ComB model

Domain II · Behavioural & cognitive · Mansueto, Golomb, Thomas · 1999

What it is

The Comprehensive Behavioral (ComB) model is a functional-analytic framework for treating body-focused repetitive behaviours (BFRBs): hair pulling (trichotillomania), skin picking (excoriation disorder), and nail, cheek or lip biting and similar behaviours. It is a framework for building an…

Format

• Goals: review each strategy weekly against monitoring data; rate goals as met, partly met or not met; keep, add, modify or replace strategies. Before dropping a strategy, check whether it was actually used and what got in the way.
• Phases III and IV cycle weekly until goals are met.

Who practises it, and how they are trained or regulated

• The Comprehensive Behavioral (ComB) model is a functional-analytic framework for treating body-focused repetitive behaviours (BFRBs): hair pulling (trichotillomania), skin picking (excoriation disorder), and nail, cheek or lip biting and similar behaviours. It is a framework for building an individual treatment, not a fixed package: the therapist and client map what triggers the behaviour and what rewards it across…

Evidence status, as the guide reports it

• Scope: individual outpatient treatment of adults, adolescents and children (with family adaptations). The model was presented in 1999 as untested; a manual and uncontrolled pilot followed (Falkenstein et al., 2016); controlled trials were reported as under way.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the object left in a drawer. Working if idle-time episodes fall.
• grooming routines that become extended examining; set time limits and lighting rules.
• shame from penalties or hair-showing; drop anything that adds shame. Working if strategy use rises.
• behaviour returning when a strategy is withdrawn; reinstate it. Working if gains hold at each step.
• statements that sound like scolding. Working if the client uses them and reports a pause before acting.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.