Skin Picking Approach Avoidance Task
Condition: Skin-Picking
Study type: Interventional

Summary: 
      Pathological skin picking (PSP) is conceptualized as a behavioral addiction. Research has
      shown that behavioral addictions (e.g., problematic alcoholism or smoking) can be reduced
      using a cognitive retraining tool called approach-avoidance training (AAT). Participants will
      be randomly assigned to a single-session of AAT: (a) approach training, (b) avoidance
      training, or (c) placebo training and will be assessed at baseline, post-training (i.e., 30
      minutes after training), and 2-week follow up. The investigators hypothesize that those in
      the approach training will show greater reduction in approach tendencies at post-treatment
      and 2-week follow up, compared to those in the approach training or placebo conditions. This
      study may produce data that will guide the development of a training program that focuses on
      the maladaptive action tendencies in skin picking symptoms.
    

Detailed description: 
      Pathological Skin Picking (PSP) is one of many debilitating Body Focused Repetitive Behaviors
      (BFRBs) that involves repetitive picking to gain the gratification of relieving anxiety or
      tension. Thus, this behavior may cause infections, lesions, and scarring, resulting in
      psychosocial impairment or medical attention. Because of the habitual/compulsive nature of
      the disorder, researchers conceptualize this maladaptive coping mechanism as a behavioral
      addiction which may occur without conscious awareness. Therefore, it is important to identify
      the automatic motivational orientations behind BFRBs. There is compelling evidence to suggest
      that a novel technological behavior paradigm, called Approach Avoidance Training (AAT), can
      be used to assess and modify action tendencies (i.e., approach or avoidance) in behavioral
      addictions like PSP. This game-like task has the participant push (=avoid) or pull
      (=approach) a joystick based on a target and control stimulus presented on a computer screen.
      This push-pull paradigm is in response to the individual's inherent action tendencies.

      The overarching goal is to determine effective principles of change in interventions for
      BFRBs. Therefore, assessing neurocognitive components using computer-based training programs
      can help identify the implicit processes underlying the disorder. The objective of the study
      is to examine the feasibility of using AAT to modify PSP action tendencies, and potentially
      improve PSP symptoms. The investigators predict that individuals with PSP will have a
      pathological approach tendency towards skin as measured by the Approach-Avoidance Assessment
      (AAA). Therefore, AAT will promote reduction of approach to skin stimuli. To retrain one's
      action tendencies the investigators will randomize participants to the following training
      conditions: Avoidance Training (AvT; avoidance of skin stimuli), Approach Training (ApT;
      approach skin stimuli), or Placebo Training (PT; equal approach/avoidance of skin stimuli).
      The investigators will also administer an eye-tracking task to assess visual gaze response to
      pictures of irregular skin and neutral stimuli to evaluate training-induced changes in action
      tendencies. Previous studies have shown the AAT's success in reducing action tendencies and
      symptoms in other addictions like problematic alcohol use and cigarette smoking Therefore,
      AAT may prove effective in modifying the behavioral addiction of PSP. Sixty adults with PSP
      will be randomly assigned to (a) approach training (b) avoidance training or (c) placebo
      training. All participants will then be sent a follow-up survey approximately two weeks after
      completion of the main study to determine changes in symptoms. This pilot study is expected
      to guide the development of an accessible, cost-efficient, and effective cognitive training
      programs for individuals with PSP.
    

Intervention name(s): Computerized cognitive training
Intervention type(s): Behavioral
Intervention description(s): Participants are trained to approach or avoid stimuli of skin using a joystick. Participants are to pull or push the joystick toward or away when skin stimuli are present. Thus, behaviorally, there may be an increase, decrease, or no change in approach tendencies towards skin.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: skin picking; cognitive training; approach-avoidance