A meta-analysis of the effectiveness of psychological interventions for adults with skin conditions

Abstract

Skin conditions can be associated with heightened levels of psychological morbidity, suggesting the need for psychological interventions. A number of specific interventions (such as habit reversal) have been developed. However, to date, there has not been a systematic review of the effectiveness of psychological interventions. We sought to systematically evaluate the effectiveness of psychological interventions designed to improve the severity of and adjustment to skin conditions in adults. Database, archival and citation searches were conducted. Studies were included if participants were allocated to either a psychological intervention (excluding educational interventions and complementary therapies) or a comparison condition, and if they measured outcomes relevant to the skin condition. Twenty-two studies met these inclusion criteria. Effect sizes for each intervention were computed and we also coded a number of potential moderators of intervention efficacy. Psychological interventions were found to have a medium-sized effect on skin conditions (g = 0·54). The type of skin condition, age of sample, nature of the intervention, time interval between the end of the intervention and follow-up, and type of outcome measure all moderated the effect of interventions on outcomes. For example, interventions had a medium effect on the severity of the condition (g = 0·40) and psychosocial outcomes (g = 0·53), and a medium-to-large effect on itch/scratch reactions (g = 0·67). Psychological interventions are beneficial for people with skin conditions. However, more research is needed to extend the variety and focus of the psychological interventions that are available. Studies are also needed to explore the longer-term benefits of such interventions.

Psychological Treatments for Dermatological Conditions

“…It is therefore of great importance that increased attention is paid to psychological research and clinical applications in the field of dermatology, such as the implementation of screening instruments in dermatological practice. Also, further development, evaluation and implementation of psychological interventions for skin-related problems, itchscratching problems and psychiatric problems in dermatological practice is important, as the existing evidence shows promising results for physical and psychological functioning in skin patients [46]. Applications through the Internet also offer promising starting points to further facilitate the psychodermatological approach [54 -56].…”

“…In these cases, cognitive-behavioral methods are used that have been proven effective for these kinds of problems [3,22,45,46].…”

Are sex and history of pruritic skin conditions factors which affect the phenomenon of visually evoked itch? An exploratory study

“…This is an exciting change of focus given that, thus far, only histamine-related PSC have an established treatment [19] , to which chronic itch is usually resistant [20] . These psychological interventions seem to have medium effect sizes for treating both AD and psoriasis, and seem equally effective in short-term group interventions, showing their cost effectiveness [18] . The clinical application of VEI may have most impact on such psychological interventions.…”

“…Behavioral interventions for skin conditions (such as habit reversal, which aims to modify/prevent unhelpful scratching behaviors by encouraging people to focus on an alternative action to scratching in response to itch such as clenching the fists or pinching the itchy spot [18] ) may be an important focus for therapeutic interventions, as this is the part of the itch-scratch cycle that seems to have the most damaging effect. This is an exciting change of focus given that, thus far, only histamine-related PSC have an established treatment [19] , to which chronic itch is usually resistant [20] .…”

“…The clinical application of VEI may have most impact on such psychological interventions. For example, people with psychogenic pruritus (where individuals experience abnormal tactile sensations such as itching, crawling, pricking, and stinging, or delusions of parasitosis) could be trained to disambiguate their perceptions of itch using a VEI-based training paradigm implemented within a psychological intervention such as autogenic training, cognitive behavioral therapy, or habit reversal behavioral training (for a review see Lavda et al [18] ), which have been shown to significantly decrease eczema severity, itching intensity, and scratching in AD patients [21] . Comorbid factors such as stress, anxiety, and depression, which can increase the perception of itch in long-term sufferers, should also be assessed and considered when developing and tailoring an effective VEI-based intervention for individuals.…”