Cognitive behavioural therapy including habit reversal training for treating dermatillomania in the context of anxiety and low mood

Abstract

Abstract Dermatillomania is characterised by repetitive skin picking, resulting in tissue damage and significant distress and/or functional impairment. Cognitive behavioural therapy (CBT) is the recommended psychological intervention for dermatillomania in clinical guidelines, with the evidence base also supporting habit reversal training (HRT) as part of CBT. However, research evaluating CBT and HRT for dermatillomania remains scarce. This case study describes a young woman with dermatillomania, in the context of co-morbid anxiety and low mood, treated with 20 sessions of CBT including HRT in a community setting. Guided by her formulation, additional techniques such as those fostering self-compassion were also integrated, and sociocultural factors were adapted for. Improvements were reported in client-centred goals and outcomes of global psychological distress, functioning, anxiety and symptoms and psychosocial impacts of skin picking. The intervention was well received by the client. Limitations as well as clinical practice implications and research recommendations for dermatillomania are discussed. Key learning aims (1) To understand using CBT, including HRT, to treat a case of dermatillomania in the context of anxiety and depression. (2) To use a formulation-driven approach to guide the intervention. (3) To consider adapting interventions for sociocultural factors.