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? Lauren uses ComB and HRT to support those with BFRBs. You can learn more about the treatments and services she provides here.


Lauren is a licensed psychotherapist in

several states. Learn more about where

Lauren sees Clients, below.

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


When she is doing work face to face, Lauren offers in person therapy in Newport Beach. She also provides online treatment for BFRBs throughout California. Her Clients span from San Francisco down to Southern Orange County and San Diego.

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


Lauren provides treatment for BFRBs in the state of Utah. Since she offers online treatment, she works 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 Lauren practices psychotherapy for Body-Focused Repetitive Behaviors in Florida.


Lauren also offers treatment for BFRBs online in Florida, and sees people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, Lauren can provide specialized counseling remotely in your area.

The iconic red rock and lush greenery of Sedona, one part of Arizona where Lauren offers therapy for Body-Focused Repetitive Behaviors.


Lauren also practices online therapy in Arizona. If you’re seeking help in Phoenix, Sedona, Scottsdale or Tucson, Lauren offers specialized treatment for BFRBS online across the Grand Canyon State.

The lavender fields of Provence, France, one international locale where  Lauren provides counseling.


Along with her work in the United States, Lauren offers teletherapy for BFRBs to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what your treatment with Lauren 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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For more information about working with Lauren

call 310-824-5200 ext. 4 to speak with Client  

Coordinator Lisa O’Reilly at the 

OCD Center of Los Angeles

310-824-5200 ext. 17

1151 Dove St., Ste. 295
Newport Beach, CA 92660

©2021 by Lauren McMeikan Rosen, LMFT.

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 me and I will happily provide you with more information