What are the Interventions for Repetitive Behavior Disorders such as Trichotillomania (Hair Pulling Disorder), Excoriation (Skin Picking Disorder), Tic Disorders, and Tourette's Disorder?
Comprehensive behavioral (ComB) model is a cognitive behavioral approach for managing body-focused repetitive behavior (BFRB) disorders such as trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. A similarly named, but different intervention, called Comprehensive Behavioral Intervention for Tics (CBIT), is an evidence-based behavioral therapy for managing Tourette's Disorder and chronic tic disorders that provides additional benefit to pharmacotherapy.
What Do You Learn in Comprehensive Behavioral (ComB) Model?
In ComB, the therapist helps the patient learn to increase awareness of his/her repetitive behavior and then respond differently to external and internal cues that trigger pulling/picking. For example, patients learn to alter physical settings (place) in which the pulling/picking tends to occur (e.g., bedroom, work desk) or remove the implements that may be employed in pulling/picking (e.g., tweezers, magnifying mirrors). Patients also learn alternative ways to address sensory (e.g., itching), cognitive (e.g., "these gray hairs look awful!"), and affective (e.g., anxiety, boredom) cues that trigger urges to pick/pull.
What Is Involved In Comprehensive Behavioral Interventions for Tics (CBIT)?
CBIT consists of:
Comprehensive behavioral (ComB) model is a cognitive behavioral approach for managing body-focused repetitive behavior (BFRB) disorders such as trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. A similarly named, but different intervention, called Comprehensive Behavioral Intervention for Tics (CBIT), is an evidence-based behavioral therapy for managing Tourette's Disorder and chronic tic disorders that provides additional benefit to pharmacotherapy.
What Do You Learn in Comprehensive Behavioral (ComB) Model?
In ComB, the therapist helps the patient learn to increase awareness of his/her repetitive behavior and then respond differently to external and internal cues that trigger pulling/picking. For example, patients learn to alter physical settings (place) in which the pulling/picking tends to occur (e.g., bedroom, work desk) or remove the implements that may be employed in pulling/picking (e.g., tweezers, magnifying mirrors). Patients also learn alternative ways to address sensory (e.g., itching), cognitive (e.g., "these gray hairs look awful!"), and affective (e.g., anxiety, boredom) cues that trigger urges to pick/pull.
What Is Involved In Comprehensive Behavioral Interventions for Tics (CBIT)?
CBIT consists of:
- Psychoeducation about tic disorders
- Training the patient to be more aware of tics
- Habit reversal training (HRT): training patients to do a competing behavior when they feel the urge to tic (e.g., put hands on knees when an urge to perform the tic happens)
- Making changes to day-to-day activities in ways that can be helpful in reducing tics (e.g., if a child with TS often has a certain tic during math class, the math teacher can be educated about TS, and perhaps the child’s seat can be changed so that the tics are not as visible).
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