In naturopathic medicine, treating acne requires a two-fold approach: incorporating foods and remedies to help the body heal from the inside out, as well as considering any topical options that may help skin.
I would argue that if we’re to treat people holistically, in the truest sense of that word, we must also be sensitive to the lived experience of acne that often brings with it feelings of embarrassment, shame, and urgency. Our skin is our first interface with the outside environment. Skin issues can, therefore, lead to judgment, frustration, and serious discomfort.
This is why I find it important to include mind-body practices as part of an acne healing toolkit. I find that they soothe the nervous system, provide internal psychological nourishment to deal with difficult emotions that arise, and provide a way to deal with an inner critic that may be quite strong if your physical appearance is affected.
Before jumping into some mindfulness practices, let’s pause to get our bearings on the connection between stress and acne. I know that clinically I’ve seen this pattern frequently: increased stress leads to more breakouts and increased redness and inflammation. This same pattern was also observed in an Italian study that reported that a high level of psychological stress was associated with acne. In a group of 248 women, those who had acne were almost three times more likely to have psychological stress. Studies that compare two groups retrospectively, in this case an acne group vs. a non-acne group, allow for patterns to emerge, but don’t definitively conclude that stress causes acne.
Still, for a long time now there has been an understanding that emotional stress and acne are linked. It appears that the skin’s sebaceous glands (tiny glands that secrete oil) have receptors for key molecules involved in the body’s immune, inflammatory and stress response.
In particular, CRH protein expression is abundant in acne prone skin. CRH stands for corticotropin releasing hormone and is what’s responsible for starting the cascade of events involved in the body’s stress response that results in immune and inflammatory processes, which researchers conclude “lead to the development and stress-induced exacerbation of acne.”
These findings are valuable, yet I think we can approach stress with a more general understanding. Our bodies were designed to respond to attack and threat by a well-choreographed fight or flight response. Although originally intended to deal with physical attacks, the fight or flight response can also be triggered by emotional attacks.
So, in the case of acne, responding to symptoms with self-judgment, criticism, or shame could very well trigger stress in the body. This can either exacerbate symptoms or, at worst, add more misery to the entire situation.
Interestingly, researchers who wanted to learn more about self-criticism and depression gathered a group of chronic acne patients to teach them self-help tools. Participants needed to currently be suffering from acne, have tried an acne treatment that had failed, and be experiencing emotional distress from their symptoms. The group was taught ways to self-soothe negative emotions and self-criticism. As part of their instructions, they were guided to write a compassionate letter to themselves and read self-compassionate statements three times daily for two weeks.
At the end of the study, researchers concluded that self-soothing “lowered the frequency with which participants were bothered emotionally, functionally, and physically by their acne.” Even more significant, is that the improvement they perceived in their skin was comparable to patients who had seen acne improve over the course of a year with dermatological treatment!
With that in mind, let’s dive into ways to incorporate stress relief and self-kindness into your daily life:
Deep belly breathing: the quickest way to calm the nervous system is via the vagus nerve, which is activated by the movement of the diaphragm during deep breathing. To start, place one hand on your belly and another on your chest. Inhale. Feel the hand on your belly move out. As the breath fills the lungs, you’ll feel the hand on your chest rise slightly. Exhale. The hand on the chest drops. Then the hand on the belly falls in. Repeat for 1 minute and work up to 3 minutes daily.
Write yourself a kind letter: As Brené Brown so wonderfully reminds us “Talk to yourself like you would to someone you love.” I find this is most accessible through writing. In this letter, let yourself know what feelings or experiences are upsetting, that you understand and empathize with the difficulties you’re facing, that other people also have felt frustrated or self-critical when in similar circumstances, and that you love and accept yourself (or are trying to) regardless of how your skin looks.
Use a guided self-compassion exercise: Kristin Neff is a pioneer in researching self-compassion and her website offers a trove of guided meditations and resources.
I find that the above techniques are not only effective in giving the body care and compassion, but are wonderful tools to create greater resiliency during the course of treatment as well as after symptoms have resolved. By treating yourself with kindness, you begin to ask the question “what’s good for me?,” thereby opening the opportunity, from this place of care, to make choices and changes that nourish your well-being and health for the long-term.
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