Experiential avoidance as mediator between maladaptive cognitions and pathological skin picking symptom severity

The importance of experiential avoidance (EA) has long been recognized in psychopathology and psychotherapy. However, empirical evidence on the role of EA in pathological skin picking (PSP), is still limited. To address this gap in the literature and inform intervention, Norberg and colleagues’ (2007) study was replicated using a PSP sample. Individuals reporting PSP symptoms (n=329) completed five questionnaires online: Brief Fear of Negative Evaluation (BFNE), Beliefs About Appearance Scale (BAAS), The Other as Shamer Scale (OASS), Acceptance and Action Questionnaire II (AAQ-II), and The Skin Picking Scale-Revised (SPS-R). Mediation analyses involving non-parametric bootstrapping were performed to determine whether EA mediates the relationship between (1) fear of negative evaluation and PSP symptom severity; (2) dysfunctional beliefs about appearance and PSP symptom severity; and (3) shameful cognitions and PSP symptom severity. Three separate analyses showed that EA acted as a full mediator for all three relationships. A fourth hypothesis predicting an indirect effect from PSP symptom severity to EA via maladaptive cognitions was not supported. Overall, results indicate that EA has a central role in PSP, supporting a therapeutic approach aimed at decreasing EA rather than targeting specific dysfunctional cognitions. Limitations and future areas of research are also discussed