About one third of patients with a skin disorder experience some form of psychological distress, such as anxiety or depression. In recent decades, physicians and doctors have become curious about how to address and treat psychological disturbances in the dermatology clinic setting. Many research studies have surfaced assessing the use of a tool called Cognitive Behavioral Therapy with dermatology patients – and the results are promising.
What Is Cognitive-Behavioral Therapy?
Cognitive-behavioral therapy (CBT) is a psychological therapy technique developed by Dr. Aaron Beck in the 1960s. Beck and his colleagues define CBT as “a time-sensitive, structured, present-oriented psychotherapy directed toward solving current problems and teaching skills to modify dysfunctional thinking and behavior.” CBT is based on the cognitive model of psychology. This tool supports individuals in recognizing their unhelpful and distressing thinking patterns and then providing them with the ability to change their thinking and behavior, thus improving their mood and mental functioning.
Implications of Cognitive-Behavioral Therapy For Skin Disorders
Researchers suggest that CBT proves helpful in a variety of dermatologic conditions, including acne, psoriasis, eczema, alopecia, and several others.[3,4] Clinicians and researchers find that negative emotions commonly surface in patients affected by a chronic skin disorder. While we are all undoubtedly going to feel things like fear, shame, and despair at some point in life, researchers point out that many of these patients perceive the severity of their skin disorder and its impact on their life as more distressing than the objective severity of their disorder. Thus, the patients’ experience of their disorder requires committed addressing by their healthcare provider.
One research group points out that patients with chronic skin disorders, such as acne, generally lack the proper knowledge and behavior skills to reduce stress when addressing their skin. This can be especially problematic since many patients, such as those with psoriasis, believe that their experienced stress can further worsen their skin condition. A pilot study of psoriasis patients treated with mindfulness CBT in addition to their regular treatments showed significant improvements in their psoriasis and quality of life among those who received the CBT, compared to those who did not. This evidence points to the success of including CBT as part of a complete approach to treatment.
Other studies show similarly promising results. One small trial of patients with vitiligo showed that those who completed CBT treatments, along with their typical vitiligo treatments, felt more self-motivated and better understood their disease. A randomized trial of vitiligo patients showed that adding CBT to their normal treatments reduced social anxiety and provided patients with an easy self-help tool. In another study of forty psoriasis patients receiving ultraviolet light-based phototherapy, adding on CBT and biofeedback enhanced the effects of the phototherapy. The authors of this study conclude that CBT and biofeedback interventions may decrease psychological disturbance, improve psoriasis severity, and enhance patient quality of life.
Other Areas For Using Cognitive-Behavioral Therapy in Skin Care
After recognizing the success that CBT has with chronic skin conditions like acne, vitiligo, and psoriasis, researchers and clinicians now look to other areas of skin care. One group assessed how CBT therapy may alleviate the stress and anxiety experienced by those with a recent melanoma diagnosis. The authors found that higher “positive reframing,” meaning the action taken during CBT to modify negative thoughts into more positive ones, was associated with enhanced life satisfaction. Consistent with the CBT philosophy, the authors found that patients who felt less emotionally attached to their behaviors were less often thinking about their behaviors.
All of these findings suggest that CBT and similar strategies may have a beneficial role when incorporated into the treatment of chronic skin conditions or in those that are dealing with skin cancer treatments. The incorporation of self-help coping mechanisms to better a patient’s experience of disease, in addition to their treatments for the disease itself, is a new and promising direction for dermatological care.
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Affleck A, Chouliara Z, Kielty S. Cognitive behavioral therapy for acne and other chronic skin disorders. Int J Dermatol.2014;53(4):e246-247; PMID: 23786756 Link to research.
Galassi F. Cognitive-behavioral techniques. Clin Dermatol.1998;16(6):715-723; PMID: 9949918 Link to research.
Jung J, Hwang EJ. Do patients with acne need cognitive behavioral therapy? An analysis of patient knowledge and behavior. Int J Dermatol.2012;51(11):1319-1324; PMID: 22804693 Link to research.
Fordham B, Griffiths CE, Bundy C. A pilot study examining mindfulness-based cognitive therapy in psoriasis. Psychol Health Med.2015;20(1):121-127; PMID: 24684520 Link to research.
Jha A, Mehta M, Khaitan BK, et al. Cognitive behavior therapy for psychosocial stress in vitiligo. Indian J Dermatol Venereol Leprol.2016;82(3):308-310; PMID: 27088935 Link to research.
Shah R, Hunt J, Webb TL, et al. Starting to develop self-help for social anxiety associated with vitiligo: using clinical significance to measure the potential effectiveness of enhanced psychological self-help. Br J Dermatol.2014;171(2):332-337; PMID: 24665869 Link to research.
Piaserico S, Marinello E, Dessi A, et al. Efficacy of Biofeedback and Cognitive-behavioural Therapy in Psoriatic PatientsA Single-blind, Randomized and Controlled Study with Added Narrow-band Ultraviolet B Therapy. Acta Derm Venereol.2016;96(217):91-95; PMID: 27283367 Link to research.
Bonnaud-Antignac A, Bourdon M, Dréno B, et al. Coping Strategies at the Time of Diagnosis and Quality of Life 2 Years Later: A Study in Primary Cutaneous Melanoma Patients. Cancer Nurs.2016PMID: 26863052 Link to research.