The importance of mindfulness in psychosocial distress and quality of life in dermatology patients

Effects of a Brief Mindfulness-based Intervention in Patients with Psoriasis: A Randomized Controlled Trial

Mindfulness is a special type of attention, namely focusing on the current moment in a non-judgmental manner. Extensive mindfulness-based interventions have been shown to have positive effects in patients with psoriasis. However, it is unclear whether brief (2-week) interventions are also beneficial. Therefore, the aim of this study was to investigate the effects of a 2-week mindfulness-based intervention in patients with psoriasis. Patients were randomly assigned to an experimental (treatment-as-usual + mindfulness-based intervention) or control group (treatment-as-usual) during their clinic stay. All variables were measured by self-report using validated questionnaires: primary outcomes were mindfulness and self-compassion, secondary outcomes were itch catastrophizing, social anxiety, stress and skin status. Variables were assessed prior to, immediately and 3 months after the intervention. Effects were tested by repeated-measures analysis of variance (ANOVA). Analyses of pre-post-measurements (n = 39) revealed a significant interaction effect on self-reported mindfulness [F(1,35) = 7.46, p = 0.010, η2p = 0.18] and a tendency to a significant effect on self-reported self-compassion [F(1,36) = 3.03, p = 0.090, η2p = 0.08]. There were no other significant effects, but most descriptive data were in favour of the experimental group. However, the control group showed a greater improvement in skin status. Further studies are needed to replicate these findings and investigate which subgroups especially profit from such an intervention.

Congenital melanocytic naevus (CMN) through the lens: Using photo-elicitation interviews to explore adjustment in adolescents with a rare birthmark condition

Adolescents with the rare birthmarks congenital melanocytic naevi (CMN) experience physical and psychosocial challenges, many of which stem from looking different from the 'norm'. However, some adjust and have positive experiences. Understanding the lived experiences of adolescents who have adjusted to CMN can provide a holistic picture of adjustment and inform the development of support and interventions for others with the condition. Open, participant-driven photo-elicitation interviews were conducted with four White females (15-17 years) who self-identified as having adjusted to CMN. Participants chose five photographs which were used to guide the interviews (47-80 min). Interpretative phenomenological analysis (IPA) was used to analyse the transcribed interview data. Three superordinate themes were identified: 'Accepting My 'True' Self' (1), 'I am Not Alone in This' (2), and 'Developing as a Person' (3). The themes related to accepting CMN as part of their identity, developing a positive body image (e.g., body appreciation, broad conceptualisations of beauty, body image flexibility), feeling supported and accepted by family, friends, and others with CMN, and developing adaptive coping skills. Findings suggest positive body image may be important for adjustment and can be determined by an individual. The benefits of using photo-elicitation within appearance research are discussed.

Mindfulness and self-compassion in dermatological conditions: a systematic narrative review

OBJECTIVE

People affected by chronic skin conditions suffer from elevated levels of psychological distress. There is a need for evidence-based treatments that integrate medical care. Mindfulness and Self-compassion programs (MCBPs) have proven effective in chronic diseases. This systematic review aims to narratively synthesize the literature on mindfulness and self-compassion as traits and interventions in chronic skin conditions.

DESIGN

We searched four electronic databases for mindfulness and self-compassion trials and correlational studies in chronic skin conditions. We narratively synthetized results regarding the effects of mindfulness and self-compassion, both as traits and as interventions, on psychological and disease outcomes.

RESULTS

Thirteen studies were included in our review. Evidence from cross-sectional studies suggest that mindfulness and self-compassion are linked to lower psychological distress and better adjustment to the disease. MCBPs appear feasible for this population and can lower psychological distress, reduce disease severity and improve quality of life. Methodological issues limit conclusions on MCBP efficacy. Based on our analysis, we propose possible mechanisms that future research could explore.

CONCLUSIONS

The integration of MCBPs in the care process of chronic skin conditions appears promising. Definitive conclusions cannot be drawn due to a lack of strong evidence. Further studies with high methodological standards are needed.

Mindfulness and negative emotions among Chinese college students: chain mediation effect of rumination and resilience

Objective

This study examines the mediation effect of rumination and resilience between the relationship of mindfulness and negative emotions in Chinese college students.

Method

A total of 3,038 college students (19.94 ± 1.10) were investigated by Mindfulness Attention Awareness Scale (MASS), Rumination Response Style Scale (RRS), Resilience Scale (RES) and Depression-anxiety-pressure scale (DASS-21), and the mediation analyses were conducted by adopting PROCESS macro in the SPSS software.

Results

① Mindfulness was negatively associated with rumination and negative emotions (r = -0.69, -0.72; P < 0.01), and positively associated with resilience (r = 0.63, P < 0.01). Rumination was negatively associated with resilience (r = -0.59, P < 0.01), and positively associated with negative emotions (r = 0.83, P < 0.01). Resilience was negatively associated with negative emotions (r = -0.71, P < 0.01). ② Mindfulness can not only directly predict negative emotions (95%CI, -0.12~-0.09) but also affects negative emotions through three indirect paths: Rumination was a mediator (95%CI, -0.24~-0.20), resilience was a mediator (95%CI, -0.07~-0.06), and resilience and rumination were a chain mediator (95%CI, -0.04 ~ -0.03).

Conclusion

Mindfulness not only influences negative emotions directly, but also through the mediating effect of rumination and resilience indirectly.

Is it really ever 'just acne'? Considering the psychodermatology of acne

Acne can create a significant burden for people of all ages. However, the psychological consequences might often be overlooked. This review comments on recent evidence in the field of psychodermatology, to highlight the importance of considering a person's mental health in the treatment of acne. A range of presenting issues are discussed, and cases of underserved patients needing additional considerations are highlighted. This article considers how the psychological sequelae can contribute to the pathogenesis of acne, and discusses how psychotherapeutic approaches can be of benefit to people experiencing appearance-related distress. Importantly, attention is paid to the need for clinicians to assess a patient's wellbeing alongside their physical symptoms. In doing this, early intervention can be facilitated if psychological comorbidities are present, with referral to appropriate specialist services, where available. To improve treatment outcomes, the skin and the mind must be addressed together in a multidisciplinary approach to dermatology care.

Interest in a short psychological intervention in patients with psoriasis: a cross-sectional observational study at a German clinic

Introduction

Utilization of health services is not only associated with the kind of illness one has, but also with patient characteristics like age, sex or psychological variables. Psoriasis (PS) is a chronic inflammatory skin condition, in which psychological interventions were shown to be beneficial regarding not only psychological variables, but also regarding the skin status. The present study investigated with regard to which patient characteristics PS-patients with interest in participation in a short psychological intervention differ from PS-patients without interest.

Methods

This cross-sectional questionnaire study was conducted at a German rehabilitation clinic. At the beginning of their stay at the clinic, 127 PS-patients filled in questionnaires to assess the severity of their PS, stress, illness perceptions, mindfulness, anxiety, and depression. Interest in taking part in a short psychological intervention was assessed using a dichotomous item. The statistical analysis comprised group comparisons using t-tests of patients with and without interest to take part in a short psychological intervention.

Results

Sixty-four of the participants were male (50.4%). Participants were 50.7 ± 10 years on average (range: 25-65). 50.4% of them had a mild, 37.0% a moderate, and 12.6% a severe PS. Results indicated that patients with interest in a short psychological intervention were younger, reported to have more skin symptoms due to their PS (higher skin-related illness identity), were more anxious and depressed, but less stressed and less mindful than patients without interest.

Conclusion

This study shows that in PS-patients with certain characteristics, it might help to raise awareness on the relationship between psychological factors and symptoms of the skin disease in order to motivate this group of patients to take part in psychological interventions to improve their skin condition. Further studies are needed to investigate whether patients who show interest in a psychological intervention also actually take part in the intervention and profit from it.Clinical Trial Registration: DRKS00017426.

Complementary and alternative medicine for alopecia areata: A systematic review

BACKGROUND

Despite high use of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear.

OBJECTIVE

To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychologic well-being.

METHODS

PubMed and Embase were searched to identify English articles containing original data investigating CAM in individuals with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria.

RESULTS

Of 1015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective noncontrolled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low-quality evidence for improvement of psychologic and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated.

LIMITATIONS

Inconsistent or poorly reported study methodology and nonstandardized outcomes limit the conclusions that can be made from these studies.

CONCLUSIONS

This work serves to inform physician treatment of patients with AA seeking CAM while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.

A brief online writing intervention improves positive body image in adults living with dermatological conditions

Introduction

Dermatological conditions can affect how individuals feel about their bodies. This research therefore seeks to evaluate the potential for a brief writing intervention, focused on body functionality, to improve body image in adults living with a range of dermatological conditions.

Methods

As part of a parallel Randomised Controlled Trial, 451 adults living with a dermatological condition were randomized to either three functionality-based writing tasks or three creative writing tasks (control). Of these, 155 participants completed pre- and post-intervention measures of body appreciation, functionality appreciation, appearance anxiety, skin-related shame, and skin-related quality-of-life.

Results

For participants with relatively low or mid-range scores on baseline body appreciation and functionality appreciation, there were medium-to-large positive effects of the intervention. Effects were smaller, with all but-one remaining significant, at 1-month follow up and in intention-to-treat analyses. No between-group effects of the intervention were found for measures of appearance anxiety, skin-related shame, and skin-related quality-of-life.

Discussion

These findings suggest that a 1-week writing intervention has the potential to improve positive aspects of body image, but not appearance- and skin-related distress in adults living with a dermatological condition.

Clinical trial registration

[https://clinicaltrials.gov/ct2/history/NCT044459 74?V_3=View], identifier [NCT04445974].

How does self-compassion help people adjust to chronic skin conditions? A template analysis study

Objectives

Skin conditions can greatly impact people's lives, but greater understanding of the processes involved in positive adjustment is required. Self-compassion has strong links to wellbeing and adaptive functioning and therefore may play an important role in adjustment to skin conditions.

Design

Template analysis was used to explore how self-compassion operates in people living with skin conditions, with reference to existing theories of self-compassion.

Methods

Semi-structured interviews were conducted with highly self-compassionate people with chronic skin conditions (N = 10). Theoretical models of self-compassion were used in the development of the initial template and interview schedule. Participants were purposively selected on the basis of having high scores on a measure of self-compassion.

Results

Participants reported a variety of ongoing skin-related difficulties and their ways of managing these. Sensitivity to distress and care for wellbeing were identified as foundation themes: necessary components of a compassionate response to distress. Eleven types of difficulty-management strategies built upon these foundation themes: empathy, non-judgement, distress tolerance, self-kindness, mindful attention, perspective-taking, self-talk, self-care, using social support, concealment, and idiosyncratic coping strategies.

Conclusions

Components of self-compassion helped people adjust to chronic skin conditions in a wide variety of ways, indicating that psychological adjustment is not a simple, linear process. Sometimes compassionate responses occurred automatically and sometimes with deliberate effort. Further research on compassion-based interventions for people with skin conditions is warranted.

Psychosocial Distress and Quality of Life Among Patients With a Chronic Skin Disorder at a Tertiary Care Hospital in Eastern India: A Hospital-Based Case-Control Study

Background Chronic skin disorder affects the physical and psychological well-being of patients. The impact of psychological burden ranges from low self-esteem and stress to anxiety and depression. Hence, this study was conducted to compare the psychological distress and quality of life (QoL) of patients with a comparative group without any apparent skin disorders. Methods This hospital-based case-control study was done on adult patients (≥18 years) suffering from any chronic skin disorder for three or more months and attending the dermatology out patient department (OPD) of a tertiary care institution of Eastern India. Data was collected from 101 patients and 101 controls (matched for age, gender, and place of residence) after obtaining written informed consent in May and June, 2017. Depression was assessed using the Patient Health Questionnaire-9, anxiety was assessed using the Generalised anxiety disorder-7 scale, and health-related quality of life (HRQoL) was assessed using the World Health Organization Quality-of-Life Scale (WHOQoL-BREF). Prevalence and mean scores were compared using Chi-square test and t-test. Results About half (49.5%) of the cases had clinically significant impairment of their dermatological quality of life. Clinically significant depression and anxiety was found in 45.54% and 41.58% patients respectively. Depression (OR=4.13, 95% CI 2.06-8.45) and anxiety (OR=4.42, CI=2.13-9.51) were significantly higher in cases as compared to the controls. No significant difference was seen in HRQoL scores. Conclusion Screening for anxiety, depression, and QoL should be done for patients of chronic skin disorders attending dermatology OPD so that appropriate psychiatric consultation can be offered to those in need.

An Open Trial on the Feasibility and Efficacy of a Mindfulness-Based Intervention with Psychoeducational Elements on Atopic Eczema and Chronic Itch

(1) Background: Mindfulness-based interventions (MBI) are psychological group interventions conducted over several weeks. Their effects on reducing stress and improving physical and psychological health have been proven in various clinical populations. Growing evidence suggests that MBIs might be beneficial for dermatology patients. This article reports on a novel Mindfulness-based Training for chronic Skin Conditions (MBTSC) with psychoeducational elements that was developed with the goal of improving self-regulation including stress management and emotion regulation in patients and to help in coping with disease symptoms such as itch and scratching. The intervention was tested in a pilot efficacy trial in order to examine feasibility and to collect preliminary data on the effectiveness of the intervention on disease severity including itch perception and on psychological distress in an atopic dermatitis (AD) sample. (2) Methods: Following an uncontrolled pre-test-post-test design based on standardized self-report measures, nine adult AD patients were recruited from a dermatology clinic. Data were collected at baseline, post-treatment and 3 month follow-up. Patients completed questionnaires assessing disease severity, itch perception, stress, anxiety and depression, mindfulness and intervention acceptability. The 7 week intervention included seven weekly sessions and a daily home-practice requirement, supported by guided audio-meditations and reading material. (3) Results: Quantitative data showed improvements in disease severity, itch perception and stress levels with small to medium effect sizes. Psychological distress increased at post-treatment—significantly in the case of depression. Qualitative data highlighted the mixed effects of MBTSC on symptoms. Treatment acceptability was high and 100% of the participants completed the intervention; (4) Conclusions: These data indicate that MBTSC is feasible and that it might be a useful tool as adjunct therapy for AD. Further studies with larger samples and control groups are needed.

The Impact of Mindfulness Meditation on the Psychosomatic Spectrum of Oral Diseases: Mapping the Evidence

The psychological aspect of dis-ease, which is indeed a lack of ‘ease’ is generally overlooked in the management of myriad maladies that affect the human body. The concept of mindfulness meditation, which is an interesting hybrid born from the meditative discipline of the east and the intellectual discipline of the west is gaining attention in the past two decades for its benefits in the holistic development of individuals. When individuals with ailments are trained under therapists supervised by the clinicians, significant results can be seen in alleviating symptoms like pain, stress, anxiety and an improvement in the quality of life is observed. This review article focuses on the structure and basics of mindful meditation and the mechanisms of mindfulness and its positive effects on various diseases like lichen planus, urticaria, psoriasis, eczema, myofacial pain dysfunction syndrome, to name a few. There are various arenas within the discipline of oral and maxillofacial medicine where mindfulness-based techniques can be explored for its effectiveness in combating psychosomatic conditions. The article highlights the importance of holistic approach in treating diseases in which mindfulness meditation techniques play an important role.

A Randomised Controlled Feasibility Trial of Online Compassion-focused Self-Help for Psoriasis

BACKGROUND

People with psoriasis can experience psychological distress that might be amenable to psychosocial self-help.

OBJECTIVES

This study tested the feasibility and acceptability of two theoretically developed self-help interventions designed to reduce feelings of shame and improve quality of life.

METHODS

A randomised controlled feasibility trial was conducted with one hundred and thirty participants with psoriasis who were randomly allocated to receive either compassion-based self-help (n =65) or mindfulness-based self-help (n =65), over a four-week period.

RESULTS

The interventions were found to be acceptable with over 70% of study completers reported finding the materials helpful. Ninety-two participants completed the study with attrition at 30%. Both interventions showed modest yet statistically significant reductions in shame (d = .20) and improvements in quality of life (d = .40).

CONCLUSIONS

Self-help based on compassion and mindfulness is acceptable to users and can reduce feelings of shame and improve quality of life for people living with psoriasis.

Psychological Impact of Infertility. Directions for the Development of Interventions

Introduction: Infertility represents a major health problem that oftentimes is experienced as a crisis situation. Because it interposes with achieving an important life goal, that of having children, its implications on the psycho-emotional level are robust. Purpose: The present article aimed at exploring the multidimensional effects of infertility on mental health, as well as suitable psychological intervention strategies for patients both at an individual and couple level. Methodology: An extensive literature review was conducted to select the most relevant information. Articles included were searched in PubMed, Google Scholar and other similar databases within a seven years interval (2014-2021) to assure the up-to-date quality of the paper. The main criteria of inclusion were: studies about the consequences of infertility on mental health, epidemiology, risk and protective factors, psychological models for infertility, psychological evaluation, established instruments, psycho-social and therapeutic interventions, intervention protocols used in public health for infertility patients. Results and Discussion: Infertility is often experienced as a crisis situation, in which the most common consequences are visible at the level of mood disorders (e.g. anxiety, depression, marked distress) and at the social level (stigma, divorce, social isolation, financial difficulties). Psychological counseling is needed throughout medical treatment and therapeutic interventions (e.g. cognitive-behavioral therapy) have shown favorable results in managing the emotional balance of the individual/couple and reducing the risk of psychopathology. Conclusions: Research highlights the beneficial effects of psychological interventions on reducing levels of stress related to infertility, anxiety and depressive symptoms and on improving the quality of life and couple dynamics

How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review

This study aimed to systematically review studies which conducted a controlled mediation analysis in order to examine the potential mechanisms which underlie mindfulness-based programme’s (MBPs) effects on anxiety, depression and psychological distress in any health or mental health population. Searches of six databases (Medline (Ovid), PsycINFO, Cochrane Central Register of Controlled Trials, EMBASE, Cinahal Plus and Cochrane Reviews) were undertaken in September 2020. After removing duplicates, 2052 records were screened, of these 1822 were excluded based on the abstract and 230 were further assessed for eligibility against the full study inclusion criteria. Full texts were acquired for the 11 studies which met the inclusion criteria. The quality of the methodologies of each of these 11 studies were assessed using the Cochrane risk of bias tool (Higgins et al., 2011). The quality of the findings from each study relating to the hypothesised mechanisms of action of the MBP reviewed were evaluated using Alsubaie et al. (2017)’s framework for abstracting and interpreting mechanistic study quality, derived from recommendations made by Kazdin (2007, 2009). We found preliminary evidence that MBCT/MBSR treatment effects on anxiety and depression may be mediated by hypothesised mechanisms, such as mindfulness, rumination, worry, self-compassion, cognitive reactivity, aversion, attention regulation skills and positive affect. An overall lack of methodological rigour does preclude us from making any definitive conclusions on causality. The results from this study do however provide some insights into what the potential causal pathways connecting MBPs with improved anxiety and depression might be.

Examining Individual Differences in Wellbeing, Anxiety and Depression in Psoriasis Using a Clinically Modified Buddhist Psychological Model

Psoriasis patients can experience a range of psychosocial difficulties, which can lead to issues with wellbeing, anxiety and depression. Mindfulness-based interventions have positive impacts on these outcomes; however, there is a need to identify the mechanisms of action of such interventions. This study attempts to do so by examining individual differences in psoriasis patients' wellbeing, anxiety and depression using a clinically modified Buddhist psychological model (CBPM). Psoriasis patients (N = 285) and (N = 209) completed measures of each CBPM component at time 1 and 2. SEM analyses found that a direct and mediated effect of CBPM model was a good fit to the participant's data. This study suggests that non-attachment, aversion, acceptance and self-compassion could have a direct effect on the wellbeing, anxiety and depression of psoriasis patients and an indirect effect through reduced worry and rumination. This study provided preliminary evidence for the CBPM as being a useful explanatory framework of psoriasis patients' anxiety, depression and wellbeing.

Coping strategies, social support, and mindfulness improve the psychological well-being of Jordanian burn survivors: A descriptive correlational study

BACKGROUND

Burn injury survivors usually experience multiple psychosocial problems, which occur commonly in low and middle-income countries. However, the previous literature provides limited information about the unique roles of coping strategies, social support, and mindfulness in improving the psychological well-being of burn survivors. Therefore, this study identified the role of coping strategies, social support, and mindfulness in improving the psychological well-being of burn survivors.

METHODS

A descriptive correlational study on 224 burn survivors at a large government hospital in Amman, Jordan, was conducted. Participants completed questionnaires about socio-demographic and clinical data, anxiety and depression, social support, mindfulness, and coping. Standard multiple regression was performed to identify the unique role of the main study variables in improving the psychological well-being of burn survivors.

RESULTS

Participants were found to have a severe level of psychological distress. Escape avoidance coping had the highest mean score among all other coping strategies, while acceptance of responsibility had the lowest mean score. Regression analysis showed that confrontive coping (β = -0.224, p=p<0.01), social support (β = -.212, p=p<0.01), and mindfulness (β = -.403, p=p<0.01) were significantly associated with less psychological distress.

CONCLUSIONS

Therefore, confrontive coping, social support, and mindfulness-based supportive interventions could be helpful in providing enhanced support to burn survivors.

Mindfulness as Predictor of Itch Catastrophizing in Patients With Atopic Dermatitis: Results of a Cross-Sectional Questionnaire Study

Itch and worry about itch are predominant symptoms in atopic dermatitis (AD). Mindfulness refers to paying attention in a certain way, non-judgementally and on purpose. In patients with chronic pain, which shares several similarities with chronic itch, a significant relationship between pain intensity, mindfulness and pain catastrophizing has been found. The aim of this study was to investigate whether itch intensity and mindfulness are related to itch catastrophizing in AD patients. Participants receiving treatment for AD (n = 155; 58 male; mean age: 46.5 ± 12 years) completed measures of itch-related catastrophizing (Itch Cognitions Questionnaire; ICQ) and mindfulness (Comprehensive Inventory of Mindfulness; CHIME) during their stay at a rehabilitation center in Borkum, Germany. In addition to other variables, their average itch intensity during the last 2 weeks was assessed by means of a visual analog scale. A positive relationship between itch intensity and itch catastrophizing was found (r = 0.409; p < 0.01). Moreover, the mindfulness scales “acting with awareness,” “accepting and non-judgemental orientation,” and “non-reactive orientation” were negatively related to itch catastrophizing. A linear regression analysis revealed that itch intensity in combination with “acting with awareness” was able to explain more than 27 % (corrected R² = 0.274; p < 0.001) of the variance of itch catastrophizing. Thus, itch intensity and certain facets of mindfulness were associated with itch catastrophizing in AD patients. Psychological interventions aiming to increase acting with awareness might have a buffering effect on itch catastrophizing, which in turn could lead to lower itch intensity in patients with AD. Future RCTs should test this hypothesis.

Methods to improve quality of life, beyond medicines. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes

The pharmaceutical approach to skin disease has been hugely successful, but despite effective drugs being available and used, there are still vast numbers of people who continue to have some level of persisting skin disease and continue to experience quality of life (QoL) impairment. So the question that needs to be answered, while we await further advances in our drug-based armamentarium, is how can we improve patients' QoL, beyond drugs? A working group was formed from members of the EADV Task Force on QoL and Patient Oriented Outcomes. Participants were asked to suggest all the ways in which they considered patients' QoL may be improved beyond medicines. Four groups of management approaches that may improve QoL in dermatology were identified: interventions within the dermatology service (hospitalization, multidisciplinary teams, patch testing and establishing relevant allergens and education), external services (corrective make-up, climatotherapy and balneotherapy), psychological (psychological intervention, cognitive therapy, hypnosis), lifestyle (lifestyle behavioural changes, religion and spirituality and music). The ultimate aim of therapy is to eradicate a disease in an individual and return the person's life to normal. But until the day comes when this has been achieved for every skin disease and for every patient there will be a need to support and assist many patients in additional non-pharmaceutical ways. These 'adjuvant' approaches receive too little attention while dermatologists and researchers strive for better pharmacological therapy. The different ways in which patients may benefit have been reviewed in our paper, but the reality is that most have a very poor evidence base. The research challenges that we have to meet are to identify those approaches that might be of value and to provide evidence for their optimal use. In the meantime, clinicians should consider the use of these approaches where QoL remains impaired despite optimal use of standard therapy.

Investigation of predictors of interest in a brief mindfulness-based intervention and its effects in patients with psoriasis at a rehabilitation clinic (SkinMind): an observational study and randomised controlled trial

INTRODUCTION

Psoriasis (PS) is a chronic inflammatory skin disease accompanied by reduced quality of life. Mindfulness is the ability to focus on the present moment without evaluation. Findings on the effects of 8-week mindfulness trainings in patients with PS reveal positive effects on the severity of the disease and quality of life. However, it remained unclear what distinguishes patients with PS interested in psychological interventions from those without interest and whether also a shorter, namely 2-week mindfulness-based intervention is beneficial in this patient group. This will be investigated with this study.

METHODS AND ANALYSES

Data will be collected at a rehabilitation clinic in Germany. The study is divided into two parts: study 1a is an observational study. Its aim is to investigate whether sociodemographic, skin-related and psychological factors are significant predictors of interest in a brief psychological intervention in 127 patients with PS. Study 1b is a randomised controlled trial, in which 60 patients (retrieved from study 1a) will be randomised to an intervention or control group (treatment as usual). The main outcome variables are mindfulness and self-compassion. In addition, mediation analyses will be used in an explorative manner to test whether there is a relationship between mindfulness/self-compassion and the severity of PS and whether it is mediated by itch catastrophising and fear of negative evaluation (first model) or perceived stress (second model).

ETHICS AND DISSEMINATION

The study protocol has been approved by the University of Giessen. Study results will be disseminated by publication of the results at (inter) national conferences and in scientific journals.

TRIAL REGISTRATION NUMBERS

DRKS00017426 and DRKS00017429.

Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms

Many dermatology patients experience social anxiety symptoms; however, few studies have investigated vulnerabilities contributing to this distress. Anxiety sensitivity (AS), or the fear of the consequences of anxiety, warrants consideration given its association with social anxiety and dermatological symptoms, respectively. The purpose of this investigation was to investigate the role of AS in social anxiety symptoms in two samples of adults with psychodermatological conditions. AS social, but not physical or cognitive, concerns were hypothesized to demonstrate unique associations with social anxiety symptoms after controlling for relevant variables. Participants completed self-report measures online (Study 1) or in-person (Study 2). Study 1 included 164 participants with active skin conditions (M_age = 31.88; 69.5% female; 83.5% White), and Study 2 included 63 dermatology outpatients (M_age = 51.49; 70.7% female; 65% White). Results revealed AS social concerns was a unique factor contributing to social anxiety symptoms in both samples. This study demonstrates replication, and the findings suggest heightened concerns about the negative consequences related to visible skin conditions may worsen social anxiety symptoms in individuals with psychodermatological conditions. Despite limitations, this study informs the conceptualization of co-occurring psychological and dermatological conditions and highlights the need to evaluate the efficacy of brief AS interventions among patients with psychodermatological conditions.

The association of chronic spontaneous urticaria (CSU) with anxiety and depression: a nationwide cohort study

Chronic spontaneous urticaria (CSU) is a dermatological disease associated with significant impairment of overall quality of life as well as psychological distress. Previous studies have demonstrated significant comorbidity between CSU and a wide range of mental illnesses. In this study we aimed to focus on the association between CSU and anxiety and depression, using an optimized matched controlled design. A nationwide matched control study was conducted using the Clalit Health Services (CHS) database. The study included 12,539 CSU patients and 60,510 age and sex matched controls. Three multiple logistic regression models were conducted to assess the association between CSU and anxiety and depression, while adjusting for age, sex, socioeconomic status (SES), diabetes, obesity, hypertension, and smoking status. A higher frequency of anxiety and depression was found in CSU patients compared to that in controls (anxiety frequency of 9.6% vs. 5.7%, p < 0.001; depression frequency of 11% vs 7.9%, p < 0.001, respectively) after adjustment for demographic and clinical factors. The association of CSU with anxiety was the strongest in the 18-29 age group, and in the high SES group, while the association of CSU with depression was the highest in the 50-69 age group, and in the low SES group. Chronic spontaneous urticaria is associated with anxiety and depression. In light of the clinical implications of a comorbid mental disorder, dermatologists should consider employing mental health screening procedures, especially for patients from specific risk groups.

Experiential avoidance and cognitive fusion mediate the relationship between body evaluation and unhelpful body image coping strategies in individuals with visible differences

Psychological flexibility, the capacity to be open to any internal stimuli and act in accordance with valued ends, has been identified as an explanatory variable in how people cope with body concerns. The role of psychological flexibility is unexplored in adults with an atypical appearance due to a health condition, injury, or medical treatment (collectively visible difference), who often encounter multiple day-to-day body image threats. Testing two core components of psychological flexibility, namely experiential avoidance (a desire to avoid or get rid of unpleasant internal experiences) and cognitive fusion (taking thoughts literally), can also provide a more precise theoretical model, with clearer implications for psychological intervention. This survey study investigated whether each psychological flexibility component mediated the relationship between body evaluation and two unhelpful body image coping strategies (behavioural avoidance and appearance-fixing behaviours) in 220 adults with various causes of visible difference. Controlling for demographic variables and subjective noticeability of visible difference, results suggest that cognitive fusion partially mediated the relationship for both body image coping strategies, and experiential avoidance partially mediated behavioural avoidance but not appearance-fixing behaviours. Cognitive fusion may be a particularly important cognitive process in the mechanisms underpinning unhelpful body image coping strategies in this population.

Acceptance and commitment therapy for appearance anxiety: three case studies

Introduction:

Due to scarring, appearance anxiety is a common psychological difficulty in patients accessing burns services. Appearance anxiety can significantly impact upon social functioning and quality of life; thus, the availability of effective psychological therapies is vital. Acceptance and Commitment Therapy (ACT) is considered useful for treating distress associated with other health conditions and may lend itself well to appearance anxiety. However, no published research is currently available.

Methods:

Three single case studies (two male burns patients; one female necrotising fasciitis patient) are presented where appearance anxiety was treated using ACT. A treatment protocol was followed and evaluated: the Derriford Appearance Scale measured appearance anxiety; the Work and Social Adjustment Scale measured impairment in functioning; the Acceptance and Action Questionnaire measured acceptance (willingness to open up to distressing internal experiences); and the Committed Action Questionnaire measured engagement in meaningful and valued life activities. Measures were given at every treatment session and patient feedback was obtained. One-month follow-up data were available for two cases.

Results:

After the intervention, all patients had reduced functional impairment and were living more valued and meaningful lives. No negative effects were found.

Discussion:

These case studies suggest that ACT may be a useful psychological therapy for appearance anxiety. The uncontrolled nature of the intervention limits the conclusions that can be drawn.

Conclusion:

A pilot feasibility study to evaluate the effectiveness of ACT for appearance anxiety is warranted.

Lay Summary

Many patients with scars can feel distressed about their appearance. This is known as appearance anxiety and can include patients accessing burns services. Appearance anxiety can stop patients from enjoying a good quality of life and impact upon important areas of daily functioning. It is therefore important that psychological therapies are effective. However, research investigating the effectiveness of psychological therapies is limited. This paper describes the psychological therapy of three patients who were distressed about scarring. A psychological therapy called Acceptance and Commitment Therapy (ACT) was used as part of standard care and evaluated using questionnaires and patient feedback. After the course of ACT, all patients were less impacted day-to-day by their appearance anxiety and were living more valued and meaningful lives. No negative effects were found. These case studies suggest that ACT may be a useful psychological therapy for appearance anxiety and further research evaluating it should be completed.

The relationship between trait mindfulness and affective symptoms: A meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ)

Trait mindfulness appears to be related to lower levels of negative affective symptoms, but it remains uncertain which facets of mindfulness are most important in this relationship. Accordingly, the present meta-analysis examined studies reporting correlations between affective symptoms and trait mindfulness as assessed by the Five Facet Mindfulness Questionnaire. A comprehensive search yielded 148 eligible studies, comprising 157 distinct samples and 44,075 participants. The weighted mean correlation for affective symptoms and overall trait mindfulness was r = -0.53. Among mindfulness facets, Nonjudge (r = -0.48) and Act with Awareness (r = -0.47) demonstrated the largest correlations, followed by Nonreact (r = -0.33) and Describe (r = -0.29). Observe was not significantly correlated with affective symptoms. No significant differences in the strength of correlations were found between anxiety, depression and posttraumatic stress disorder (PTSD) symptoms, though symptoms of generalized anxiety disorder exhibited a weaker negative relationship with the Describe facet compared to PTSD symptoms. Describe also showed a stronger relationship with affective symptoms in Eastern samples compared to Western samples, whereas Western samples had a stronger relationship with Nonjudge. These results provide insight into the nature of the association between trait mindfulness and negative affect.

Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial

STUDY QUESTION

What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI?

SUMMARY ANSWER

A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables.

WHAT IS KNOWN ALREADY

Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress.

STUDY DESIGN, SIZE, DURATION

A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG.

LIMITATIONS, REASONS FOR CAUTION

The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population.

WIDER IMPLICATIONS OF THE FINDINGS

The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-16008452.

TRIAL REGISTRATION DATE

9 May 2016

DATE OF FIRST PATIENT’S ENROLMENT

15 May 2016.

Validation and psychometric evaluation of a brief screening questionnaire for psychological distress in patients with psoriasis

BACKGROUND

Patients with psoriasis are at risk of a co-morbid diagnosis of depression and/or anxiety. It is therefore essential for dermatologists to have valid and effective instruments that can screen and monitor depression and anxiety symptoms in psoriasis patients.

OBJECTIVE

The aim of this study was to validate the Mental Health Inventory (MHI-5) as a brief measure that can be used to evaluate psychological distress related to anxiety and depression in psoriasis patients.

METHODS

The sample included 76 adult dermatological outpatients diagnosed with psoriasis. Participants completed the MHI-5, the Hospital Anxiety and Depression Scale (HADS) and six subscales of the Self-Compassion Scale (SCS). Confirmatory factor analysis (CFA) was applied to examine the factor structure of MHI-5. Convergent validity was examined by applying correlations among all measures. Discriminant validity was examined by applying hierarchical regression models. Reliability was examined by calculating Cronbach's alpha coefficient.

RESULTS

Confirmatory factor analysis showed that the proposed one-factor model has a good fit to the data. The MHI-5 demonstrated satisfactory convergent validity by yielding significant moderate to strong correlations with the HADS and with the positive and negative subscales of the SCS. Discriminant validity was also evident with being at risk of anxiety predicting MHI-5 scores above and beyond the effect of gender and age. Hierarchical regressions were not performed because a very small number of participants (n = 3) were classified at risk of depression. The MHI-5 showed high internal consistency (α = 0.84).

CONCLUSION

This investigation provided evidence that MHI-5 is a reliable and valid instrument that can be used to effectively capture psychological distress in psoriasis patients.

Sleep disorders and atopic dermatitis: A 2-way street?

Sleep disturbance is very common in patients with atopic dermatitis (AD) and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review we describe a variety of sleep disorders associated with AD and a wide range of effect that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in patients with AD. The relationship between sleep disorders and AD might be bidirectional and could form a vicious cycle. Therefore we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.

The potential role of mindfulness in psychosocial support for dermatology patients

While it is widely acknowledged that people living with skin conditions can experience higher levels of psychosocial distress than the general population, access to psychologic support in dermatology is limited. Given the physical and psychosocial consequences of living with skin conditions, interventions used within physical and mental health may be beneficial. Mindfulness, defined as "paying attention in a particular way: on purpose in the present moment and non-judgmentally," has shown promise in improving outcomes in both mental and physical health populations, and studies have implicated a role for mindfulness in improving distress associated with skin conditions. The current review explores the theoretical underpinnings of mindfulness, in particular, the role it may play in reducing physiologic arousal and managing maladaptive thought processes. Although mindfulness interventions offer promise in reducing distress associated with skin conditions, further research is required to fully understand the underlying mechanisms of mindfulness and the active ingredient responsible for improving outcomes in dermatology patients. Mindfulness is one potential psychologic intervention and practitioners should be aware of the range of psychologic support options available. The current review also draws attention to the urgent need for further research into the effectiveness of psychologic interventions for dermatology patients.

Stress and skin disease quality of life: the moderating role of anxiety sensitivity social concerns

BACKGROUND

Stress is an important factor in the onset, exacerbation and reoccurrence of many skin diseases. Little is known about psychological risk factors that affect the association between stress and dermatological conditions. One relevant factor that may modulate this link is anxiety sensitivity (AS) social concerns - the propensity to respond fearfully to anxiety-related sensations (e.g. sweating, flushing) owing to perceived social consequences (e.g. rejection or humiliation).

OBJECTIVES

To gain insight into psychological factors affecting skin disease, we examined the moderating role of AS social concerns in the relationship between stress and skin disease quality of life (QoL).

METHODS

Participants [n = 237 (161 female), mean ± SD age 34·18 ± 9·57 years] with active skin disease symptoms were recruited online and completed questionnaires assessing stress, AS social concerns, skin disease QoL and global skin disease symptom severity.

RESULTS

AS social concerns moderated the association between stress and skin-related emotional and social functioning in adults with skin disease. Stress was a significant predictor of the impairment associated with skin disease.

CONCLUSIONS

Stress was linked to skin disease-related emotional and functional impairment associated with skin disease among individuals with high AS social concerns. These results highlight the potential for AS reduction interventions to break the vicious cycle of stress and skin disease symptoms and to improve psychosocial well-being in dermatology patients.

Brain mechanism of itch in atopic dermatitis and its possible alteration through non-invasive treatments

Atopic dermatitis (AD) is a common chronic skin disease that is characterized by intense pruritus and has high impairment of quality of life. AD is often described as "the itch that rashes, rather than the rash that itches". Several studies suggest that mechanisms of central modulation play an important role in the development and maintenance of chronic itch. Therefore, treating the neurosensory aspects of itch is an important part in the management of chronic itch. However, little attention has been paid to the role of the central nervous system in the processing of itch in AD. Targeting itch-related anatomical structures in the brain with non-invasive treatments such as psychological interventions and transcranial Direct Current Stimulation (tDCS) could have an antipruritic effect in AD. Therefore, in this review article, we discuss the current progress in brain imaging research of itch, as well as the efficacy of non-invasive interventions for itch relief in this patient group.