Could skin diseases be alleviated through psychological intervention?

Author: British Association of Dermatologists

Date: Aug 2012

The symptoms of some of the most common skin diseases could be alleviated through psychological interventions, according to a study released in the British Journal of Dermatology.

While it is accepted that psychological interventions can help with the emotional impact that many skin diseases entail, this study reveals that such services can actually improve physical symptoms also.

In a study, published in the British Journal of Dermatology, this week, a team from the Department of Psychology at the University of Sheffield carried out an analysis of previous studies and concluded that psychological interventions did provide benefit to patients with skin conditions.

It is accepted that skin conditions can be associated with psychological distress and interventions targeting this, such as habit reversal, relaxation, cognitive behavioural therapy (CBT) and other psychological interventions have been developed to manage this. However the effectiveness of these interventions has not, until now, been systematically reviewed.

From a meta-analysis of 22 studies involving over 900 participants the team at the University of Sheffield concluded that there was evidence of benefit but also that there was also a need to develop further specific interventions and to conduct more rigorous evaluation of these, including assessments of effects over longer follow-up periods and a wider-range of skin conditions.

From the evaluation they found that psychological interventions had a medium-sized effect on skin conditions but that a number of different factors influenced the effectiveness of the interventions, including: the type of intervention, the time interval between the end of the intervention and follow up, and the type of outcome measure (itch/scratch reduction, psychosocial outcomes)

Psychological interventions had:

  • a large size effect on itch/scratch
  • a medium size effect on psychological outcomes
  • a medium size effect on skin severity

The larger effect on itch/scratch may have occurred because changes in behavioural factors (e.g., the extent of itching) need to take hold first to help facilitate gains elsewhere (e.g. severity of the condition).

The number of skin conditions represented by the study was small but a medium sized effect was seen for interventions treating psoriasis and atopic dermatitis (eczema). The analysis showed that psychological interventions generally had less effect on skin conditions accompanied by pain.

From the studies analysed only four types of intervention were well enough represented for analysis: Habit reversal, CBT, Arousal Reduction and Combined Techniques.

Habit reversal had the largest effect size, followed by CBT (medium to large) and arousal reduction and combined techniques (medium). Although the duration of the intervention did not have a great impact on effectiveness, the length of time between the end of the intervention and the follow up did have a significant impact with longer follow up periods being associated with smaller effects, suggesting that there may be a need to provide ‘booster sessions’. Group therapies appeared to be as effective as one-to-one sessions.

However, the authors also drew attention to the finding that age was negatively associated with effect sizes, such that the older the person was, the less effective the psychological intervention was. They concluded that interventions may require modification so as to be able to better address the needs of older patients.

The authors of the study concluded that there is now evidence that psychological interventions should be made more widely available within dermatology services and that some interventions such as habit reversal could be delivered in nurse-led clinics. Complex cases should still be referred to mental health professionals for consideration with treatment with formal psychotherapies such as CBT. However, the team were also keen to point out that there remain relatively few studies in this area and only a narrow range of interventions have been developed and evaluated. Consequently, further research is needed to develop interventions targeting specific problems. In addition, psychological interventions also require evaluation across a wider range of skin conditions and with the use of more robust methods (e.g. randomized controlled trials).

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