. They can choose to face the problem or difficult situation, or they can choose to avoid it. While avoidance has its own set of problems, it’s actually the logical choice when something is just too unpleasant. It feels better in the moment, relieving the worry and stress of having to deal with the issue directly. Avoidance gives you better control over events in your life. We don’t necessarily choose what feels good. We choose what brings us clarity and what allows us to act in ways that are predictable and reliable.

It’s important to note that choice isn’t always a conscious one. Sometimes we make choices on a subconscious level which can be more efficient and can avoid even having to think about what’s unpleasant.

The assumptions we make about emotions also drive how we choose to deal with them. The implicit assumptions we have are rooted in family, culture, and previous experiences. They determine how we conceptualize feelings and what options we see for coping. Understanding the implicit assumptions you have can help you to understand why you avoid certain things.

Even though it serves a purpose, avoidance isn’t without its consequences. In the short term, avoidance brings some relief. Yay! You don’t have to deal with what you were trying to avoid. There’s even a certain amount of gratification that comes along with it. You avoided the issue. But there’s a price to pay for that temporary relief. Over time, avoidance inevitably leads to more avoidance. What you’re trying to avoid only gets worse. Avoiding it doesn’t make it go away. Avoidance robs you of the opportunity to really get to know yourself. It masks important experiences from your conscious mind.

How Avoidance Leads to Skin Picking

The beginnings of avoidance are found in distress. When you experience distress, it triggers strong emotional responses. This distress can be external, like having an argument with your partner. Distress can be internal, as when you remember something unpleasant. Your body responds and you start to experience sensations or feelings that are uncomfortable. This discomfort in turn, activates those implicit assumptions you have. You’re at that crossroads where you choose to face the distress or avoid it. Avoidance seems to the best choice. Somewhere along the way, picking at your skin becomes part of your avoidance behaviors. The skin picking results in successful avoidance and feelings of relief and gratification, reinforcing the behavior. You may also experience other feelings such as guilt or shame but the skin picking validates the cycle. This process reinforces the skin picking, setting up the cycle to be repeated.

Breaking the Cycle

Breaking this self-reinforcing cycle is difficult. Eliminating distress is not realistic. It’s an unavoidable part of life, despite what your assumptions might try to convince you otherwise. Avoidance reinforces the idea that distress is harmful.

Dr. Miletic suggests that the missing piece and more realistic point to break the cycle is where assumptions are activated. Implicit assumptions guide the response to distress. If you change the assumptions, you can change the course of the cycle.

Here’s where you have to go a little deeper. The traditional treatment for skin picking, Habit Reversal Therapy (HRT), is a behavioral intervention and does not generally include cognitive work to address assumptions. It only addresses the behavior. You also need something that can take on those assumptions.

The Value of Acceptance

Acceptance is the antidote to avoidance. Acceptance is a willingness to seek out our internal experiences and being open to all aspects of one’s experience. Acceptance doesn’t mean that you just have to make peace with or just accept assumptions that are not helpful. On the contrary. Acceptance means that you can accept and see your assumptions clearly. It is this clarity that is the precursor to change. You cannot change what you don’t recognize. And, without acceptance change is highly unlikely. When you are open to the experience of distress, you can use it in ways that are constructive. You start seeing patterns and take steps to break the cycle of skin picking. 

How To Recognize and Challenge Your Implicit Assumptions

The first step is to look at your behavior patterns. What are the avoidance behaviors you use? Identify as many as you can.

Next, think about what your implicit assumptions are. How do they affect how you deal with difficult experiences? This step sounds easy but it’s challenging. So many of our choices are made subconsciously and may not be readily apparent. Take your time and really let yourself fully explore your actions and the assumptions you hold.

Next, allow yourself to be open to difficult experiences. This doesn’t mean you need to suffer incessantly or that you have to just accept that you’ll always have this problem. It means that you allow yourself to look at your distress and not feel shame or guilt. Instead, allow yourself to just see it as fact of your experience. You’re allowing yourself to be emotionally open and vulnerable in the moment. In other words, it is what it is.

Once you are able to see your implicit assumptions clearly, you can begin to rewrite the narrative and find healthy strategies to cope. Emotions can be a source of information rather than a source of distress and suffering.

Experiencing emotions is a learning experience. Instead of fearing and avoiding difficult experiences, allow yourself to see what they can teach you. What wisdom can you take from them? When you can reframe something in a more positive way, it changes the way you think, feel, and act. And when that happens, you open the door to change and healing.

Ultimately, to eliminate avoidance behavior like skin picking, you have to allow yourself to be open to the difficult experiences and willing to risk doing something different. When you open yourself up to deal with the hard emotions and experiences, you open yourself to the possibility of growth and change. This is a difficult journey to take alone. Working with a therapist can help guide you through this journey of growth and change.

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Dr. Dawn Ferrara


With over 25 years of clinical practice, Dawn brings experience, education and a passion for educating others about mental health issues to her writing. She holds a Master’s Degree in Marriage and Family Counseling, a Doctorate in Psychology and is a Board-Certified Telemental Health Provider. Practicing as a Licensed Professional Counselor and Licensed Marriage and Family Therapist, Dawn worked with teens and adults, specializing in anxiety disorders, work-life issues, and family therapy. Living in Hurricane Alley, she also has a special interest and training in disaster and critical incident response. She now writes full-time, exclusively in the mental health area, and provides consulting services for other mental health professionals. When she’s not working, you’ll find her in the gym or walking her Black Lab, Riley.

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