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Psychological Interventions benefit people with skin conditions report concludes

The symptoms of some of the most common skin diseases could be alleviated through psychological interventions, according to a study released today 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 Dermatology1 this week, a team from the Department of Psychology at the University of Sheffield2 carried out an analysis of previous studies and concluded that psychological interventions did provide benefit to patients with skin conditions.3

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 this4. 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).

ENDS
NOTES

Notes to editors:

1. The information in this press release is embargoed until 00:01 on 26 August 2012. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists
 

For more information please contact: Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6355, Email: deborah@bad.org.uk, Website: www.bad.org.uk (Mon-Wed) or Comms Team on 020 7391 6084 email comms@bad.org.uk (Thur-Fri)

2. Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2TN
3. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: A meta-analysis of the effectiveness of psychological interventions for adults with skin conditions. A.C. Lavda, T.L. Webb, A.R. Thompson. The Department of Psychology, University of Sheffield
4. Interventions include: psychodynamic psychotherapy (targeting underlying psychopathology via exploration of unconscious conflicts); cognitive behavioural therapy (CBT; which aims to modify unhelpful cognitions and behaviours associated with coping or/and treatment adherence); arousal reducing techniques – such as relaxation or meditation; behavioural therapies including habit reversal (which aims at modification of unhelpful behaviours such as scratching); and written emotional disclosure (expression of distress through writing)


The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.
The British Journal of Dermatology (BJD) strives to publish the highest quality dermatological research. In so doing, the journal aims to advance understanding, management and treatment of skin disease and improve patient outcomes. BJD is an official organ of the British Association of Dermatologists but attracts contributions from all countries in which sound research is carried out, and its circulation is equally international. The overriding criteria for publication are scientific merit, originality and interest to a multidisciplinary audience. Journal content and further information-including author guidelines and submission details-can be found online at www.brjdermatol.org. The 2011 impact factor is 3.666.
The University of Sheffield:
With nearly 25,000 students from 125 countries, the University of Sheffield is one of the UK’s leading and largest universities. A member of the Russell Group, it has a reputation for world-class teaching and research excellence across a wide range of disciplines.
The University of Sheffield has been named University of the Year in the Times Higher Education Awards for its exceptional performance in research, teaching, access and business performance. In addition, the University has won four Queen’s Anniversary Prizes (1998, 2000, 2002, 2007). These prestigious awards recognise outstanding contributions by universities and colleges to the United Kingdom’s intellectual, economic, cultural and social life. Sheffield also boasts five Nobel Prize winners among former staff and students and many of its alumni have gone on to hold positions of great responsibility and influence around the world.
The University’s research partners and clients include Boeing, Rolls Royce, Unilever, Boots, AstraZeneca, GSK, ICI, Slazenger, and many more household names, as well as UK and overseas government agencies and charitable foundations.
The University has well-established partnerships with a number of universities and major corporations, both in the UK and abroad. Its partnership with Leeds and York Universities in the White Rose Consortium has a combined research power greater than that of either Oxford or Cambridge.
For further information, please visit www.sheffield.ac.uk

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