nonpharmacological management of psychodermatalogical
conditions. Proven interventions — typically used as
complements to traditional dermatological approaches —
include hypnosis, support groups, biofeedback, meditation,
guided imagery, progressive muscle relaxation, cognitive-behavioral therapy and other forms of psychotherapy.
The key, says Fried, is to give patients a sense of control
over their conditions and their reactions to them. Cognitive-behavioral therapy, for example, can help patients manage
stress and stop catastrophizing, such as saying they’ll kill
themselves if their psoriasis acts up on an important day.
Boston psychologist Ted A. Grossbart, PhD, a private
practitioner who specializes in psychodermatology, uses a variety
of therapies to help people with skin conditions, including
imaging and meditation. Hypnosis can be especially helpful, he
says. The key is to help patients focus on an image associated
with the desired change, whether it’s warmer, cooler, dryer,
moister or less itchy skin, says Grossbart, who is also an assistant
professor of psychology at Harvard Medical School. A patient
with eczema, for instance, might zero in on the image of a
tropical rainforest to counteract the drying the condition brings.
“Often, people are doing what I call inadvertent negative
hypnosis anyway,” says Grossbart. “If that very same
mechanism can get used in a focused way and in a proper
dimension, the results can be quite dramatic.”
These kinds of interventions don’t just help patients’
distress, says Fried. They can also improve patients’ skin and
their responsiveness to treatment. In one study Fried cites
in his literature review, for example, patients who listened
to a mindfulness meditation program while undergoing
phototherapy treatment for psoriasis needed 40 percent less
exposure to ultraviolet light than others.
Fried refers his patients who need more intensive
psychological assistance to psychologists, whom he calls
“skin-emotion specialists” as a way of reducing stigma and
overcoming patients’ reluctance to seek mental health care.
In some cases, adds Grossbart, skin problems are the
outward manifestation of an underlying mental disorder.
Take skin picking, for example. “Sometimes people would
have perfect skin if they would just leave it alone,” says
Grossbart. “But they can’t.” Their picking may be a form of
addiction, a symptom of attention-deficit disorder or the
outward sign of obsessive-compulsive disorder, all of which
require different treatment approaches. “You’ve got to do
detective work first,” says Grossbart.
Psychologists are also helping prevent dermatological
problems from developing.
Kasey Lynn Morris is investigating the best ways to prevent
melanoma and other problems caused by excessive tanning,
“Tanning is one of those areas where even though people
know how bad it is for them, they still do it,” says Morris, a
graduate student in social psychology at the University of
Research has shown that reminding people of tanning’s
potentially fatal consequences can help curb people’s desire
to tan, at least temporarily. But as thoughts of death slide into
the unconsciousness, which happens very quickly, people’s
desire to tan actually increases if being tan is relevant to self-esteem, as is often the case for women, says Morris.
“The reason is that non-conscious thoughts of death
motivate a desire to maintain self-esteem,” Morris explains.
“If a person’s appearance is relevant to their self-esteem —
and being tan is a part of that cultural appearance ideal —
then non-conscious thoughts of death will motivate a desire
Adding an appearance-related element to the intervention
can “re-route” that self-esteem, Morris and colleagues found
in two experiments described in a 2014 paper published in
Psychology and Health. In the experiments, the researchers
exposed women not just to a reminder of mortality via a
funeral scene depicting a woman sunbathing on a beach but
also to UV-filtered photos of their own skin, a technique that
reveals sun damage. “If you’ve ever seen a UV-filter photo of
yourself, you know you look terrible,” says Morris. When the
death- and appearance-related interventions were combined,
they decreased participants’ intentions to tan and increased
the amount of sunscreen they took from the researchers.
“It relies on the assumption that people value their
appearance — and research suggests the majority of women
do — and the knowledge that unconscious thoughts of death
motivate a desire to maintain self-esteem,” says Morris. “If
you prime thoughts of death, followed by a delay to give
it time to no longer be conscious and then remind people
how much sun damage can hurt their appearance, they
are subsequently going to try to boost their self-esteem by
maintaining their appearance through using sun protection.”
Now Morris and her team are exploring whether
participants follow through on their intentions in everyday life.
Other psychologists are working on interventions
designed to prevent psychological problems from developing
among dermatology patients.
Heidi Williamson, DHealth, Psychol, for example, has
worked with young people to develop an online interactive
intervention called YP Face IT. It’s designed for youth ages
12 to 17 who are distressed because of conditions or injuries
affecting their appearance, including skin issues such as acne,
psoriasis, burns or scars. The seven-week program teaches
kids coping strategies and social skills.
“What young people fear most is being judged negatively
for their appearance,” says Williamson, a senior research
fellow at the Centre for Appearance Research at King’s