What is Comprehensive Behavioral Therapy for Trichotillomania, Skin Picking Disorder, and other Body Focused Repetitive Behaviors?

I get these questions a lot: What is Comprehensive Behavioral Therapy (ComB)? What is is for? Does it work? It says its for Trichotillomania, so why use it for skin picking, chewing, and other body focused repetitive behaviors?

Comprehensive Behavioral Therapy, or ComB for short, was developed by Dr. Charles S. Mansueto as a way to more effectively help people who have trichotillomania, as the existing methods were just not helping enough people. Yes, other methods of treatment do help some people, but too many were left unsatisfied. Now that this method has been around for a while, we are seeing that it is effective not only for hair pulling problems, but skin pickers, nail biters, and chewers are finding relief also.

It is true that this method of therapy has limits, which is why it is designed to be integrated or used along side other therapies to help each person fully. ComB helps specifically with the body focused repetitive behavior (BFRB), which means just the pulling, picking, chewing, etc. It does not directly take on what other factors impact a client’s life, such as depression, anxiety, relationship problems, trauma… the list goes on.

So what does ComB actually it look like in session? After getting to know each other, the therapist evaluates the client’s picking, pulling, and/or chewing through 5 different angles (below). This evaluation will likely consist of long interview like discussions and the client logging their behaviors between sessions.

Many people who struggle with trichotillomania and skin picking disorder find using fidgets helpful.

Many people who struggle with trichotillomania and skin picking disorder find using fidgets helpful, but this is only a small part of effective treatment.

  1. Sensory: The 5 senses, aversions, what’s soothing, and what is part of the rituals.
  2. Cognitive: Thought processes, patterns, and Thinking errors.
  3. Emotional: What emotions happen before, during, and after the behaviors.
  4. Motoric (Body): What patterns are happening with the body, posture, movements, etc.
  5. Place: Where does the client usually engage in the behavior (Tv, car, bathroom?). What sites are picked, pulled, or chewed?

This information gives both you and the therapist a much more detailed understanding of what factors drive your specific behaviors. When we understand it better, we can strategically select coping skills that meet your unique needs and circumstances.

Read Dr. Charles S. Mansueto original paper about it here: http://www.trich.org/dnld/comprehen_model_btt.pdf

 

I have been formally trained in ComB method of therapy through the Trichotillomania Learning Center in conjunction with the Behavior Therapy Center of Greater Washington. Additionally, I am trained and experienced in the other more general types of therapy that help people with the many other issues to round out this approach. After all, each of us is a whole person and it helps to address the whole picture of our wellness.

Priscilla Elliott is a Licensed Professional Counselor and Somatic Experiencing Practitioner in south Austin. She owns and provides psychotherapy at Courage Counseling, PLLC. While specializing in helping clients who are struggling with trauma, trichotillomania, and/or skin picking disorder; she also supports many in life transitions, anxiety, and depression. Call now for help: 512-673-3987

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  1. […] or skin picking disorder. Members will get a free copy of the work book I created based on the ComB method of BFRB recovery, as well as much support, acceptance, and new strategies to get you on your personalized path to […]