ACT Guide for Skin Picking

What is ACT Guide for Skin Picking?

ACT Guide for Skin Picking is an online mental health program designed by psychologists at Utah State University for people who suffer from chronic skin picking. Participants will learn skills to help manage and effectively respond to skin picking impulses and to reengage with aspects of life that they avoid due to the condition. The development and testing of this program are financially supported by the Huntsman Foundation.

How does it work?

ACT stands for Acceptance and Commitment Therapy, which is a type of therapy that targets psychological flexibility, or the ability to engage in meaningful activities while uncomfortable thoughts or sensations (such as urges) are present. The ACT Guide for Skin Picking incorporates Habit Reversal Training (HRT), which helps build awareness around skin picking urges and teaches new behavioral strategies. HRT has been widely studied as an effective treatment for skin picking.

Dr. Michael Twohig, professor in the Combined Clinical/Counseling PhD specialization in the Department of Psychology at Utah State University, has conducted research on treating body-focused repetitive behaviors (BFRBs) for more than 20 years and has produced several studies that demonstrate that ACT is helpful in reducing skin picking behavior. ACT Guide for Skin Picking is designed to teach the skills taught in Acceptance and Commitment Therapy, but in a self-guided format so individuals may learn at their own pace.

ACT-enhanced behavior therapy has been previously shown to be effective for skin picking through case studies and randomized controlled trials. These include:
  • Asplund, M., Lenhard, F., Rück, C., Andersson, E., Grimlund, T., Nilsson, M., ... & Ivanov, V. Z. (2024). Therapist-guided internet-delivered acceptance-enhanced behavior therapy for skin-picking disorder: A randomized controlled trial. Behavior Therapy.
  • Asplund, M., Rück, C., Lenhard, F., Gunnarsson, T., Bellander, M., Delby, H., & Ivanov, V. Z. (2021). ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: A feasibility study. Journal of Clinical Psychology, 77(7), 1537–1555. https://doi.org/10.1002/jclp.23147 
  • Flessner, C. A., Busch, A. M., Heideman, P. W., & Woods, D. W. (2008). Acceptance-enhanced behavior therapy (AEBT) for trichotillomania and chronic skin picking: exploring the effects of component sequencing. Behavior Modification, 32(5), 579-594.
  • 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://doi.org/10.1016/j.brat.2005.10.002 

The ACT Guide for Skin Picking program was found to be effective in a clinical trial of 84 adults who suffer from chronic skin picking. Most participants experienced improvements with skin picking urges and general quality of life. Participants reported that the examples provided in the online program were relevant to them. They also reported that having behavioral skills to turn to were beneficial as they cope with skin picking urges.

  • Bowers, E. M., Capel, L. K., Woolley, M. G., Barnes, A., Twohig, M. P., & Levin, M. E. (in press). The efficacy and feasibility of web-based ACT-enhanced behavioral treatment for skin picking in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders. 

What to expect?

ACT Guide for Skin Picking is an entirely online program and has eight self-guided modules that participants can complete at their own pace. The course will teach participants to regulate their skin picking, provide new ways to interact with urges to pick their skin, and help them engage with the things that matter most in their lives.
Participants should expect to spend approximately 30 minutes completing each module. Most people complete one new lesson each week, so the entire program should last approximately two months; however, the pace of the program can be personalized to meet each participant’s needs. For more information, r
ead the Privacy Notice  and the Terms of Use.

Who created the ACT Guide?

The creators of the ACT Guide are a group of researchers at Utah State University who focus on helping others with all aspects of their mental health. They have spent the past 20 years researching body-focused repetitive behaviors and have learned how to best help individuals cope with skin picking urges. The researchers created ACT Guide for Skin Picking so that the evidence-based resources they have developed will be widely available to anyone who might benefit from them. Learn more about these researchers at Utah State University ACT Research Group.

How do I sign up?

The program costs $25, which gives participants access to ACT Guide for Skin Picking for six months. During that time, you can work through the program at your own pace.
Program payments are used to directly support program maintenance and future program development. Payments are processed securely via PayPal.

Who can I contact if I have questions?

We’d love to hear from you! If you have any questions about ACT Guide, please email us at ACTGuide@usu.edu.