101 S. Main St. Suite 7 PMB#252 Hiawassee, Georgia 30546

dr.pdorsett@drpameladorsett.com

404-444-7603

Comprehensive Behavioral Model (ComB)

The comprehensive behavioral (ComB) model is a multi-component treatment approach specifically designed for addressing body-focused repetitive behaviors (BFRB’s), such as trichotillomania (hair-pulling), excoriation disorder (skin-picking), and onychophagia (nail-biting). Developed by psychologists Drs. Charles Mansueto, John C. Woods, and Ruth Golomb, the ComB model combines several behavioral and cognitive strategies, allowing for a highly individualized treatment based on each person’s unique triggers and needs.

The ComB model focuses on five main domains that can influence body-focused repetitive behaviors:

  • The sensory domain involves the sensory aspects of the behavior, such as how it feels, sounds, or looks. For instance, some people find the sensation of pulling hair or picking skin to be soothing or satisfying. The therapist works with the client to understand what sensory experiences reinforce the behavior and to help the individual find alternative sensations.
  • The cognitive domain focuses on the thoughts, beliefs, and mental states that contribute to the behavior. This can include negative self-talk and beliefs about the behavior. Cognitive restructuring techniques may help to address these thought patterns and replace them with more helpful and realistic thought patterns.
  • The affective domain includes the emotional triggers or states that lead to or reinforce the behavior. This might involve using the behavior to cope with stress, anxiety, boredom, or frustration. Therapy includes learning new skills to manage these triggers.
  • The motor domain examines the physical movements that lead to the behavior; for example, behaviors that involve searching for a hair to pull. The therapist helps the person become aware of these physical patterns and identify ways to modify them, such as using competing responses.
  • The place domain includes the environment or specific locations where the behavior frequently occurs. For example, the person might pull their hair more when alone in their bedroom. Environmental changes, like adjusting lighting, using reminders, or changing seating arrangements, can help reduce the likelihood of engaging in the behavior.

The ComB process includes:

  • Thorough assessment to identify triggers and consequences of the behaviors
  • Development of specific strategies for each relevant domain
  • Self-monitoring throughout assessment and treatment

 

In summary, the ComB model is a comprehensive, flexible treatment approach for BFRBs, aiming to identify and modify the specific sensory, cognitive, emotional, motor, and environmental functions of the behavior. The treatment is evidence-based and practical.