Skip to main content
ABCT 2025 59th Annual Convention Main banner
Psychology Tools Ad
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded Session
Recorded Session
Ticketed Session
Ticketed Session
ViewAttendees 3

Symposia

Technology/Digital Health

Advancing Digital ACT Interventions: Evidence-Based Strategies for Expanding Access to Care

4 - (SYM 52) Mediators and Moderators for Adults with Skin Picking Disorder in an Digital A-EBT Intervention

Friday, November 21, 2025
4:09 PM - 4:30 PM CST
Location: Bolden 6, Level 2
Keywords: Technology / Mobile Health, ACT (Acceptance & Commitment Therapy), Randomized Controlled Trial
Recommended Readings: Ong, C. W., Lee, E. B., Levin, M. E., & Twohig, M. P. (2022). Online process-based training for perfectionism: A randomized trial. Behaviour Research and Therapy, 156, 104152.,   Arch, J. J., Mitchell, J. L., Schmiege, S. J., Levin, M. E., Genung, S. R., Nealis, M. S., Fink, R. M., Bright, E. E., Andorsky, D. J., & Kutner, J. S. (2022). A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. BMC palliative care, 21(1), 198. https://doi.org/10.1186/s12904-022-01087-z,   Bowers, E. M., Capel, L. K., Woolley, M. G., Barnes, A., Twohig, M. P., & Levin, M. E. (2024). Efficacy and feasibility of web-based ACT-Enhanced behavioral treatment for skin picking in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 43, 100909.,   Donahue, M. L., & Levin, M. E. (2024). Pilot evaluation of a prototype online acceptance and commitment therapy program for adults living with a chronic health condition. International Journal of Mental Health, 53(4), 397–419. https://doi.org/10.1080/00207411.2024.2321432,   Klimczak, K. S., San Miguel, G. G., Mukasa, M. N., Twohig, M. P., & Levin, M. E. (2023). A systematic review and meta-analysis of self-guided online acceptance and commitment therapy as a transdiagnostic self-help intervention. Cognitive behaviour therapy, 52(3), 269–294. https://doi.org/10.1080/16506073.2023.2178498
Abstract Body



Objective:  Skin picking disorder is a chronic and impairing condition with limited treatment options. Acceptance-enhanced behavior therapy (A-EBT) has shown promise in reducing skin picking symptoms, yet no prior research has examined for whom this intervention is most effective and how it exerts its effects. This study examined moderators of treatment efficacy and whether changes in psychological inflexibility mediated symptom improvement in a randomized controlled trial of a digital intervention for adult with skin picking disorder.





Method:  Participants (N = 84) meeting DSM-5 criteria for skin picking disorder were randomized to an online 8-week A-EBT intervention or waitlist control condition. Symptoms were assessed at baseline, mid-intervention (4 weeks), post-intervention (8 weeks), and follow-up (12 weeks). Multilevel modeling (MLM) was used to test moderation effects of baseline psychological inflexibility, age, anxiety, depression, stress, and skin picking type (focused or automatic) on treatment response. Structural equation modeling was conducted to test whether reductions in psychological inflexibility mediated changes in skin picking severity.





Results:  Participants in the A-EBT condition showed significantly greater reductions in skin picking severity over time compared to the waitlist group (β = -0.35, p < .001). No baseline psychological characteristics significantly moderated symptom improvement. However, in exploratory analyses, higher levels of automatic skin picking behavior at baseline predicted greater reductions in time spent picking during treatment (β = -1.25, p = .001). Mediation analyses indicated that reductions in psychological inflexibility partially mediated the relationship between treatment condition and symptom improvement (β = 1.04, p = .036).





Conclusions:  Findings support A-EBT as an effective intervention for SPD, with psychological flexibility as a key process of change. The lack of significant moderators suggests that A-EBT may be broadly effective across clinical presentations, though automatic skin picking behaviors may influence engagement with treatment. Future research should explore additional mechanisms of change and refine interventions for individuals with distinct SPD subtypes.