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Randomized Controlled Trial
. 2025 Jul 2;15(1):22782.
doi: 10.1038/s41598-025-04360-2.

A randomized crossover trial with experience sampling to test placebo effects on pathological skin-picking

Anne Schienle  1   2 , Sara Kohlhofer  3 , Johannes Wilhelm  3 , Sandra Tanzmeister  3
Affiliations
Randomized Controlled Trial

A randomized crossover trial with experience sampling to test placebo effects on pathological skin-picking

Anne Schienle et al. Sci Rep. .

Abstract

Emotional distress is a typical trigger for pathological skin-picking (PSP). Given that placebo treatments can reduce emotional distress, the present study sought to investigate placebo responsiveness in individuals with PSP. In this randomized crossover trial, 69 participants (90% female, M = 31 years) with self-reported PSP underwent two weeks with daily placebo treatment (pills introduced as 'N-acetylcysteine' to reduce skin-picking) and two weeks without placebo treatment. Participants used a smartphone application to provide daily ratings for their skin-picking symptoms, as well as their stress levels. Questionnaires assessing the severity of skin-picking, stress, and difficulties in emotion regulation were completed before and after the two-week intervals (with and without the placebo). Questionnaire data indicated that placebo treatment reduced skin-picking severity (large effect) as well as perceived stress and difficulties in emotion regulation (medium effects). App-based assessments revealed that the placebo effect was limited to a moderate reduction in the urge to engage in skin-picking behavior, observed only during the second week of treatment, with no significant impact on daily stress levels. Individuals with PSP are responsive to placebo treatment. However, the magnitude of the placebo effect appears to be overestimated when relying on retrospective questionnaire data compared to ecological momentary assessments.

Keywords: Ecological momentary assessment; Emotion regulation; Placebo; Skin-picking disorder.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Design.
Fig. 2
Fig. 2
Questionnaire scores before vs. after the placebo and control condition. Note. n = 68; (score range) Skin-Picking Scale revised (SPS-R: 0–32); Brief Symptom Inventory (BSI-Anxiety: 0–24); Perceived Stress Scale (PSQ: 0–100); Difficulties in Emotion Regulation Scale (DERS); DERS—limited access to emotion regulation strategies (0–40), DERS—difficulties engaging in goal-directed behaviors (0–25), DERS–impulse control difficulties (0–30).
Fig. 3
Fig. 3
Percentage of completed app-ratings per day with/without placebo treatment.
See this image and copyright information in PMC

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