Comprehensive Behavioral Treatment (ComB) for BFRBs in Columbus

At Proven Pathways, we utilize Comprehensive Behavioral Treatment (ComB), which is a collaborative and highly personalized evidence-based therapy designed to treat Body-Focused Repetitive Behaviors (BFRBs) such as skin picking (excoriation) and hair pulling (trichotillomania). ComB is rooted in the understanding that BFRBs are complex, ingrained behaviors that often serve multiple psychological or emotional functions. ComB is a highly personalized treatment that is matched to your specific experiences and behavioral patterns.

The process begins with a thorough assessment to help you and your therapist identify the triggers and maintaining factors for your BFRBs across five key domains:

• Sensory (e.g., the feel or visual appearance of skin or hair),

• Cognitive (e.g., thoughts or beliefs that arise before or after the behavior),

• Affective (e.g., emotional states such as stress, boredom, or anxiety),

• Motoric (e.g., physical movements or routines associated with the behavior), and

• Place/Environmental (e.g., locations or settings where BFRBs typically occur).

Once these domains are mapped out, your therapist will work with you to develop targeted, practical strategies for each one. This may include behavioral substitutions, environmental modifications, sensory tools, emotional regulation techniques, and cognitive interventions. A core part of ComB is also building awareness skills, so that you can better recognize when, where, and why BFRBs occur, and begin to interrupt or redirect them before they escalate.

Throughout the process, treatment is collaborative—you are an active participant in designing interventions that feel realistic and effective for your lifestyle. The ultimate goal of ComB is to empower you with a toolbox of skills to reduce the frequency and intensity of your BFRBs, increase self-awareness, and replace harmful habits with healthier, more adaptive coping mechanisms that support your overall well-being.

To read more about ComB treatment, click here.