BFRB Therapists in Marin County
Trichotillomania & Skin Picking
Reframe CBT provides specialized treatment for Body-Focused Repetitive Behaviors (BFRBs) , including trichotillomania (hair pulling) and excoriation disorder (skin picking), using the Comprehensive Behavioral (ComB) model for children, teens, and adults in Marin County.
What Are BFRBs, And Why Can't You Just Stop?
Body-Focused Repetitive Behaviors are repetitive, self-grooming behaviors that involve touching, pulling, picking, or biting the body. They are not habits or bad choices, they are recognized mental health conditions listed in the DSM-5 that often serve important emotional regulation functions.
BFRBs are maintained by a complex mix of sensory stimulation, emotional relief, and automatic habit. Telling yourself to "just stop" rarely works because willpower alone doesn't address the underlying triggers and functions of the behavior.
BFRBs affect an estimated 1 in 20 people to some degree. Despite being common, they are significantly underdiagnosed and undertreated, in part because many people feel too ashamed to seek help. With the right treatment, meaningful improvement is absolutely achievable.
Trigger
An emotional state (stress, boredom, anxiety) or sensory cue (an uneven nail, a rough patch of skin) activates the urge.
Urge
A strong, often automatic urge to pull, pick, or bite arises, sometimes without conscious awareness.
Behavior
The BFRB occurs, often providing temporary sensory satisfaction or emotional relief.
Temporary Relief
The urge subsides and tension is released, reinforcing the behavior as an effective coping strategy.
Shame & Distress
Guilt, embarrassment, or physical damage follows, often increasing the emotional distress that triggered the behavior in the first place.
The ComB model addresses this cycle by identifying the specific sensory, cognitive, emotional, motor, and environmental factors that maintain the behavior — and targeting each one directly.
BFRBs We Treat
From trichotillomania to skin picking to nail biting, our team is trained to treat the full spectrum of BFRBs across all ages using the ComB model.
Trichotillomania (Hair Pulling)
Recurrent urges to pull hair from the scalp, eyebrows, eyelashes, or other areas, treated with the ComB model targeting sensory, emotional, and environmental triggers.
Excoriation Disorder (Skin Picking)
Repetitive picking at skin, scabs, or blemishes causing tissue damage, treated with the ComB model to address the specific triggers and functions of the behavior.
Onychophagia (Nail Biting)
Compulsive nail biting that causes physical damage or significant distress, addressed with habit reversal and competing responses.
Dermatophagia (Skin Biting)
Repetitive biting of skin, especially around the fingers or cheeks, treated with awareness training and behavioral intervention.
BFRBs in Children
Hair pulling and skin picking in children (ages 6+), treated with child-adapted ComB and active parent coaching.
BFRBs in Teenagers
Adolescent BFRBs often intensify with academic and social stress, addressed with teen-adapted CBT and family involvement.
BFRBs with Co-occurring Anxiety
When BFRBs occur alongside anxiety or OCD, our therapists integrate ComB with CBT and ERP for a comprehensive, coordinated treatment plan.
BFRBs with Co-occurring OCD
Some clients present with both BFRBs and OCD — our dual expertise in ComB and ERP allows for integrated, tailored treatment.
How ComB Treats BFRBs
The Comprehensive Behavioral (ComB) model is the evidence-based gold standard for BFRB treatment. It examines five interacting domains — sensory, cognitive, emotional, motor, and environmental — and targets the specific factors maintaining the behavior for each individual. Here's what to expect.
Assessment & Functional Analysis
We conduct a thorough assessment of your BFRB, identifying triggers (emotional, sensory, situational), the function the behavior serves, and the impact on your daily life.
Psychoeducation
You'll learn what BFRBs are, why they develop, and why willpower alone isn't enough to stop them. Understanding the behavior is the foundation of effective treatment.
Awareness Training
Many BFRB behaviors happen automatically, outside conscious awareness. Your therapist will help you develop heightened awareness of urges, triggers, and the behavior itself, a critical first step.
Competing Response & Stimulus Control
You'll learn to replace the BFRB with a physically incompatible competing response, and modify your environment to reduce triggers and opportunities for the behavior.
Maintenance & Relapse Prevention
As treatment concludes, you'll have a personalized toolkit to manage urges, handle setbacks, and maintain your progress long-term.
BFRB Therapy in Marin County
ComB Trained
Our team is trained in the Comprehensive Behavioral (ComB) model — the evidence-based gold standard for treating trichotillomania, skin picking, and other BFRBs. ComB examines five domains (sensory, cognitive, emotional, motor, environmental) to tailor treatment to each individual.
Compassionate, Non-Judgmental Care
Many BFRB clients have never spoken openly about their behaviors due to shame. We create a safe, non-judgmental space where clients can be fully honest about their experiences.
All BFRB Types & Ages
From trichotillomania in children to skin picking in adults, Reframe CBT treats the full spectrum of BFRBs across all life stages with tailored, evidence-based approaches.
Integrated OCD & Anxiety Expertise
When BFRBs co-occur with OCD or anxiety, our therapists integrate ComB with ERP and CBT for a comprehensive, coordinated treatment plan.
Julie H., LMFT
Nicole S., Registered AMFT
Reframe CBT · San Rafael, CA
BFRB Treatment Questions Answered
Have more questions about trichotillomania, skin picking, or BFRB therapy in Marin County? Reach out directly.
You Don't Have to Keep This to Yourself
Reframe CBT offers a free 20-minute consultation to discuss your BFRB and answer questions about ComB treatment. In-person in San Rafael, Marin County, or telehealth anywhere in California.
Serving San Rafael, Novato, Mill Valley, Tiburon, Sausalito, Fairfax, Corte Madera & all of Marin County.
Telehealth available throughout California.