Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol: a randomized clinical trial

Alice C M Xavier, Camila M B de Souza, Luís H F Flores, Mariane B Bermudez, Renata M F Silva, Ariadne C de Oliveira, Carolina B Dreher, Alice C M Xavier, Camila M B de Souza, Luís H F Flores, Mariane B Bermudez, Renata M F Silva, Ariadne C de Oliveira, Carolina B Dreher

Abstract

Introduction: Although behavioral therapies can effectively treat skin picking disorder (SPD), there is no standardized treatment for improving SPD and its comorbidities and there is no group intervention option. This trial aimed to adapt the Rothbaum trichotillomania protocol to SPD (Study 1) and test its efficacy for treating SPD and comorbidities in individual and group formats (Study 2).

Methods: The adapted protocol was applied to 16 SPD patients, who were allocated to group or individual treatment (Study 1). Afterwards, 54 patients were randomly allocated to treatment in an individual (n=27) or group format (n=27) (Study 2). In both studies, assessments of SPD severity, anxiety, depression, clinical status and skin lesion severity were performed at baseline and the endpoint.

Results: The adapted protocol was feasible in both treatment modalities (Study 1) and led to high SPD remission rates (individual 63%; group 52%), with no significant difference between intervention types (p = 0.4) (Study 2). SPD, anxiety, and depression symptoms and objective patient lesion measures improved after treatment. There was large effect size for SPD symptom improvement in both treatment types (Cohen's d: group = 0.88; individual = 1.15) (Study 2).

Conclusion: The adapted Rothbaum protocol was effective for SPD remission, comorbidities, and skin lesions, both in individual and group formats.

Clinical trial registration: NCT03182478.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1. Flow diagram of Study 1.…
Figure 1. Flow diagram of Study 1. CBT = cognitive behavioral therapy.
Figure 2. Flow diagram for Study 2.…
Figure 2. Flow diagram for Study 2. CBT= cognitive behavioral therapy; SPD = skin picking disorder.

References

    1. Tucker BT, Woods DW, Flessner CA, Franklin SA, Franklin ME. The skin picking impact project: phenomenology, interference, and treatment utilization of pathological skin picking in a population-based sample. J Anxiety Disord. 2011;25:88–95.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Arlington: American Psychiatric Publishing; 2013.
    1. Machado MO, Köhler CA, Stubbs B, Nunes-Neto PR, Koyanagi A, Quevedo J, et al. Skin picking disorder: prevalence, correlates, and associations with quality of life in a large sample. CNS Spectr. 2018;23:311–20.
    1. Grant JE, Odlaug bL, Chamberlain SR, Keuthen NJ, Lochner C, Stein DJ. Skin picking disorder. Am J Psychiatry. 2012;169:1143–9.
    1. Schumer MC, Bartley CA, Bloch MH. Systematic review of pharmacological and behavioral treatments for skin picking disorder. J Clin Psychopharmacol. 2016;36:147–52.
    1. Selles RR, McGuire JF, Small BJ, Storch EA. A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder. Gen Hosp Psychiatry. 2016;41:29–37.
    1. Gelinas BL, Gagnon MM. Pharmacological and psychological treatments of pathological skin-picking: a preliminary meta-analysis. J Obsessive Compuls Relat Disord. 2013;2:167–75.
    1. Azrin NH, Nunn RG. Habit-reversal: a method of eliminating nervous habits and tics. Behav Res Ther. 1973;11:619–28.
    1. Schuck K, Keijsers GP, Rinck M. The effects of brief cognitive-behaviour therapy for pathological skin picking: a randomized comparison to wait-list control. Behav Res Ther. 2011;49:11–7.
    1. Teng EJ, Woods DW, Twohig MP. Habit reversal as a treatment for chronic skin picking: a pilot investigation. Behav Modif. 2006;30:411–22.
    1. O’Connor K, Lavoie M, Desaulniers B, Audet JS. Cognitive psychophysiological treatment of bodily-focused repetitive behaviors in adults: an open trial. J Clin Psychol. 2017;74:273–85.
    1. Keuthen NJ, Tung ES, Reese HE, Raikes J, Lee L, Mansueto CS. Getting the word out: cognitive-behavioral therapy for trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder. Ann Clin Psychiatry. 2015;27:10–5.
    1. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther. 2012;43:666–78.
    1. Gallagher MW, Sauer-Zavala SE, Boswell JF, Carl JR, Bullis J, Farchione TJ, et al. The impact of the unified protocol for emotional disorders on quality of life. Int J Cogn Ther. 2013;6(1)
    1. Health Quality Ontario. Psychotherapy for major depressive disorder and generalized anxiety disorder: a health technology assessment. Ont Health Technol Assess Ser. 2017;17:1–167.
    1. Flessner CA. Cognitive behavior therapy for childhood repetitive behavior disorders: tic disorders and trichotillomania. Child Adolesc Psychiatr Clin N Am. 2011;20:319–28.
    1. Rothbaum BO. The behavioral treatment of trichotillomania. Behav Cogn Psychother. 1992;20:85–90.
    1. Van Ameringen M, Patterson B, Simpson W. DSM-5 obsessive-compulsive and related disorders: clinical implications of new criterea. Depress Anxiety. 2014;31:487–93.
    1. Snorrason I, Belleau EL, Woods DW. How related are hair pulling disorder (trichotillomania) and skin picking disorder? A review of evidence for comorbidity, similarities and shared etiology. Clin Psychol Rev. 2012;32:618–29.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33. quiz 34-57.
    1. Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Braz J Psychiatry. 2000;22:106–15.
    1. Gorenstein C, Andrade L. Validation of a Portugues version of the beck depression inventory and the state-trait anxiety inventory in Brazilian subjects. Braz J Med Biol Res. 1996;29:453–7.
    1. Kummer A, Cardoso F, Teixeira AL. Generalized anxiety disorder and the Hamilton anxiety rating scale in parkinson's disease. Arq Neuropsiquiatr. 2010;68:495–501.
    1. de Lima MS, Soares BG, Paoliello G, Vieira RM, Martins CM, da Mota JI, Neto, et al. The Portuguese version of the clinical global impression - schizophrenia scale: validation study. Braz J Psychiatry. 2007;29:246–9.
    1. Keuthen NJ, Deckersbach T, Wilhelm S, Engelhard I, Forker A, O´Sullivan RL, et al. The Skin Picking Impact Scale (SPIS): scale development and psychometric analyses. Psychosomatics. 2001;42:397–403.
    1. Hasler G, Klaghofer R, Buddeberg C. [The University of Rhode Island Change Assessment Scale (URICA)] Psychother Psychosom Med Psychol. 2003;53:406–11.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5.
    1. Busner J, Targum SD. The clinical global impression scale – applying a research tool in clinical practice. Psychiatry (Edgmont) 2007;4:28–37.
    1. Xavier AC, de Souza CM, Flores LH, Prati C, Cassal C, Dreher CB. Improving skin picking diagnosis: validation of the skin picking impact scale and development of a photographic instrument. An Bras Dermatol. 2019;94:553–60.
    1. Szupszynski KP, Oliveira MS. Brasilian version of the University of Rhode Island Change Assessment (URICA) for illicit substance users. Psico-USF. 2008;13:31–9.
    1. Wright JH, Basco MR, Thase ME. Aprendendo a terapia cognitivo-comportamental. Porto Alegre: Artmed; 2008.
    1. Carpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JA, Hofmann SG. Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018;35:502–14.
    1. Schulz KF, Altman DG, Moher D, CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726–32.
    1. Stangier U, Heidenreich T, Peitz M, Lauterbach W, Clark DM. Cognitive therapy for social phobia: individual versus group treatment. Behav Res Ther. 2003;41:991–1007.
    1. Grant JE, Chamberlain SR. Clinical correlates of symptom severity in skin picking disorder. Compr Psychiatry. 2017;78:25–30.
    1. Keuthen NJ, Rothbaum BO, Falkenstein MJ, Meunier S, Timpano KR, Jenike MA, et al. DBT-enhanced habit reversal treatment for trichotillimania: 3- and 6-month follow-up results. Depress Anxiety. 2011;28:310–3.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren