Tackling Selecting and Pulling from all Angles – the ComB Mannequin for BFRBs

What are BFRBs?

Physique centered repetitive behaviors or BFRBs are extra generally referred to as pores and skin choosing or hair pulling problems. They contain “any repetitive self-grooming conduct that entails biting, pulling, choosing, or scraping one’s personal hair, pores and skin, lips, cheeks, or nails that may result in bodily injury to the physique and have been met with a number of makes an attempt to cease or lower the conduct.” (TLC basis)

One therapy choice that has promising knowledge and analysis to assist is the ComB mannequin.

What’s the ComB mannequin?

The excellent behavioral therapy or the ComB mannequin is a therapy protocol developed by (Mansueto 2019) that tackles the complexity of treating BFRBs. It begins with utilizing a CBT evaluation device, a practical evaluation. This seems to be at ways in which inside and exterior environments are impacting the BFRB that the shopper desires to alter. It’s a means for the clinician to develop a really distinctive and particular therapy for the shopper. It’s a technique to arrange your atmosphere so that you’re extra prone to handle the urge to select or pull.

Let’s undergo an instance!

The SCAMP mannequin is a framework that guides the clinician by totally different areas or domains to evaluate. Every area tackles therapy from quite a lot of inventive angles and leaves the shopper with quite a lot of expertise and strategies for particular triggers.

Sensory – All of us have a nervous system that has totally different wants. Utilizing this area, we have a look at specific sensory wants the shopper has and select strategies primarily based on that. For instance: If a shopper’s nervous system is craving a easy feeling, the clinician can present examples of easy objects the shopper can use comparable to utilizing a face masks or pimple patches that create a smoothness over a pimple or bump. Or utilizing a fear stone or calm patch to the touch.

Cognitive – There are particular cognitive perception methods and ideas that ceaselessly come up in remedy. The self-help e-book lists out a few of them. This can be a technique to see how the shopper’s inside self-talk and ideas can unknowingly enhance choosing/pulling or managing it. For instance: “I’ll simply decide/pull for a minute/only one” Rebuttal: How typically do I cease after a minute or after only one? Reply: By no means!. Utilizing post-it notes within the lavatory with a few of these rebuttals could be useful.

Affective – Our moods and feelings impression how we view issues and the way we work together with them. This a part of the mannequin goes by emotion regulation expertise. For instance: If a shopper’s choosing/pulling occurs each time they get harassed, the clinician would supply stress relieving strategies and choices for the shopper to do as an alternative of choosing/pulling.

Motor – Particular motions {that a} shopper does or a place they place their hand may set off an urge to select or pull. Pondering of issues to make it much less interesting or tougher to tug/decide. For instance: getting gel nails or a manicure can change the sensation of the shopper’s nails and they’re much less prone to get the identical reduction/feeling from choosing and pulling.

Place – Particular locations may set off a shopper to select or pull extra, comparable to the lavatory or whereas driving. For instance: dimming the lights within the lavatory as a way to’t see within the mirror as clearly/intently and fewer prone to get triggered by a hair or pores and skin bump.

I’d advocate the next in case you are serious about receiving extra coaching or sources. The TLC basis BFRBs coaching program:
Medical Coaching Institute – TLC Basis for Bfrbs.” Medical Coaching Institute – TLC Basis for BFRBs. Accessed 21 Aug. 2023.

Guide: Mansueto, Charles S., et al. Overcoming Physique-Centered Repetitive Behaviors: A Complete Behavioral Therapy for Hair Pulling and Pores and skin Selecting. New Harbinger Publications, 2019.

This publish is offered in collaboration with ADAA’s OCD and Associated Issues SIG. Be taught extra in regards to the SIG.


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