The example below of Jake1, a 29 year-old psoriasis sufferer who developed the condition 10 years ago is instructive:
'I had always been a real sports fan for as long as I can remember. Through my teens I had been involved in county and school teams at cricket, rugby and football. That changed when I started to develop psoriasis on my legs in my late teens. I became really aware of it and self-conscious and couldn't face going in the showers in case team-mates saw it and felt repulsed. I knew that they would think it was contagious. I certainly did at first, you know, like I was a leper or something so rather than let this happen I gradually dropped out of sport, certainly team sport anyway. I suppose the same thing happens when the weather gets warm in the summer. My psoriasis is more progressive now and so I always cover it up, regardless of the weather. This can mean that I'm often uncomfortable in the summer heat and feel almost permanently vigilant but at least this disease doesn't get seen by others.
It's a shame that I can't play sport any more but I suppose I could have worse diseases, even if
I do worry a lot about my psoriasis spreading again.'
The above vignette from one of the participants who came to take part in a London Metropolitan University research therapy programme is informative of the issues that these patients can face. As soon as Jake developed the disease, a number of precepts were automatically activated, which created the framework for Jake to con-textualise his condition and the effect that it would have on his everyday life. Automatic assumptions regarding the repulsed attitudes of friends, team-mates and the general public concerning contagion and leprosy were untested and unchallenged but these cognitions became settled into a pattern of contextualising future social episodes regarding his disease. An automatic picture of'what others thought' was created in conjunction with ideas of what the condition represented. This consideration of the social impact of the disease vitiated Jake's quality of life, serving to influence the clothes that Jake wore and hone a sense of vigilance with regards to the visibility of his condition. The lack of reality testing and creation of possible alternative thoughts had led to a seemingly unequivocal acceptance of his inability to play sport, an activity that he had previously enjoyed immensely.
This example touches upon the importance of the cognitive architecture that can frame beliefs about the disease, its social context and the way that patients can allow aspects of a disfiguring illness to exert a measure of control over their life. As
1 The name of this participant has been changed to protect his identity and permission to use his account was secured.
mentioned in Chapter 8, CBT allows us to challenge and change these thoughts and beliefs. It allows participants to be located outside of their own automatic thoughts and actions and hence be able to reflect on the way that they may have profoundly limited aspects of their everyday life and that this need not be the case. CBT can work by altering deeply held schematic conceptualisations of the self and the disease such that patients are not confined by the often untested representations that they construct.
Of crucial importance in many cases, and with particular relevance to Jake is why he developed these concepts of his disease and why he initially believed that friends and colleagues, not to mention strangers, would automatically react so negatively to the presence of his psoriasis. Jake developed psoriasis as a man with 19 years of experience that had informed and fashioned a cognitive structure that worked to guide him in the different challenges that he faced. Another skin disease patient may not have created the automatic thoughts that Jake did and it is this history that plays such an important role in influencing and guiding our reactions.
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Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.