Psychological approaches to treatment for dermatological conditions

Increasingly then, within the dermatological literature, attention was given to the therapeutic benefits that might derive from psychological interventions beyond those of standard medical care. Given the close and clear associations between psychological factors and cutaneous conditions, it is not surprising that the effects of such treatment have been investigated. The literature has documented psychological interventions for a number of cutaneous conditions, such as vitiligo, psoriasis, acne and atopic dermatitis, which have been suggested to be as effective for each of these types of disorders as classical medical procedures (Van Moffaert, 1992; Papadopoulos & Bor, 1999). For example, in their review of psychological therapies for the treatment of psoriasis, Winchell and Watts (1998) describe a case in which two psychiatric patients with psoriasis were given a suggestion that imipramine would have beneficial effects on their skin condition. Following this suggestion one of the patients experienced complete remission while the other improved significantly.

The methodological rigour of trials in this field has improved over time. Specifically, early research must be viewed as tentative in view of certain methodological shortcomings. It often used single-case experimental designs with few attempts to evaluate the progress of patients after the termination of therapy or to compare results with those of other patients or matched controls (Papadopoulos & Bor, 1999). Studies were also based on small samples with no control groups. Outcome measures were unsophisticated and were usually given by a single observer. Furthermore, outcome was measured by changes to either psychological or dermatological health but rarely by both. Since the early 1980s, psychocuta-neous research investigating the efficacy of psychological interventions has started to employ controlled trials with large samples and quantitative cross-sectional designs, and to examine outcome from both psychological and dermatological perspectives (Papadopoulos & Bor, 1999).

Psychological approaches, such as psychoanalysis and hypnosis (Gray & Lawlis, 1982) as well as behavioural (Wolpe, 1980) and cognitive-behavioural therapy (Papadopoulos et al., 1999b) have been used to treat people affected by skin disorders (see Table 8.1). Indeed, such interventions have been shown to produce clinically significant improvements in cutaneous conditions, such as atopic dermatitis

Table 8.1. Approaches to treatment of dermatological conditions

Cognitive-

Behaviour

behaviour

Group

Psychodynamic

therapy

therapy

therapy

psychotherapy

Time frame

Here-and-now

Here-and-now

Here-and-now

Understanding the past, focuses on current relationships

Cost

Cost-effective

Cost-effective

Cost-effective

Expensive

Techniques

Systematic

Problem-solving,

Psychoeducation,

Analysis of

desensitisation,

cognitive

social and

transference

modelling,

restructuring,

assertiveness

and counter-

relaxation,

guided imagery,

skills training,

transference,

habit-reversal

modelling

role-play

hypnosis

training,

assertiveness

and social skills

training, imagery

Time

Short-term

Short-term

Short-term

Long-term

Efficacy

Psoriasis, eczema,

Psoriasis, eczema,

Psoriasis, eczema,

Eczema

vitiligo, acne

vitiligo, acne

vitiligo

(eczema), psoriasis, vitiligo and virus-mediated diseases (Van Moffaert, 1992) and have helped patients to improve their psychological well-being and quality of life (Cole et al., 1988; Papadopoulos et al., 1999a). Outlined below are the main therapeutic techniques used in dermatology settings.

Acne Myths Uncovered

Acne Myths Uncovered

What is acne? Certainly, most of us know what it is, simply because we have had to experience it at one time or another in our lives. But, in case a definition is needed, here is a short one.

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