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Skin-PickingNCT03182478

Treating Skin Picking With Cognitive-Behavioral Protocol in Individual and Group Format.

A study testing Rothbaum protocol in individual format and Rothbaum protocol in group format in people with Skin-Picking, run by Federal University of Health Science of Porto Alegre at 1 site in Brazil.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Skin Picking Disorder (SPD) affects 1.4-5.4% of the general population. It has a high association with anxiety and depressive symptoms. Only behavioral treatments demonstrated significant benefits compared with inactive control conditions, but with poor accessibility of this treatment to patients. Read more about this study

Who is it for?
Ages 15 years and older
Conditions the study is for
Skin-Picking
What is being tested?
Rothbaum protocol in individual format and Rothbaum protocol in group format
Could I receive a placebo?
No, everyone receives an active treatment
How many people
55 participants
Where
1 siteBrazil
Study dates
Jul 2016to Jun 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 15 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Skin Picking diagnosis according to DSM 5 criteria

Who cannot join

  • Current psychotic disorder
  • Current suicide risk
  • Intellectual disability

Trial locations and contacts

1 site in 1 country.

Brazil1 site
  • Universidade Federal de Ciências da Saúde de Porto Alegre

    Pôrto Alegre, Rio Grande do Sul, 90050-170

Other trials in Brazil

About this study

Official title: Improving Skin Picking Treatment Using a Cognitive-Behavioral Protocol in Individual and Group Format: a Randomized Clinical Trial

Skin Picking Disorder (SPD) affects 1.4-5.4% of the general population. It has a high association with anxiety and depressive symptoms. Only behavioral treatments demonstrated significant benefits compared with inactive control conditions, but with poor accessibility of this treatment to patients. Besides this, behavioral treatment does not address the associated anxious and depressive symptoms. Trichotillomania and SPD have co-occurrence rate greater than expected, indicating that can be part of the same disease spectrum. The Rothbaum Cognitive Behavioral Therapy(CBT) protocol is effective in treating trichotillomania. Based on the similarity of these diseases, this study uses the Rothbaum Protocol to treat SPD in individual and group format. We hypothesize that this protocol will be effective in treating SPD, anxiety and depression symptoms associated and also facilitate therapist training. Methods: A community sample of 40 participants with SPD will be randomly allocated to receive treatment with the Rothbaum Protocol individually or in group format. Patients with current psychotic disorder, suicide risk or mental disability will be excluded. Instruments measuring anxiety, depression and SPD severity will be applied in the baseline, after the intervention and after a 6 months follow-up. Motivation of patients to therapy will be evaluated at the baseline. The primary outcome will be the remission of symptoms evaluated by the overall clinical impression. The secondary outcomes will be the degree of improvement in anxiety, depression and SPD severity.

Read the detailed description

Skin Picking Disorder (SPD) is a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 and affects about 1.4% to 5.4% of the general population, increasing this prevalence to 7% to 30% in psychiatric patients. Despite the importance of this pathology, less than half of the patients with SPD seek treatment, only 53% receive the correct diagnosis and more than 57% are not satisfied with the treatment received. About 85% of patients think that professionals are not trained to treat SPD. Skin Picking Disorder occurs frequently with other mental disorders, with 13-48% of patients having major depressive disorder and 5-23% having anxiety disorders. The literature suggests that neither Selective Serotonin Reuptake Inhibitors (SSRIs) nor Lamotrigine are effective when compared to placebo in treating SPD, and only treatment with behavioral techniques are effective. However, studies using behavioral techniques do not address associated symptoms, as anxiety and depression.

Some studies found that the rate of co-occurrence of dermatillomania and trichotillomania is higher than expected, so it has been hypothesized that these disorders are part of the spectrum of a single pathology. It is known that the Rothbaum Protocol, a standardized treatment for Trichotillomania, is effective in treating this disorder, addressing also the management of anxiety and depressive symptoms, besides working with relapse prevention.

Thus, our study works with the hypothesis that the Rothbaum CBT Protocol can be effective in the treatment of dermatillomania, in both individual or group format. Having the same protocol to treat SPD and Trichotillomania might facilitate the patient access to treatment and the therapist training, and also might improve the SPD treatment in a long-term, by managing the relapse prevention.

Methods: this study is a thwo armed randomized controlled and single masked clinical trial. Participants with SPD according to DSM 5 will be included and randomly allocated in individual or group format of treatment with the Rothbaum CBT Protocol. The protocol will be adapted to SPD, changing the habit of pulling the hair to the habit of picking the skin. Symptoms of anxiety, depression and the SPD severity will be evaluated by specific instruments and by a photographic measurement before the intervention, after and in a 6 moths follow-up. The motivation of patient to the CBT will be measured at the baseline. Will be excluded patients with current psychotic disorder, suicide risk or mental disability.

The CBT protocol will consist of 8 weekly sessions, during 45 minutes in individual format and 90 minutes in group format, always applied by a trained therapist. This protocol includes psychoeducation, habit reversal techniques, anxiety management, change of disfunctional cognitive schemes and relapse prevention.

The primary outcome will be the remission of symptoms of SPD, assessed by the Clinical Global Impression scale. The secondary outcomes will be the improvement of depressive symptoms, anxiety and SPD symptoms assessed by the others instruments.

Conditions
Skin-Picking
Being tested
Rothbaum protocol in individual format, Rothbaum protocol in group format
Keywords
skin picking, SPD, Cognitive-Behavioral Therapy, CBT, Group treatment, Rothbaum protocol
Medical subject headings
Excoriation Disorder

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Rothbaum protocol in individual formatBehavioural

    Also called Cognitive-Behavioral Protocol

    8-week 45 minute session Rothbaum CBT protocol adapted to Skin Picking, changing the focus on pulling hair to picking skin. Session 1: psychoeducation of the skin picking habit and how CBT works, patients initiate the self-monitoring of the habit. Session 2: techniques of habit reverse, adapted by having the skin as a target instead of the hair. The session 3: anxiety management using diaphragmatic breathing and muscle relaxation. Sessions 4 to 6: management of dysfunctional thoughts, using cognitive tools as the evidence analysis, reattribution of roles and gravity scale. Session 7: change of roles and role-playing, with patient playing the role of therapist, applying the Rothbaum Protocol to treat Skin Picking, so reviewing all the protocol techniques. Session 8: relapse prevention.

  • Rothbaum protocol in group formatBehavioural

    Also called Cognitive-behavioral protocol

    8-week 90 minute session of Rothbaum CBT protocol adapted to Skin Picking, changing the focus on pulling hair to picking skin. Session 1: psychoeducation of the skin picking habit and how CBT works, patients initiate the self-monitoring of the habit. Session 2: techniques of habit reverse, adapted by having the skin as a target instead of the hair. The session 3: anxiety management using diaphragmatic breathing and muscle relaxation. Sessions 4 to 6: management of dysfunctional thoughts, using cognitive tools as the evidence analysis, reattribution of roles and gravity scale. Session 7: change of roles and role-playing, with patient playing the role of therapist, applying the Rothbaum Protocol to treat Skin Picking, so reviewing all the protocol techniques. Session 8: relapse prevention.

Study groups in NCT03182478
Study groupRoleWhat they receive
Individual TreatmentActive comparatorIntervention with the Rothbaum Protocol in individual format, with eight weekly sessions each one of 45 minutes, applied by a trained investigator. Session 1: Psychoeducation and self-monitoring. Session 2: habit reversal techniques. Session 3: muscle relaxation and diaphragmatic breathing. Session 4: stop the thought. Session 5: oriented internal dialogue. Session 6: cognitive techniques. Session 7: role-play. Session 8: relapse prevention
Receives: Behavioral: Rothbaum protocol in individual format
Group TreatmentActive comparatorIntervention with the Rothbaum Protocol in group format up to 10 patients, with eight weekly sessions each one of 90 minutes, applied by a trained investigator. Session 1: Psychoeducation and self-monitoring. Session 2: habit reversal techniques. Session 3: muscle relaxation and diaphragmatic breathing. Session 4: stop the thought. Session 5: oriented internal dialogue. Session 6: cognitive techniques. Session 7: role-play. Session 8: relapse prevention
Receives: Behavioral: Rothbaum protocol in group format

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Remission of symptoms

    Remission of Skin Picking symptoms, evaluated by the Clinical Global Impression Scale, with a score under or equal 2 considered remission.

    Measured: baseline, 8 weeks, 6 months

Secondary outcomes (4)
  1. Improvement in anxious symptoms

    Mean Change From BaselineI in anxious symptoms assessed by the Hamilton Anxiety Scale

    Measured: baseline, 8 weeks, 6 months

  2. Improvement in depressive symptoms

    Mean Change From Baseline, assessed by the Beck Depression Inventory

    Measured: baseline, 8 weeks, 6 months

  3. Improvement in Skin Picking lesions

    Mean Change From Baseline, assessed by the photographic measurement

    Measured: baseline, 8 weeks, 6 months

  4. Improvement in Skin Picking life impact

    Mean Change From Baseline, assessed by the Skin Picking Impact Scale.

    Measured: baseline, 8 weeks, 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Jun 2017
  2. Study startJul 2016
  3. Primary completionApr 2018
  4. Study completionJun 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Intervention with Rothbaum protocol adapted to skin picking disorder, in individual or group format, consisting of eight weekly sessions, each session during 45 minutes in individual format and 90 minutes in group format
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
55 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03182478
Sponsor's protocol ID
U1111-1185-5527
Status last verified
Apr 2020
First submitted
7 Jun 2017
Last updated
29 Apr 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Grant JE, Odlaug BL, Chamberlain SR, Keuthen NJ, Lochner C, Stein DJ. Skin picking disorder. Am J Psychiatry. 2012 Nov;169(11):1143-9. doi: 10.1176/appi.ajp.2012.12040508.

    PubMed 23128921
  • 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 Nov;32(7):618-29. doi: 10.1016/j.cpr.2012.05.008. Epub 2012 Jul 20.

    PubMed 22917741
  • Hayes SL, Storch EA, Berlanga L. Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord. 2009 Apr;23(3):314-9. doi: 10.1016/j.janxdis.2009.01.008. Epub 2009 Jan 23.

    PubMed 19223150
  • Gupta MA, Gupta AK. Current concepts in psychodermatology. Curr Psychiatry Rep. 2014 Jun;16(6):449. doi: 10.1007/s11920-014-0449-9.

    PubMed 24740235
  • 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 Jan;25(1):88-95. doi: 10.1016/j.janxdis.2010.08.007. Epub 2010 Aug 13.

    PubMed 20810239
  • 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 Feb;27(1):10-5.

    PubMed 25696776
  • 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 Jan;49(1):11-7. doi: 10.1016/j.brat.2010.09.005. Epub 2010 Sep 22.

    PubMed 20934685
  • 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 Jul-Aug;41:29-37. doi: 10.1016/j.genhosppsych.2016.04.001. Epub 2016 Apr 13.

    PubMed 27143352
  • Xavier ACM, de Souza CMB, Flores LHF, Bermudez MB, Silva RMF, de Oliveira AC, Dreher CB. Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol: a randomized clinical trial. Braz J Psychiatry. 2020 Sep-Oct;42(5):510-518. doi: 10.1590/1516-4446-2019-0636.

    PubMed 32401873

Questions about this trial

What is this clinical trial studying?

A study testing Rothbaum protocol in individual format and Rothbaum protocol in group format in people with Skin-Picking, run by Federal University of Health Science of Porto Alegre at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Apr 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Remission of symptoms (time frame: baseline, 8 weeks, 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03182478, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Apr 2020.

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