Should You Try Psychodermatology?

Should You Try Psychodermatology?

Those who have ever had hormonal acne will know that our emotions and our skin are intrinsically linked. For some people, emotional turmoil and mental anguish seem to make particular skin conditions worse, and vice versa. So could psychotherapy be the treatment to help break this cycle?

What is psychodermatology?

Psychological factors like stress can have a huge effect on many skin disorders, and in turn, having a skin disorder can have an effect on your mood and behaviour. According to the NHS, psychological treatment can be helping in both coping and treating many skin disorders, either alone or combined with conventional medication.

As anyone who has ever had a stressful exam or has been worried about a meeting at work will know, your skin is an expert at inflaming at a time when you need it the least. Most of us put it down to coincidence, but there’s actually scientific proof of the link between mind and skin: a study published in the British Journal of Dermatology tracked the medical records of around two million men and women over a 15-year period: 134,427 of these participants suffered with acne, and over the first year of being diagnosed with the skin condition, these people were 63% more likely to develop major bouts of depression than those without the skin condition.

For most, it's a vicious cycle; a report into stress and psoriasis revealed: “Stressed nerves release substances that activate mast cells, and these cells encourage the growth of more nerve fibres, which in turn release more of the molecules that activate mast cells.” Essentially, you’re stressed because of your skin disorder, and your disorder gets worse the more you get stressed. Psychodermatology aims to help break this cycle using a number of different therapies.

How does it work?

The NHS runs a psychodermatology service that provides support and offers therapy – mostly cognitive behavioural therapy (or CBT) – for those with skin conditions, using a treatment that’s tailored to the needs of each individual person. Most courses consist of 12 weekly sessions of 50 minutes, and the aim of the therapy is to teach patients new ways of thinking and behaving in order to help reduce psychological symptoms that can cause skin flare-ups, like stress or anxiety. This therapy covers such topics as one’s beliefs about their appearance and attractiveness; bad habits with your skin; self-esteem; relationships; social interaction skills; and psychological distress.

“It isn’t just to make your skin better – it’s to make you feel better about your skin.”

Matt Traube, a licensed clinical therapist who specialises in psychodermatology, uses several different methods to help people overcome their skin issues. “Not too long ago, I had somebody who just felt like they couldn’t really leave their house if they had redness on their face,” he said. “So for that, I used exposure therapy, which is essentially learning how to expose yourself to the situation that causes fear and anxiety – but doing it in a very small, safe way. Over time, your mind and body learn that you don’t really need to fear the thing you’re fearing.” As exposure therapy is usually used to treat anxiety, Traube likes to think of his job as “psychology with a twist”.

Does it work?

While not necessarily a complete cure, the overwhelming opinion is that psychodermatology certainly helps. In a paper published in 2013, Rick Fried, a clinician specialising in psychodermatology, reviewed the evidence for managing skin conditions using psychotherapy. He found that such interventions as hypnosis, support groups, meditation, CBT and other forms of psychotherapy were proven to have worked – but usually as a compliment to more traditional dermatological treatments.

The great thing about psychodermatology is that the aim isn’t just to make your skin better – it’s to make you feel better about your skin. If a professional is able to help someone get to bottom of their anxiety around a skin imperfection, then they can manage that stress appropriately. As Dr Richard Granstein, a researcher specialising in psychodermatology at Weill Cornell Medicine told The Cut: “Even if it’s not true, it’s useful anyway. Because the disease makes you stressed. And this can help you cope with the disease, even if it doesn’t make it better.”

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