JMIR Publications

ABSTRACT

Background:

In spite of the psychosocial burden and medical risks associated with skin picking disorder, healthcare does not provide sufficient treatment for affected individuals to date. Therefore, an Internet-based self-help program for skin picking was developed to offer easily accessible support for this population.

Objective:

The present pilot study evaluated the Internet-based self-help program ‘SaveMySkin’. The 12-week program is based on cognitive-behavioral therapy, and contains comprehensive information and exercising materials, a daily supportive monitoring system, and dermatological and psychological counseling via Internet-chat. Primary objectives were the investigation of attitudes and expectations towards the program, intervention effects on skin picking severity, user satisfaction, adherence, and the willingness to participate. Secondary outcomes included the feasibility of study procedures, the adequacy of assessment instruments, and effects on skin picking related impairment, dimensions of skin picking, and general psychological impairment.

Methods:

A 2-arm randomized controlled trial was conducted in a sample of N=133 participants (93.2% female, N=124; mean age: M=26.67; SD=6.42), who were recruited via Internet. Inclusion required a minimum age of 17 years, and at least mild skin picking severity. Participants were randomly allocated to the intervention (N=64) or waitlist control group (N=69). All assessments were conducted online and based on self-report.

Results:

The willingness to participate was very high in the present study, so that the initially planned sample size of N=100 was exceeded after only 18 days. Participants’ expectations indicate that they believed the program to be beneficial for them (98.5%, N=131), and provide a feeling of support (89.5%, N=119). Reasons for study participation were insufficient outpatient healthcare (62%, N=83), and flexibility regarding time (79.7%; N=106), and location (82.0 %; N=109). The post assessment was completed by 65% (N=87) of the sample. The majority of the intervention group, who completed the entire post assessment (N=38), were satisfied with SaveMySkin (74%, N=28), and agreed that the program is an appropriate support service (92%, N=35). On average, participants viewed 29.31 (SD=42.02) pages in the program, and 47% of the total intervention group (N=30) used the monitoring at least once a week. In comparison to the control group, the intervention group displayed substantial improvements of the skin picking severity total score (Cohen’s d=0.67), and especially on the subscale symptom severity (Cohen’s d=0.79). No effects on secondary outcomes were found.

Conclusions:

The present study confirms the need for easily accessible interventions for skin picking disorder and the high interest in Internet-based self-help within the target population. It provides important insights into both, the attitudes towards online support and the actual user experiences. Participant feedback will be used to further enhance the intervention. Furthermore, the results point to the preliminary efficacy of the SaveMySkin and may thus lay the foundation for future research into the efficacy and cost-effectiveness of the program in a multi-center clinical trial. Clinical Trial: German Register for Clinical Trials (DRKS; DRKS00015236)