Habit Reversal Training (HRT) and Comprehensive Behavioral (ComB) Treatment

What are Habit Reversal Training and Comprehensive Behavioral Treatment?

Both habit reversal training (HRT) and the Comprehensive Behavioral (ComB) Treatment are evidence-based treatments of body-focused repetitive behaviors (BFRBs), such as excoriation disorder (skin picking) and trichotillomania (hair pulling). HRT involves clients increasing their awareness of BFRB symptoms through self-monitoring. Clients are taught to engage in competing responses, in the form of relaxation training and alternative physical acts. Clients are also encouraged to make use of habit blockers, in order to keep their hands occupied, and stimulus control techniques, meaning altering or removing environmental elements that promote or trigger BFRB urges. ComB is a more recent BFRB treatment, in which therapists collaborate with clients to identify unique variables that foster and perpetuate their BFRB behaviors. Those variables are categorized into five domains: sensory, cognitive, affective, motor, and place (SCAMP). ComB also makes use of self-monitoring. ComB emphasizes developing strategies to reduce BFRB behaviors while targeting the thoughts, feelings, and physical sensations that serve to perpetuate those behaviors. Client and therapist work together to create an individual action plan to implement those strategies. 

Can Habit Reversal Training and Comprehensive Behavioral Treatment Help Children and Adolescents with BFRBs?

HRT and ComB can help children and adolescents to reduce their BFRB symptoms. However, it is important to note that BFRB behaviors are self-soothing, and not every child or adolescent diagnosed with a BFRB is motivated to do the work it requires to change their behavior. That motivation is generally sparked by negative feelings associated with their behavior and/or the effect their behavior has on their appearance, rather than by their parents’ desire for them to reduce symptoms. When working with children and adolescents diagnosed with BFRBs, we encourage clients and their parents to resist fixating on the BFRB behaviors and the physical effects of those behaviors. Instead, emphasis is placed on management of urges through the use of HRT and ComB tools, along with cognitive, mindfulness, acceptance, and calming/self-soothing practices, in order to resist urges to pick, pull, bite, or scratch. We modify treatment to be developmentally appropriate, especially when working with young children. Parents may have to help younger clients to engage in treatment.