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


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.


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) 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.


Are you or a loved one struggling with a BFRB and looking for help? Therapists at the Center for the Obsessive Mind use ComB and HRT to support those with BFRBs. You can learn more about the treatments and services we provide here.


The Center for the Obsessive Mind offers

therapy in several states and internationally.

Learn more about where the staff practices, below.

Pastel skies and a pristine beach in Northern California, one of the areas where The Center for the Obsessive Mind helps people with Body-Focused Repetitive Behaviors.


The Center for the Obsessive Mind’s staff therapists offer online treatment for BFRBs throughout California. Our Clients span from San Francisco down to Southern Orange County and San Diego. Whether you’re in Silicon Valley, Santa Barbara, Beverly Hills or Dana Point, the Center’s staff can support you in your recovery.

The red rock spires of Bryce Canyon in Utah, one of the states where The Center for the Obsessive Mind offers counseling for Body-Focused Repetitive Behaviors.


Staff members at the Center for the Obsessive Mind offer treatment for BFRBs in the state of Utah. Since we offer online treatment, wework with people who live all across the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.

Clear turquoise waters in the Keys, one of the places where The Center for the Obsessive Mind practices psychotherapy for Body-Focused Repetitive Behaviors in Florida.


Therapists at the Center for the Obsessive Mind also offer treatment for BFRBs online in Florida. We see people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, we can provide specialized counseling remotely in your area.

The placid, clear waters of Sand Harbor in Lake Tahoe, one part of Nevada where The Center for the Obsessive Mind offers therapy for Body-Focused Repetitive Behaviors.


Therapists at the Center for the Obsessive Mind also practice teletherapy in Nevada. So if you’re seeking help in Glenbrook, Incline Village, Reno or Las Vegas, we offer specialized treatment for BFRBS online across the Grand Canyon State.

The Seven Sisters sea cliffs in Sussex, England, one international locale where The Center for the Obsessive Mind provides counseling.


In addition to all of the locations previously listed, the staff at the Center for the Obsessive Mind offer teletherapy for BFRBs to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what your treatment with The Center for the Obsessive Mind could look like.


Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy will meet for your needs. You can reach out here to learn more.


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Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email us and we will happily provide you with more information.