The Comprehensive Behavioral (ComB) model is a an evidence-based, flexible, individualized approach to treating Body-Focused Repetitive Behaviors (BFRBs) such as hair pulling, skin picking, and nail biting. It was developed by Charles Mansueto and his colleagues as a new wave Cognitive Behavioral Therapy (CBT). ComB is a four phase treatment that begins with a detailed functional assessment to identify the specific factors that maintain the behavior for each individual. These factors fall into five domains: sensory, cognitive, affective, motoric, and environmental (“place”). For example, someone may engage in a BFRB in response to a sensory urge, out of boredom, during moments of anxiety, or automatically while in a certain location.
Once these patterns are identified, treatment focuses on developing personalized strategies that directly target the most influential domains. This may include using competing responses, modifying the environment, building emotional regulation skills, and challenging cognitive distortions. The goal is not only to reduce the behavior but to increase the individual’s awareness and sense of control over their triggers.
ComB emphasizes collaboration and self-efficacy, helping clients create a toolbox of coping skills tailored to their own needs. As progress is made, treatment shifts to maintenance and relapse prevention, preparing the individual to manage future challenges independently.