Grieving the Old Behavior: Why Is It So Hard to Let Go of Skin Picking?

Letting go of familiar ways of coping is central to any therapeutic change — including changes related to skin picking. And while it may sound unusual at first, every change involves losing something meaningful. 

Early in treatment, it rarely feels this way.  Skin Picking is often seen as “the problem” - something to eliminate. But as understanding deepens, many people begin to see something more nuanced: the behaviour has served a purpose. It has helped regulate difficult emotions, fill moments of boredom, soothe stress, or create a sense of relief. That realization can be confronting.

Once we understand why something has been hard to stop, we begin to see what it has provided. And when something has supported us for a long time, even in ways we wish it hadn’t- letting go can bring a very real sense of grief.

How Does the Process of Letting Go Begin?

Although individual differences always exist, some common patterns can be observed in therapeutic work. When a person begins to recognise skin picking as an emotion regulation strategy — something present in difficult, boring, stressful, lonely, or even quiet or exciting moments — its significance becomes clearer.

Before that awareness, it’s common to see the behavior as simply “bad.” That reaction makes sense. It can feel almost threatening to admit that something causing so much distress may also have had helped in some way. 

But grief only arises when something matters.

And in order to grieve, there has to be an emotional connection with what is being lost. 

This is why understanding and acceptance are such important parts of treatment. Learning to sit with urges. Practicing mindfulness. Discovering that you don’t have to run from discomfort- that you can stay present with yourself, even with the parts that feel overwhelming. 

This is often where  Acceptance and Commitment Therapy (ACT) becomes helpful- not just focusing on stopping the behaviour, but on changing your relationship with the urges underneath it.

What Comes Next?

After someone has seen their skin picking from the perspective of its function and meaning, they are often ready to look beyond the urges themselves. They may begin to notice what their body is communicating, what messages it is sending, and what needs might be hidden behind a behavior that, on the surface, appears like an unpleasant habit.

This step marks the beginning of the grieving process. Once there is understanding of what lies beneath, it becomes easier to face those reasons directly, without avoidance, and to begin responding to them in new ways.

At the same time, this can be a phase in therapy when slips (relapse) may occur. A person may return to more intense skin picking even after a period of improvement. 

Slips are not failures. In fact, at this stage, it is meaningful: it shows just how important the behavior has been. If it didn’t matter,  it wouldn’t be so hard to change. Slips often reflect a need to remain a little longer in what is familiar and safe — even if it is uncomfortable — because the unknown that comes with change can feel more frightening.

Then Comes Uncertainty

After moving through a slip phase and learning why it happened — and, even more importantly, what future slips might mean and how to handle them — active grieving often begins. 

There may be grief for the coping strategies that were never learned earlier. There may also be grief for the “friend” that skin picking has been: always available, always present, always responsive when needed.

And naturally, new fears arise:

What if these new tools don’t work?

What if they aren’t enough?

What if I can’t cope without the old behaviour?

Facing The “What If”

ACT and mindfulness don’t promise certainty. Instead, they teach something gentler and more powerful: how to sit with uncertainty without needing to solve it immediately. 

They help us notice the  “what if” thoughts without letting them control the future. They remind us that anxiety does not have to write the script for what comes next.

Over time, something quiet but important begins to grow: trust.

Trust that you can face discomfort.

Trust that you can learn.

Trust that even if something feels hard, you will find your way through it.

Letting go of skin picking is not just about stopping a behaviour. It is about building a new relationship with yourself- one rooted in understanding, compassion, and courage.

And that process, though difficult at times, is deeply human.

If you would like support as you move through this process, SkinPick offers structured, therapist-guided treatment grounded in evidence-based approaches. You don’t have to navigate the grieving, the uncertainty, or the change alone.

 References

1. Grodinsky, A. M. (2022). A JOURNEY TO AUTHENTICITY: An Autoethnography of Compulsive Excoriation (Skin Picking) Disorder. https://ruor.uottawa.ca/items/246bcef3-eddb-48b2-a15d-a75c91af6d6d 
2. Hayes, A. M., Laurenceau, J. P., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical psychology review, 27(6), 715-723. https://www.sciencedirect.com/science/article/abs/pii/S027273580700027X 
3. Lochner, C., Roos, A., & Stein, D. J. (2017). Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatric disease and treatment, 1867-1872. https://www.tandfonline.com/doi/full/10.2147/NDT.S121138 
4. McAleavey, A. A., & Castonguay, L. G. (2014). The process of change in psychotherapy: Common and unique factors. In Psychotherapy research: Foundations, process, and outcome (pp. 293-310). Vienna: Springer Vienna. https://bpb-us-e1.wpmucdn.com/sites.psu.edu/dist/6/129281/files/2024/02/McAleavey-Castonguay-2015-3e1cbdf20f14aa38.pdf 
5. Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking. Behaviour Research and Therapy, 44(10), 1513-1522. https://www.sciencedirect.com/science/article/abs/pii/S0005796705002111