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Assessment (Functional Analysis): During this phase in treatment, the clinician will spend time understanding the factors that foster and maintain the BFRB in the individual. Behavioral, emotional, cognitive, and sensory variables will be explored in this phase. ComB uses a behavioral framework to identify which antecedents (A) make the behaviors more likely to occur, which behaviors (B) constitute the actual action of the pulling or picking, and the consequences (C) that make the behaviors more likely to continue to occur. Five domains are explored during this phase: Sensory (sensations), Cognitive (thoughts), Affective (emotions), Motor (Behaviors), and Place (environment).
Identification and Selection of Target Domains: During this phase an individualized plan is developed to try and interrupt problematic behaviors while implementing new healthier alternatives. These methods are developed using the five domains mentioned above. The therapist and patient work together to understand how the antecedents and consequences are linked and how to identify specific targets contributing to the problem behaviors.
Implementation of Specific Interventions: Patients will explore a variety of specific interventions used to decrease their BFRB symptoms. Interventions are chosen based on the information collected in Phase 1 and Phase 2. Many interventions include behavioral and cognitive strategies while also implementing sensory components. Having the patient develop new sensory substitution techniques will be a key part of treatment. When potentially helpful interventions have been identified the patient will try out several outside of the session. For example, someone that may pull or pick during driving may wear gloves while driving (stimulus control, response prevention), listen to relaxing music (sensory distraction), do breathing exercises (controlled breathing), and keep hands on the steering wheel (competing response). The usefulness of the techniques will be assessed when the patient returns to their next session. At this time, the patient and therapist can determine what was successful and what was not, and what they can modify to maximize control of their BFRB.
Evaluation, Termination, and Relapse Prevention: In the final phase, the patient continues to assess for progress and modify interventions when needed. The patient begins to self-manage their symptoms by utilizing the skills used in their treatment. The focus moves to maintenance and preparing for setbacks that can occur during recovery. Relapse prevention planning occurs so the patient feels confident in navigating their symptoms independently.
At CalmOCD we treat individuals ages 5 and up with obsessive-compulsive disorder, generalized anxiety disorder, social anxiety, eating disorders, panic disorder, agoraphobia, phobias, misophonia, body-focused repetitive behaviors (BFRBs), and co-occurring depression.
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