Running head: SELF MODIFICATION PROJECT: SKIN PINCHING

Self Modification Project:

Skin Pinching

Brennan Perreault

Mount Royal University

SELF MOD: PINCHING

Introduction

Acne is a common skin condition that most individuals in our world experience at

some point in life. The degree and length that this condition can manifest differs vastly

between people. I myself have what I consider to be rather mild but persistent acne and

thus had an increasing amount of experience in the ways that I mange it. Over this time I

have learned to use a minimum of two fingers and/or thumbs from either one or two

hands to apply pressure on adjacent sides of acne or blemishes with the intention of

expelling what may exist beneath the skin. Simply referred to as skin pinching, this

behaviour occurs not only in excess but also in a manner that has the potential to cause

significant and/or permanent damage to my skin. Satisfaction would be reached if the

original visual stimuli was removed (eg white or black head) and thus provide a sense of

relief and reinforcement. This pattern of reinforcement by relief of an adverse stimulation

is know as automatic negative reinforcement. .This behavioural excess has developed or

nurtured a cognitive process that is expressed in aggressive, frustrating, repeated attempts

that only result in further harm. It has also expanded to other parts of the body such as

arms, neck and shoulders. Therefore, I have recorded, developed and instituted an

informal treatment plan with the goal of decreasing the frequency that this problem

behaviour occurs and the harm that it can lead to.

As noted above, the use of a minimum of two fingers and/or thumbs from either

one or two hands to apply pressure on adjacent sides of acne or blemishes with the

intention of expelling what may exist beneath the skin was used to define what would

constitute skin pinching. I used a direct observational assessment method called the ABC

SELF MOD: PINCHING

diary (Antecedent, Behaviour, Consequence). Briefly summarized, this method provided

me with the ability to record ABCs immediately, accurately and was used to establish a

baseline for the problem behaviour over a period of four days (March 8th - 11th). The

ABC diary was the first step in assessing the current frequency, antecedents and

consequences and led to patterns in both antecedents and consequences (see appendix A

for ABC diary). For example, the most common antecedents were that I was alone and in

close proximity to a mirror. In some cases anxiety was a factor but was rather

inconclusive. Another frequent antecedent was the use examining skin with a hand,

detecting a distortion and moving to a mirror if necessary. The most concerning pattern

that was recognized was in some cases where the antecedent for one pinch was the pinch

only moments before. Patterns within consequences were noted as well, in particular, the

relief of a blemish or frustration resulting from failure to do so. Frustration as a result of

failure often provoked a following attempt, revealing an important correlation between

frustration as an antecedent and a consequence. Other common consequences were

simply biological such as redness, soreness, clear fluid, blood, and contents of acne relief

(popping). After the ABC period, a treatment phase and follow-up phase took place each

lasting four days. Results were graphed to show the baseline, treatment and follow up to

visually depict the effectiveness of the self modification (Figure 1).

SELF MOD: PINCHING

Skin Pinching Behaviour Modification

0

1

2

3

4

5

6

7

8

0 1 2 3 4 5 6 7 8 9 10 11 12 13

Day

Frequency

Baseline Treatment Follow-up

Treatment

Based on the reasons outlined in the previous section and to reiterate, my goal in

this behaviour modification was to reduce the frequency and harm (intensity) of the

problem behaviour. To begin, frequency was addressed through the introduction of

differential reinforcement of low rates of responding - full session variation (DRL-FS).

DRL-FS was used because skin care is an important component of good hygiene but must

be practiced at a reasonable frequency. The allotted number of skin treatment attempts for

a single day to receive reinforcement was 4 or less. Reinforcement was given in the form

of permission to listen to music in bed. To increase the establishing operation (EO) of

music use was restricted for the treatment period.

Figure 1. Skin Pinching Behaviour Modification. Each of the three phases in the ABA graph above represents one third of the total time. During the baseline phase, frequency was recorded with an ABC diary and depicts the highest frequency count. When the treatment was instituted in phase 2, there was an initially high recording, but on average frequency was lower. The third and final phase - follow-up - suggests the presence of a successful treatment effect due to lower frequency levels continuing from phase 2 in comparison to the first (baseline) phase.

SELF MOD: PINCHING

Harm was addressed through a variation of differential reinforcement of

alternative behaviour (DRA) called differential reinforcement of incompatible behaviours

(DRI). I did some investigating into tools designed to deal with white and black head

acne types and found one that was to my liking (see appendix B for visual). It functions

by applying pressure to acne spots and gently pushing the contents out with minimal

irritation to the skin. While executing this behaviour it would be impossible to also use

hands to pinch the skin. The sub goal here was to take the underlying motivation (skin

care) for skin pinching and direct it through a healthier and sensitive alternative.

In addition to this, antecedent controls were introduced: a new antecedent (and

consequence) was added - washing of the skin using a cleansing scrub (see appendix B

for visual) to ensure that my skin was clear and refreshed before and after skin care. A

visual cue or prompt was also placed on the desktop of my computer (high traffic and

frequent area of exposure) to remind myself to stick to my DRI and newly developed

antecedent/consequences. Equally important was the choice to included a brief sentence

to remind myself to remain calm and not to treat skin care as a matter of success or

failure. The purpose was to lower damage to the skin by prompting for less aggressive

skin care treatment (see appendix C for visual). Frequency counts were recorded through

a simple notepad on an iPhone (see appendix D for details). As seen in the graph above

(Figure 1), phase 2 (treatment) depicts the introduction of the aforementioned measures.

Follow-up

The final phase of behaviour modification was the follow-up period. During this

time most treatment measures were ceased (DRL-FS and visual prompt) and a frequency

SELF MOD: PINCHING

count was again maintained using the iPhone notepad app (see appendix D for details). It

should be noted that the newly introduced behaviour and some antecedent controls were

kept (eg. DRI, cleansing scrub before and after) as they were integral to properly

maintaining the instituted treatment in this phase. Although the visual prompt was

removed, it appeared to have the desired effect of reducing aggression and frustration

related to perceived failure to treat blemishes. The treatment appeared to have an effect

on the frequency count of the DRI behaviour that was instituted as depicted by the

follow-up interval of the graph (Figure 1).

Conclusion

Over the 12 day ABA behaviour modification, the frequency data suggests a

decreased rate of occurrence in skin pinching. The problem behaviour was also

successfully replaced by more appropriate methods of skin care - facial cleansing scrub

and a black head/white head removal tool. I would suggest that this had much to do with

the original motivation (skin care) that was transferred and applied by the use of the acne

tool. This helped to decrease the harm that was previously being caused by the problem

behaviour and allowed for less frequent and more efficient treatment. The placement of

the visual cue prompted treatment to be less aggressive and frustrating during both the

treatment and follow-up phases. Graphed data (Figure 1) suggests that the overarching

goal of the treatment plan (to reduce frequency and harm) was reached and the

underlying incentive (skin care) should provide significant motivation for an enduring

treatment effect.

SELF MOD: PINCHING

Appendix B

Blackhead/whitehead removal tool and cleansing scrub:

Appendix C

Visual prompt:

Appendix D

Frequency data: