Mind-Body
Because psoriasis affects the physical appearance of the skin, many patients suffer from psychological instability as a result of this condition. Interactions between stress and emotion on the skin are controlled by the nervous system, immune system, and hormonal system (Shenefelt P. D., 2010, p. 10). The skin, which is the largest sensory organ of the body, is composed of numerous subcutaneous nerves. Neurocutaneous interactions explain the connection between skin disorders psychological and behavioral effects (Shenefelt P. D., 2010, p. 9). This connection between mind and body supports an interdisciplinary approach to treatment of psoriasis. This section of this website describes evidence-based techniques for managing the psychological component of psoriasis.
Hypnosis
Stress plays an important role in the onset, exacerbation, and prolongation of psoriasis. Hypnosis and suggestion have been shown to have a positive effect on psoriasis. Hypnosis can be useful as a complementary therapy for resistant psoriasis, especially if there is a significant emotional factor involved in its triggering.
Shenefelt, P. D. (2000, March). Hypnosis in Dermatology. Archives of Dermatology, 136(3), 393-399.
Hypnosis can affect many physiological functions, including blood flow, pain sensation, and immune response. In this state, the mind has a heightened capacity to affect autonomic functions. A therapist using the technique called guided imagery may ask the patient to imagine having healthy skin or picture immune cells on the march. In small studies, hypnosis has been shown to decrease stress and anxiety; reduce pain and inflammation; control sweating and itching; speed healing; and limit behaviors such as scratching, picking, or hair pulling.
Recognizing the mind-skin connection. (2006, November). Harvard Health Publications: Harvard Medical School. Retrieved from http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2006/November/Recognizing_the_mind-skin_connection
Researchers from Johns Hopkins School of Medicine performed a three month randomized, single-blind, controlled trial in the use of hypnosis in adults with stable, chronic, plaque-type psoriasis. Eleven subjects received hypnosis therapy for three months. The group was divided, five subjects received hypnosis with active suggestion of improvement and 6 subjects received neutral hypnosis with no mention of their disease. After three months time, the group was un-blinded and all subjects were treated for an additional three months with active suggestion of improvement. The results showed that subjects who were highly hypnotizable demonstrated significantly greater improvement in their skin condition than did subjects who were only moderately hypnotizable. Although the study was limited by the size of the subject pool, the results showed that hypnosis may be a useful therapeutic modality for highly hypnotizable subjects with psoriasis, and warrants further testing in a larger patient population.
Tausk, F., & Whitmore, S. (1999). A pilot study of hypnosis in the treatment of patients with psoriasis. Psychotherapy and Psychosomatics, 68(4), 221-225.
Shenefelt, P. D. (2000, March). Hypnosis in Dermatology. Archives of Dermatology, 136(3), 393-399.
Hypnosis can affect many physiological functions, including blood flow, pain sensation, and immune response. In this state, the mind has a heightened capacity to affect autonomic functions. A therapist using the technique called guided imagery may ask the patient to imagine having healthy skin or picture immune cells on the march. In small studies, hypnosis has been shown to decrease stress and anxiety; reduce pain and inflammation; control sweating and itching; speed healing; and limit behaviors such as scratching, picking, or hair pulling.
Recognizing the mind-skin connection. (2006, November). Harvard Health Publications: Harvard Medical School. Retrieved from http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2006/November/Recognizing_the_mind-skin_connection
Researchers from Johns Hopkins School of Medicine performed a three month randomized, single-blind, controlled trial in the use of hypnosis in adults with stable, chronic, plaque-type psoriasis. Eleven subjects received hypnosis therapy for three months. The group was divided, five subjects received hypnosis with active suggestion of improvement and 6 subjects received neutral hypnosis with no mention of their disease. After three months time, the group was un-blinded and all subjects were treated for an additional three months with active suggestion of improvement. The results showed that subjects who were highly hypnotizable demonstrated significantly greater improvement in their skin condition than did subjects who were only moderately hypnotizable. Although the study was limited by the size of the subject pool, the results showed that hypnosis may be a useful therapeutic modality for highly hypnotizable subjects with psoriasis, and warrants further testing in a larger patient population.
Tausk, F., & Whitmore, S. (1999). A pilot study of hypnosis in the treatment of patients with psoriasis. Psychotherapy and Psychosomatics, 68(4), 221-225.
Biofeedback
Biofeedback has been shown to improve skin problems that have autonomic nervous system components, such as heart rate and temperature (Shenefelt, 2012). A study conducted at Tel Aviv University in Israel examined the benefit of biofeedback in the treatment of psoriasis. The study included 32 subjects who had a definitive diagnosis of psoriasis given b y a dermatologist (Keinan, Segal, Gal, & Brenner, 1995, p. 236). The instruments used in this study included the biofeedback apparatus, which is a computerized biofeedback instrument that trains subjects to lower their electromyography level and the temperature of their limbs. Study measures also included an initial questionnaire, a symptom severity scale (1=no symptoms and 6=very severe symptoms), a symptom improvement scale (1=complete remission and 9=extreme worsening), and a self report questionnaire, which was administered at the end of the study (Keinan, Segal, Gal, & Brenner, 1995, p. 236). Subjects were randomly divided into three groups, the relaxation group, the biofeedback and relaxation group, and the waiting list group. The relaxation group involved a three month therapy session, which included progressive relaxation instructions. Subjects were asked to imagine the affected areas of their skin becoming cooler as a result of contact with ice, snow, or a cool breeze. The biofeedback and relaxation group involved in progressive relaxation training in addition to biofeedback training. Subjects were trained to lower their electromyography level and body temperature by means of biofeedback. Levels were monitored with electrodes attached to the frontalis anterior and the limbs respectively. The waiting list group served as the control group and received no treatment (Keinan, Segal, Gal, & Brenner, 1995, p. 237). Three months into the study, subjects from all three groups were asked to come in for a medical examination and a symptom improvement scale rating. The results of the study showed that psoriasis patients who received biofeedback and relaxation techniques reported considerably more improvement than the other two groups. The subjects in the biofeedback and relaxation group succeeded in learning to relax their muscles and lower their skin temperature, and reported improvement in their condition relative to the beginning of the study (Keinan, Segal, Gal, & Brenner, 1995, p. 240).
Keinan, G., Segal, A., Gal, U., & Brenner, S. (1995). Stress management for psoriasis patients: The effectiveness of biofeedback and relaxation techniques. Stress Medicine, 11, 235-241.
Keinan, G., Segal, A., Gal, U., & Brenner, S. (1995). Stress management for psoriasis patients: The effectiveness of biofeedback and relaxation techniques. Stress Medicine, 11, 235-241.
Support Groups
A study that examined the benefits of online psoriasis support groups by determining the demographics, usage patterns, attitudes, and experiences of online support site users, found that psoriasis virtual communities offer a valuable educational resource and source of psychological and social support. The study suggests that these benefits could be even further enhanced with input of a physician. The study included 260 subjects were recruited from 5 online psoriasis support groups. The study design used a cross-sectional online survey (Idriss, Kvedar, & Watson, 2009, p. 46). Online support groups are designed to develop and reinforce positive coping strategies, which improve medical and social outcomes. The findings of the study showed that participants in this study reported improvements in their psoriasis severity, quality of life, and support network (Idriss, Kvedar, & Watson, 2009, p. 52). The results of the study reinforced that “treatment plans for psoriasis include advice on increasing personal control, reinforcing active coping methods, and encouraging patients to express themselves emotionally and to seek social support (Idriss, Kvedar, & Watson, 2009, p. 53). Psoriasis is a condition that causes many to seek an isolated life-style. In actuality, the disorder affects a significant percentage of the population, and sufferers may find solace in bonding with others in similar positions.
Idriss, S. Z., Kvedar, J. C., & Watson, A. J. (2009, January). The role of online support communities: Benefits of expanded social networks to patients with psoriasis. Archives of Dermatology, 145(1), 46-51.
Idriss, S. Z., Kvedar, J. C., & Watson, A. J. (2009, January). The role of online support communities: Benefits of expanded social networks to patients with psoriasis. Archives of Dermatology, 145(1), 46-51.
Meditation
Meditation produces a relaxing and stress-reducing state that can effectively complement other psoriasis treatments. Meditation has been shown to help speed up the rate at which phototherapy (artificial sunlight) can clear psoriasis. A study conducted at University of Massachusetts Medical Center tested the hypothesis that stress reduction methods, mindfulness meditation, can positively influence the rate psoriasis clears in patients undergoing phototherapy (UVB) and photochemotherapy (PUVA). There were 37 subjects in this study. Half of the group received UVB or PUVA with an audiotape of guided meditation. The other half of the subjects served as the control group, and only received UVB or PUVA. The status of psoriasis was assessed by unblinded nurses and blinded physicians. The results of the study demonstrated that the group of subjects who listened to the guided meditation audiotape during UVB or PUVA progressed to the clearing point significantly more rapidly that the control group did. This data suggests that mindfulness meditation during UVB or PUVA can increase the rate of resolution of psoriatic lesions in patients with psoriasis (Kabat-Zinn, et al., 1998).
Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M., Cropley, TG; Bernhard, J. (1998, September-October). Influence of a midfullness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine, 60(5), 625-632.
Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M., Cropley, TG; Bernhard, J. (1998, September-October). Influence of a midfullness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine, 60(5), 625-632.
Cognitive Behavioral Therapy
Cognitive Behavioral therapy has shown efficacy in decreasing the psychological symptoms of psoriasis. A study conducted by Hope Hospital in Manchester, UK investigated the effects of a cognitive-behavioral psoriasis symptom management program (PSMP) on patients’ perceptions about their condition. The intervention group included 40 patients who were treated with PSMP in addition to standard pharmalogical care. The control group was treated with pharmalogical care only. The study measures included The Illness Perception Questionnaire, which assessed patients’ beliefs about illness identity, time-line, consequences, cure/control, and perceptions of the cause of their symptoms (Fortune, Richards, Griffiths, & Main, 2004). The study measures also included the use of a COPE questionnaire, which assesses patients’ self-reported coping strategies, and the Toronto Alexithymia Scale, which is a measure of deficiency in understanding, describing, and processing emotions. The results of the study showed that after 6 months, patients in the intervention group demonstrated significant reduction in illness identity, according to the PSMP measure, compared to the control group. There was not a significant difference in scores of perceptions about the anticipated course of the disease, its cure or controllability, ideas about physical causative agents, or coping strategies between the intervention group and the control group (Fortune, Richards, Griffiths, & Main, 2004). Although PSMP did not show effectiveness in all psychological areas measured, it did show improvement in some aspects of disease acceptance, which may contribute to more successful management of the psoriasis, particularly when used in conjunction with other therapies.
Fortune, D., Richards, H., Griffiths, C., & Main, C. (2004, March). Targeting cognitive-behaviour therapy to patients' implicit model of psoriasis: results from a patient preference controlled trial. Brittish Journal of Clinical Psychology, 43, 65-82.
Fortune, D., Richards, H., Griffiths, C., & Main, C. (2004, March). Targeting cognitive-behaviour therapy to patients' implicit model of psoriasis: results from a patient preference controlled trial. Brittish Journal of Clinical Psychology, 43, 65-82.