Cognitive-behaviour therapy (CBT) is a treatment approach that aims to change maladaptive ways of thinking, feeling and behaving through the use of cognitive and behavioural interventions. This model takes the view that it is not situations in and of themselves that are stressful, but rather the perception that one takes of them that makes them so. According to the cognitive model, the beliefs that patients hold about their condition often influence how they cope with and adapt to it. A common feature in the beliefs of people with emotional difficulties is that they have negative and irrational content. These perceptions are often the result of distortions in processing, such as 'cognitive errors' (Beck, 1976,1993).
CBT focuses on examining and trying to challenge dysfunctional beliefs and appraisals, which may be implicated in a person's low mood or avoidance of certain situations or behaviours. Consequently, targeting cognitions and maladaptive behaviour are the key areas of CBT interventions for facilitating change. According to this approach, beliefs are considered as hypotheses to be tested rather than assertions to be uncritically accepted. Therapist and client take the role of'investigators' and develop ways to test beliefs, such as 'Others do not like me because of my eczema' or 'I won't be happy anymore because of my vitiligo'. Success at challenging these beliefs involves providing evidence that they are erroneous, and underscored by anxiety and depression (Beck, 1993).
CBT has been successfully applied to various skin conditions. For example, Horne et al. (1989) used cognitive-behavioural therapy along with standard medical treatment in treating three patients suffering with atopic eczema. All three showed a post-treatment reduction in symptom severity, an increase in their ability to control the disorder and a decrease in their reliance on medication. Four controlled studies have also used a cognitive-behavioural approach with psoriasis patients (Price et al., 1991; Zacharie et al., 1996; Fortune et al.,2002; Fortune et al., 2004). Findings have shown adjunctive cognitive-behavioural interventions result in a reduction of psychological distress and in the clinical severity of the condition. Additionally, Papadopoulos et al. (1999b) compared two matched groups of vitiligo patients, one of which received CBT while the other received standard medical treatment alone. Results suggested that patients could benefit from CBT in terms of coping and living with vitiligo. There was also preliminary evidence to suggest that gains made through CBT influences the progression of the condition. Finally, Ehlers et al. (1995) employed CBT with patients with atopic dermatitis and found significant reductions in anxiety, frequency of scratching and itching as well as cortisone use.
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