This guest blog was written by Tasneem Abrahams, a CBT therapist who treats BFRB clients, mainly with skin excoriation disorder and trichotillomania.
Cognitive behavioral therapy has been shown to have the most effective results for helping people with BFRBs manage their behavior. CBT helps the individual identify the thoughts and emotions that trigger certain undesirable patterns of behavior and the situations or events that trigger those thoughts and emotions. The idea is that with that knowledge you can either address the triggering stimulus, or address the way you think or feel about it, and therefore change the way you react behaviourally toward the trigger.
But what if I don’t even know when I’m doing it?
The problem is that BFRBs such as compulsive skin picking and hair pulling can become so engrained that people often report that they don’t know how much time they spend engaging in the behavior.
In clinical terms, there are two types of BFRBs—focused and automatic. Focused picking or pulling is a behavior that is premeditated in that you experience an urge and then consciously engage in the behavior in response to that urge. Automatic picking or pulling is when you are not overtly aware of an urge and without realising it, begin engaging in the behavior. People who engage in automatic picking or pulling often say that once they realise they are doing it, it is very difficult to stop, likening it to being in a trance-like state.
One of the cornerstones of CBT is becoming more aware of when you experience urges, what you are thinking or feeling just prior to engaging in the behavior, what situations and times of day you tend to engage, and the emotional consequences you experience afterwards. It is for this reason that your therapist will require you to keep what is known as a picking or pulling record where you will document all this information each time you pick or pull. However, this is not an easy task and many clients find it challenging. Yet it is a fundamental tool in the effective management of the disorder.
It is for this reason that Skinpick.com has developed and launched a free App to help people with compulsive skin picking to record this information quickly, easily and on the go.
As a therapist supporting clients who sign up for the Skinpick.com online therapy program since its inception, I found that most my clients were struggling to keep the picking record on paper. Picking is not always predictable, and doesn’t only happen when it is convenient. Clients were reporting that they didn’t always have a pen and paper on hand, they were not always in an environment conducive to writing down what was going on, or they found it tedious and demotivating.
From a therapist perspective, it was also difficult to use the information from the picking record in communication with clients as written records are not easily shareable and readily available at the times the client was logging in to the program. I was finding myself often suggesting to clients to use some sort of note-taking app such as Evernote or Onenote on their mobile. Our administrators heeded the feedback they were receiving from the therapists, and to continually improve the service to our clients and to the broader BFRB community, the development of the Skinpick app began.
It was felt by therapists that a mobile app would be a better option because:
- Better accessibility as you don’t have to be signed up for the therapy program to benefit from it
- Faster and more convenient – we are a digital generation; nobody goes anywhere without their mobile phones or another smart technology device.
- The app would also serve as a reminder to those who are enrolled in the therapy program to log in, which would hopefully improve client engagement with the program
August 2016, the Skinpick app was ready for launch. Before going public with the app, we first got feedback from our therapy clients with whom we are in regular and close communication. Finally, in October 2016, the app was launched to the public via our newsletter, website, and social media channels. The main role of the self-monitoring tool is to create awareness for the client about their behavior, and identify patterns.
The app, Skin Pick—Dermatillomania Journal, is completely free to download on any android or iOS device and early adopters have already had very positive reviews. The data can also be exported and sent to your therapist to be used in sessions. Some users of the app have even gone so far as to say that simply being more aware has already reduced the severity of their picking or pulling.
Through the Google Play store, we’ve received a number of positive reviews, including one calling the app a “groundbreaker.” The reviewer even had some suggestions we found really helpful, such as tracking days and challenges.
So far, even as a therapist, I have seen a marked difference in awareness in my clients, which has had a positive impact on progress within therapy. Of course, from a technical aspect, there have been some issues, but our app development team are very responsive and will be addressing some of the bug fixes in next versions or updates of the app. The app is available on both Android and Apple devices and is free to use. We at Skinpick.com hope that it will help many people come closer to managing their compulsive skin picking.