Skin Picking Disorder (SPD) affects up to 10% of the general population, causing significant socioeconomic damage in 75% of affected individuals. It is characterized by the repeated habit of touching the skin itself, causing or aggravating wounds, with difficulty in controlling the habit. It is associated with anxiety disorders in about 20% of cases and with depressive disorder in about 50%. Patients with SPD have difficulties in regulating emotions, being more vulnerable to having their mental symptoms aggravated in face of stressful situations, such as the current coronavirus-19 pandemia. Among the treatments available to SPD, cognitive behavioral therapy is the only intervention superior to placebo, and there is still no medication approved by the FDA indicated specifically to SPD. The effectiveness of cognitive behavioral therapy was assessed in a randomized clinical trial with Brazilian patients with SPD, but its long-term benefit has not yet been evaluated. Additionally, telemedicine interventions can be effective and used during pandemia, but the effectiveness of internet delivered cognitive behavioral therapy for SPD is not clear yet.
This study is a randomized clinical trial, in which patients diagnosed with skin picking
disorder (SPD) will be evaluated and, if symptomatic for the disease, will be randomized to
one of the arms: intervention arm with 2 booster sessions of cognitive behavioral therapy in
online format; active control arm, in which individuals will watch videos with quality of
life orientation. Patients included in this study are coming from a brazilian clinical trial
conducted between the years of 2014 and 2018, in wich patients with SPD were treated with a
cognitive behavioral treatment protocol in individual or group formats, resulting in
improvement of SPD symptoms and comorbid anxiety and depression. Before the intervention,
individuals will be evaluated by a psychiatrist, to assess SPD and comorbid symptoms
severity, thru the application of some instruments to assess SPD, anxiety, depression and
emotional regulation. Also, the CRISIS questionnaire, about the impact of COVID-19 in mental
health, will be applied. After the interventions, the instruments will be applied again, by
the same evaluator, wich is blinded to the type of intervention that the patient received.
Behavioral: Internet-based Cognitive Behavioral Therapy
2 booster sessions of cognitive behavioral therapy (CBT) delivered thru internet to patients previously treated with CBT. First session focus on understanding the symptoms of skin picking and training techniques to reverse the habit. Second session focus on comorbid symptoms of anxiety and depression, training strategies to improve it.
Other: Quality of life promotion
2 videos about quality of life promotion will be send to patients in the active control arm. In the first week, the videos will consist in: social support techniques and sleep hygiene. After one week, 2 another videos will be send, consisting in: guide about healthy diet and about physical exercise.
Inclusion Criteria:
- Skin picking as a primary diagnosis
- Treatment with cognitive behavioral therapy in the past, received in previous clinical
randomized trial conducted by our research group between 2014 and 2018
Exclusion Criteria:
- Acute psychotic disorder, bipolar affective disorder in an acute episode, substance
use disorder (except tobacco), severe depressive episode or suicidal ideation,
dementia
Hospital de Clínicas de Porto Alegre
Porto Alegre, Rio Grande Do Sul, Brazil
Carolina Blaya Dreher, PhD, Principal Investigator
Federal University of Rio Grande do Sul