Behaviour therapy

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Behaviour therapy incorporates applications derived from learning theory (classical and operant conditioning) and employs them to the treatment of persistent, maladaptive, learned habits. Among behaviour therapy techniques are systematic desensitisation, assertiveness and social skills training, behaviour analysis, relaxation training (e.g. autogenic and progressive muscle relaxation, biofeedback) habit-reversal training and imagery. The aim of these techniques is to progressively diminish maladaptive behavioural responses by repeatedly inhibiting the anxiety by means of competing responses (Wolpe, 1980). A behaviour analysis is conducted where the clinician collects information about the relationship between stimuli and behavioural responses in order to understand the role of anxiety.

Diverse behavioural therapeutic strategies have been applied, either separately or in combination with other psychological techniques to dermatological conditions.

Systematic desensitisation is an appropriate technique for the treatment of dermatoses which feature anticipatory anxiety (Van Moffaert, 1992). The fear and apprehension that patients with skin disease may feel about themselves may be challenged by this technique. Through graded exposure, the patient enters situations that they may fear and avoid. The habit-reversal technique is a common strategy used to inhibit scratching and it has been reported to have some success with skin disorders, such as eczema and psoriasis (Ginsburg, 1995). It involves self-monitoring for early signs and situational cues of scratching and practising alternative responses, such as clenching the fists (Ehlers et al., 1995). Relaxation has beneficial effects on skin disorders because it reduces stress levels. It is a useful way to help patients prepare for anxiety-provoking situations or to cope with stressful social predicaments. Relaxation can be used on its own as a means to reduce anxiety or tension or can be paired with imagery. There are various different techniques, such as progressive muscle relaxation or autogenic relaxation training.

Imagery with skin disease patients is employed in order to help them cope with anxiety relating to their condition. Imagery is a useful technique for helping the patient to visualise the feared situation while in a relaxed state (Papadopoulos & Bor, 1999). Assertiveness and social skills training is appropriate for patients with cutaneous conditions that attract attention from others, such as staring or personal questions. Interventions focus on improving social skills and ways of expressing emotions, thus helping patients deal more effectively with the reactions of others and learn a more positive mode of social functioning (Robinson et al., 1996).

Weinstein (1984) found that compared with patients receiving only medical treatment (psorasen plus ultraviolet light A, PUVA), both psychological treatment groups, one receiving progressive relaxation and guided imagery and the other meeting to discuss psychosocial concerns about psoriasis, were effective in reducing the signs and symptoms of psoriasis. Robinson et al. (1996) found a significant decrease in anxiety and an increase in confidence of facially disfigured people (among whom were people with acne and vitiligo) after a social skills workshop that aimed at improving social interaction skills. Additionally, Ehlers et al. (1995), in their controlled trial, used relaxation therapy with patients with atopic dermatitis and found significant improvement in the skin condition.

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