Using technology as a competing response in excoriation disorder

Tasneem Abrahams
Apr 24th, 2016

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Excoriation disorder does not develop overnight. It starts as a habitual behavior and over time develops into a full blown disorder. Every habit has three components: a cue (or a trigger for an automatic behaviour to start), a routine (the behaviour itself) and a reward (which is how our brain learns to remember this pattern for the future).

The Role of Habit Reversal and Competing Responses

Habit Reversal Training (HRT) is a form of Cognitive Behavioural Therapy (CBT) which says that  in order to reverse a habit, the old cue and reward needs to be diagnosed, followed by changing the routine. Instead of fighting the urge to pick, HRT helps the individual understand what motivates the urge. HRT has four main components:

  • Awareness Training

An individual is taught to be aware of their picking. Once an understanding of the picking behavior is gained, the individual is better equipped to gain self-control.

  • Development of a Competing Response

A competing response is essentially an alternating behaviour in order to resist the urge to pick. Every time the person is aware of the urge to pick they can put their hands in their pockets, keep their hands busy with a fiddle toy, or grip an object until the urge passes. This then prevents the use of the hands to pick skin. The competing response also needs to provide a similar reward to skin picking. The choice of competing response therefore differs from individual to individual and an option that works best is explored through HRT.

  • Building Motivation

The results of replacing skin picking with a competing response are slow. It is important that the individual is encouraged and motivated to continue to practice until the new behaviours replace the old.

  • Generalization skills

The key to successfully replacing skin picking with your chosen competing response is to practice the tools learned through HRT in the real world.

Technology as a competing response

Over the years, excoriation disorder sufferers have found relief through various competing responses such as fiddle toys, hobbies such as arts and crafts and through exercise and yoga. In this age of technology though, there are now many new competing responses in the form of apps and games that can provide relaxation, stimulation and distraction by keeping the mind and hands occupied.

Brain training games

Since mental changes affect not only every part of our lives in general, but also increase the urge to pick, brain trainin

g games are a good anxiety and stress reliever.

Personal Zen

The player follows two characters, one angry and one calm. The idea is to train your brain to focus more on the positive 

and less on the negative. A single session of play can build resilience over several hours and using the app before or during a stressful event can help build more enduring positive effects. Suitable for all ages. Available for iOS, free.


This game is split into sessions of three games, tailored to memory, attention, problem solving, processing speed or flexibility of thinking. The games are played against the clock and change every time. Suitable for adults. Available for iOS, free limited access.

Relaxation apps

Apps can be used to combat anxiety while at the same time keeping the mind and hands busy and resulting in a more relaxed state.


Provides calming sounds for any child who may have trouble concentrating or focusing. For children. Available for iOS, free.

Pocket Pond

The child controls an animated koi pond, where they can feed the fish, listen to sound effects, watch thunderstorms and watch fish react to touches and swipes. For children. Avalable for Android and iOS, free.

Anti-Anxiety APP

You can tell the app your problems or reasons for feeling of anxiety by taking a quiz. Using your answers, the app will design a treatment plan 

for you. Follow instructional self-help videos and keep a daily journal of your anxiety, then track your progress as you learn to regain a sense of calm. For adults. Available for Android, free.


Our dependence on technology is evident in our reliance on our smart phones and the Internet. The use of technology is a useful tool to compete with the act of picking in adults and children. The process of dealing with excoriation disorder is different for everyone; there is a multitude of apps to test out until one finds one that works. Excoriation disorder sufferers have access at their fingertips to apps and games that can educate, help alleviate stress or triggers and keep them distracted when the urge to pick arises and until it passes. Most of these resources are free and very user friendly.


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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