Treatments for Body-Focused Repetitive Behaviors (ComB & HRT)

TREATMENTS FOR BODY-FOCUSED REPETITIVE BEHAVIORS

ComB & HRT

There are two different treatments for Body-Focused Repetitive Behaviors (BFRBs): Comprehensive Behavioral Model of Treatment (ComB) and Habit Reversal Traning (HRT). ComB is considered one of the go-to approaches for treating BFRBs, and, likewise, HRT is a common and effective BFRB treatment.

COMPREHENSIVE BEHAVIORAL MODEL OF TREATMENT (ComB)

People with Body-Focused Repetitive Behaviors (BFRBs), such as Trichotillomania (compulsive hair-pulling) and Excoriation Disorder (compulsive skin-picking), pick and pull for a number of of reasons. For instance, many pull to reduce stress or pick out of boredom. In other cases, individuals pull because they don’t think a hair belongs or pick because they want their skin to look perfect. As a result of the variety, it’s important to discover your personal picking or pulling profile. Because of this, ComB is an ideal approach.

In order to help people understand their profile, this therapy breaks down factors that initiate and perpetuate BFRBs into five categories. Firstly, “sensory” experiences, such as bumps or coarse hairs, can trigger the desire to pick or pull. People also pull or pick in order to experience a sensation, for instance, the feeling of a hair’s root across the lips. Secondly, the “cognitive” or thought domain is considered. In order to address this, individuals learn cognitive restructuring. Thirdly, the “affective” domain involves feelings that trigger and perpetuate the disorder. As mentioned above, people pick and pull to avoid unpleasant emotional states and to create pleasant ones. In addition, the “motor” category targets automatic picking and pulling. This includes the type that occurs outside of awareness. Lastly, “place” refers to environments that promote picking and pulling. Sometimes, this occurs as a result of associations that develop between the behavior and place.

When combined, these five domains create an acronym: SCAMP. Individuals use this acronym as well as logging to support their awareness of the behavior. Once people identify their triggers, they collaboratively determine how to interrupt the behavior. From there, individuals experiment with the effectiveness of each intervention. In sum, ComB uses all of these methods to help BFRB sufferers develop a personalized plan for recovery.  

HABIT REVERSAL TRAINING (HRT)

Habit-Reversal Training (HRT) likewise focuses on cultivating awareness and implementing interventions. Unlike the interventions in ComB, those within traditional HRT are less varied. HRT does involve several components though, such as competing response training. In this practice, when an urge to pick or pull arises, a person tenses their muscles in a way that is fundamentally incompatible with their behavior for one minute. HRT also involves the implementation of relaxation techniques, like diaphragmatic breathing.

Moreover, recent models of HRT, often called HRT Plus, include additional elements, like stimulus control. Simply put, stimulus control refers to the fact that certain stimuli can influence behavior through conditioned responses. As a result, changing stimuli can support behavior change. Furthermore, HRT Plus employs other support techniques including the use of habit blockers (implements that prevent the behavior) and stimulation replacements (like fidget toys) to support behavioral change.