Old Habits Die Hard

This article describes the course of treatment for a 55-year-old woman presenting with a particularly challenging case of skin picking disorder. Treatment consisted of five phases (psychoeducation, habit-reversal training, cognitive training, exposure, and relapse prevention), over an 11-month period, in which each new phase built on to the previous phase. Digital photos of wounds resulting from skin picking were also taken during treatment. Several sources of information (continuous self-monitoring, rating scales, self-report, photos) indicated significant treatment gains, especially following Phases 3 and 4. Several challenges were encountered, most notably designing exposure-based techniques that were tailored to match the client’s needs and content of symptoms. Several treatment implications are discussed, including tailoring manualized treatments, managed care concerns, and suggestions for clinicians and supervisors. Taken together, this study adds to the scant literature on treatment of skin picking in older, typically developing adults.