Panic Disorder

Anxiety type

Panic Disorder

Anxiety type
The term body-focused repetitive behavior represents a group of behaviors including hair pulling, skin picking, nail biting, cheek biting, nail picking, nose picking, scab picking/eating, knuckle cracking, tooth grinding, tongue chewing, and more. Psychologically, those suffering often feel guilt, shame, and hopelessness. They also tend to start avoiding the things they once enjoyed doing.

Common BFRBs


Trichotillomania is known as hair pulling disorder and is characterized by the behavior of pulling one’s hair. Examples include scalp hair, eyelashes, eyebrows, arm/leg hair, pubic hair, chest hair, and facial hair. People suffering from trichotillomania may experience significant hair loss and overall impairment due to the severity of their pulling.


Excoriation disorder is known as skin picking disorder or dermatillomania. This disorder consists of repetitive behaviors centered around repetitive skin picking including touching, rubbing, scratching, and digging in the skin. This disorder can be debilitating to those suffering as it can cause damage to issues, discoloration of skin, and scarring.


Onychophagia is known as nail-biting and consists of habitual biting of fingernails. Nail biting commonly occurs in childhood and can develop into severity resulting in permanent damage tonails and skin.

Cheek Biting:

Cheek Biting is also known as “cheek chewing” and can create many complications such as redness, painful sores, and tears. In some cases when repetitive biting occurs, the lining of the cheek may feel irregular which can make the individual continue to bite to try and create a smooth surface.

Treatment at CalmOCD

At CalmOCD our clinicians are trained in a therapy approach called Comprehensive Behavioral Treatment (ComB) treatment to treat body-focused repetitive behaviors. The clinician works collaboratively with the patient, to identify and change relationships with BFRB triggers while addressing the variables that are maintaining the behaviors. Treatment includes a wide variety of techniques drawn from behavioral, cognitive, and CBT treatment modalities. Those suffering from BFRBs all their own very unique experiences with the disorder. Because of this, treatment is tailored to the individual's needs and is viewed as a creative and fluid process rather than a set of rigid treatment guidelines. ComB treatment addresses the complexities of treating BFRBs and helps to develop treatment fitting uniquely to the individual.

Phases of Treatment

Phase 1

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).

Phase 2

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.

Phase 3

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.

Phase 4

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.


Treatment for Panic Disorder

At CalmOCD we treat Panic Disorder with a combination of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is used to treatment panic disorder and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. This type of treatment helps the patient gain insight into their anxiety symptoms and what current behaviors are making them worse and alternative ways to process anxiety triggers. Exposure Therapy is another treatment modality used to treat panic disorder. Exposure therapy helps anxiety sufferers confront the fears and worries that are holding them back in their daily life. Exposure therapy incorporates helping the patient to reduce safety behaviors.

Typically, the anxiety sufferer is participating in behaviors to ‘stay safe.’ However, when the patient relies on internal or external safety behaviors to help maintain safety and manage their anxiety this is communicating to the brain there is a problem when there is not one. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter. The goal is to help the patient develop greater psychological flexibility rather than working to eliminate or suppress their struggles and experiences. Mindfulness-Based Therapy can assist panic disorder sufferers in bringing awareness to what they are directly experiencing in the present moment and not what has occurred in the past or could occur in the future. Through bringing awareness to the present moment with one’s senses for example, the brain can focus on the inner workings of ones mental, emotional, and physical processes.

Ready to Start Your Healing Journey?

If interested, please follow the steps below! Due to the high volume of inquiries please allow 48 hours for a response.


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Intake Session

If CalmOCD seems to be a good fit based on your individual needs, an intake session will be scheduled.