Skin Picking Therapy · Marin County, CA
Excoriation Disorder (Skin Picking) Therapy in Marin County
Excoriation disorder — compulsive skin picking — is a Body-Focused Repetitive Behavior that causes significant distress and shame. Reframe CBT specializes in ComB (Comprehensive Behavioral Model) treatment for skin picking in Marin County.
Understanding Excoriation Disorder
Excoriation disorder (also called dermatillomania or skin picking disorder) is not a bad habit or lack of willpower — it's a recognized mental health condition that responds to specialized behavioral treatment. Many people with skin picking feel intense shame and go to great lengths to hide the evidence.
- Recurrent picking of skin on the face, scalp, arms, legs, or other areas
- Picking triggered by specific textures, imperfections, or emotional states
- Automatic picking (without awareness) and focused picking (with full awareness)
- Significant distress about skin damage, scarring, or visible wounds
- Hours lost each day to picking and wound care
- Co-occurring anxiety, OCD, or trichotillomania
ComB Treatment for Skin Picking
The ComB (Comprehensive Behavioral Model) is the most effective treatment for excoriation disorder. It targets the specific sensory, cognitive, emotional, motor, and environmental factors that maintain skin picking for each individual.
BFRB Assessment
We assess the five ComB domains to understand what drives your skin picking — sensory triggers, emotional states, automatic vs. focused picking, and environmental contexts.
Awareness Training
Many people pick automatically without awareness. We build moment-to-moment awareness of picking urges and behaviors.
Competing Responses
We develop personalized competing responses — alternative behaviors incompatible with skin picking that address the same sensory or emotional need.
Sensory Substitutes
For texture-driven picking, we identify substitute sensory experiences — fidget tools, textured objects, or skin-safe alternatives.
Environmental Modifications
We modify picking environments — bathroom lighting, mirror access, skin care routines — to reduce automatic picking.
Emotional Regulation
For emotionally-driven picking, we build CBT skills for managing anxiety, boredom, frustration, and stress without picking.
Meet Your Therapists
Julie Hingsbergen, LMFT
Julie is a Licensed Marriage and Family Therapist and the founder of Reframe CBT. She specializes in CBT and ERP for OCD, anxiety disorders, phobias, and BFRBs, and holds specialized credentials including IOCDF Clinical Member and Certified ADHD Professional (ADHD-CCSP).
- Licensed Marriage & Family Therapist (LMFT)
- IOCDF Clinical Member
- Certified ADHD Professional (ADHD-CCSP)
- Fear of Flying Clinic (FOFC) Affiliate
- 15+ years clinical experience
Nicole Springer, Registered AMFT
Nicole is a Registered Associate Marriage and Family Therapist at Reframe CBT, supervised by Julie Hingsbergen, LMFT. She specializes in CBT and ERP for OCD, anxiety, phobias, and BFRBs, and works with children, teens, college students, and adults.
- Registered Associate Marriage & Family Therapist
- Supervised by Julie Hingsbergen, LMFT
- IOCDF Member
- Specializes in CBT & ERP
- Works with children, teens, college students & adults
Frequently Asked Questions
Skin Picking Therapy in Marin County
Book a free 20-minute consultation to discuss your skin picking. Specialized treatment works — you don't have to manage this alone.