Online Therapy for Skin Picking: Options and Costs

The options, one at a time

1. A BFRB-trained therapist over video

Best for: you want to talk to a specialist in real time and may be able to use insurance.

Cost: private-pay rates in the US run roughly $100 to $250 per session, based on national cost guides, and our guide to CBT for skin picking goes through the numbers. At one session a week, that's about $400 to $1,000 every four weeks. A typical course is 8 to 16 weekly sessions, so somewhere between $800 and $4,000 in total before insurance.

Insurance: some specialists are in-network. If yours isn't, ask for a superbill, an itemized receipt you send to your insurer to claim out-of-network reimbursement.

What it's like: a scheduled call each week, usually built around habit reversal training (HRT) or the ComB (Comprehensive Behavioral) model, with practice to do before the next call. Our habit reversal training guide covers what that involves.

Where to find one: our list of therapists who work online, or the full therapist directory if you'd also consider someone local. Outside our site, try the IOCDF directory or the TLC Foundation's directory at bfrb.org, whose programs have moved to the IOCDF.

The catch: this is the most expensive route, and the therapist must be licensed where you are physically sitting during the session, which can shrink your choices a lot. Our guide to finding a BFRB therapist explains how that rule plays out across US states.

2. SkinPick

Best for: your week won't hold a fixed appointment, or writing about picking feels easier than saying it out loud.

Cost: $49 to $70 per week, billed every 4 weeks, so $196 to $280 per billing cycle (SkinPick FAQ). The price depends on your location, ability to pay and therapist availability.

Insurance: not accepted. FSA and HSA cards are.

What it's like: you work through digital modules and exchange secure text and voice messages with a therapist, with no appointments to book. Their site says the therapist replies within 24 hours on weekdays. The Personal Program starts at age 14, and a separate Parent Program covers children 13 and under. SkinPick's IOCDF directory listing carries a "BTTI Trained" tag.

The catch: there are no scheduled live sessions, and replies come on weekdays, so a message sent late on a Friday may wait until Monday. The price is a range, so ask which end of it applies to you before paying.

3. TrichStop, if pulling is part of it too

Cost: $60 to $90 per week, billed every 4 weeks, so $240 to $360 per cycle (TrichStop FAQ).

Insurance: not accepted. FSA and HSA cards are.

What it's like: the sister platform to SkinPick, with the same messaging-and-modules setup, built around hair pulling.

The catch: if picking is your main concern, SkinPick is the closer fit. TrichStop makes more sense when pulling is a big part of the picture.

4. General therapy platforms (BetterHelp and similar)

Cost: BetterHelp's own cost page (updated 31 March 2026) puts therapy at $70 to $100 a week, billed weekly or every four weeks. That's $280 to $400 per four weeks.

Insurance: BetterHelp says some therapists on the platform now accept insurance, limited by state.

What it's like: a large pool of licensed therapists. None of them is promised to have BFRB training, so the match you get may know anxiety and depression well and know very little about picking.

The catch: you're paying close to specialist-platform prices for a generalist unless you screen for training yourself.

5. Low-cost therapy through Open Path Collective

Cost: a $65 one-time membership, then $40 to $70 per session, open to households earning under $100,000. Weekly sessions come to $160 to $280 per four weeks, plus the membership fee once.

What it's like: reduced-fee sessions with private therapists. Ask each therapist whether they see clients by video.

The catch: Open Path isn't BFRB-specific. You'll need to check each therapist's training using the checklist further down.

6. Self-guided: the USU ACT Guide for Skin Picking

Cost: $25 for six months of access (Utah State University).

What it's like: eight online modules of about 30 minutes each, based on acceptance and commitment therapy (ACT), which teaches you to make room for urges without acting on them. The program was tested in a clinical trial with 84 adults. It's the lowest-cost option on this list with research behind it, and few people seem to know it exists.

The catch: no therapist. Nobody notices if you stop after module three, and the program is only open to adults 18 and over, who were also the people in the trial.

7. Online groups

The OCD Center of Los Angeles runs low-fee weekly CBT groups for BFRBs by webcam. They're limited to California residents, adults only, with an assessment before you join, and the price is on request. Limits like that usually come from the same licensing rule as option 1, so check your state before getting attached to any clinician-led group.

Free peer-led groups are listed on our support groups page. They're a place to talk with people who get it, and they count as support, not treatment.

What the research says about each format

There's direct trial evidence for online treatment of skin picking, and good evidence from other conditions that online CBT holds up against face-to-face sessions.

The platform data has clear limits. A 2024 study in Cognitive Therapy and Research by Dar, Schonbach and Wenzler looked at 840 SkinPick and 583 TrichStop users and found that people who completed more sessions had larger drops in symptoms (Dermatology Times summary). The study had no control group, and its authors are the platform's own clinicians. It tells you the program's users improved. It can't show how much of that came from the program itself.

How that maps onto the options:

• Messaging plus modules with a therapist (SkinPick, TrichStop): the closest match to the Asplund trial and to guided internet CBT in the reviews. The platform's own outcome data is encouraging but uncontrolled.
• Live video: the same kind of treatment as an office visit, through a screen. None of the studies cited here tested video sessions for picking specifically.
• Self-guided (USU ACT Guide): tested in a clinical trial of 84 adults.
• Groups: no picking-specific outcome data among the sources here.

Checking a therapist's training

Online, you can work with someone hundreds of miles away, which makes it easier to hold out for real BFRB experience. Signs you've found it:

• They bring up habit reversal training or ComB themselves when you describe picking.
• Their profile or website mentions BFRB-specific training. On IOCDF directory listings this can show up as a "BTTI Trained" tag, so ask what that training covered.
• They talk about picking as a pattern with triggers and settings, and don't treat it as a symptom to be fixed by tackling anxiety first.
• They hold a license that covers the place you'll be sitting during sessions.

For the full process of searching directories and screening therapists, see how to find a BFRB therapist.

What a first online session looks like

On a video service, the first session is mostly listening and mapping. Expect questions about when picking happens, which areas of skin, what you tend to be doing or feeling beforehand, and what you've already tried. Many therapists end the first session by asking you to start noticing or logging episodes, because the treatment plan depends on that information.

A few practical things make it easier: a room where nobody will walk in, headphones so you're not worried about being overheard, and your camera angled so you feel comfortable. You decide what you show. If you'd rather describe your skin than hold it up to the camera, say so.

On a messaging program, the first step happens in writing, at your own pace. It can help to draft your first message somewhere else, since describing picking in detail can take a few tries before it feels right.

Between sessions

Most of the change in behavior therapy happens in the days between appointments: catching urges earlier, practicing a competing response, adjusting the places and moments where picking tends to happen. Your therapist only sees what you bring back, and memory after a hard week tends to blur the details.

SkinAware is built for that stretch of the week. You log episodes and urges you resisted in a few seconds, with body area, trigger, intensity and mood. If you connect your therapist with a code, you see a consent screen first showing what's shared and what stays private, and you can switch sharing off whenever you like. Your therapist gets their own view with your pick-free time, the last 7 days (picked, resisted, practices), your top trigger and detailed insights, plus optional messaging they can switch off. Therapists use it free for one client.

Frequently asked questions