A pilot study examining mindfulness-based cognitive therapy in psoriasis

Abstract

A sub-population of people with psoriasis have strong causal beliefs about stress, high levels of emotional distress (anxiety and depression) and an impaired quality of life (QoL). Mindfulness-based cognitive therapy has been found to reduce levels of stress and distress and to improve QoL. This pilot study in people with psoriasis aimed to test the hypothesis that mindfulness could reduce stress and thereby lessen psoriasis severity, improve QoL and reduce distress. Twenty-nine people with psoriasis (22-70-years old; 16 females; 13 males) were randomised to an eight-week mindfulness treatment as an adjunct to their usual psoriasis therapy or to a control group which continued with usual psoriasis therapy alone. All subjects completed self-reported measurements of psoriasis severity, perceived stress, distress and QoL, at baseline and again post-intervention. The mindfulness group reported statistically lower psoriasis severity (Self-Assessed Psoriasis Area Severity Index; z = 1.96, p = .05) and QoL impairment scores (Dermatology Life Quality Index; z = 2.30, p = .02) than the control group. There was no significant difference between groups on perceived stress (Perceived Stress Scale; z = .07, p = .94) or distress scores (Hospital Anxiety Depression Scale; z = 1.60, p = .11). People with psoriasis who received mindfulness as an adjunct to their usual therapy reported a significant improvement in both psoriasis severity and QoL. These pilot results suggest that a full randomised control trial is justified to examine the effectiveness of mindfulness as an adjunctive treatment for people with psoriasis.

Stress and psoriasis

“…Several studies have reported the improvement in skin symptoms following the initiation of SSRI treatment . Nonpharmacological treatments have been associated, such as relaxation, a method teaching how to reduce muscle tone, and meditation . Meditation is reported to reduce by 30–35% the predefined time required to obtain a clinical response to PUVA therapy or UVB phototherapy .…”

Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines

“…In adults with eczema, psychotherapy aimed at helping patients to identify and constructively deal with life stresses has also shown benefit for decreasing disease severity when used as an adjunct to standard treatment 60. Similar findings have been observed in patients with psoriasis, where supplemental psychotherapeutic interventions have resulted not only in improvements in HRQoL scores and subjective measures of anxiety/depression but also in reductions in psoriasis severity 61,62…”

Major Depression and Psoriasis: A Psychodermatological Phenomenon

“…In fact in two studies done by Gupta et al [18,19], an increase in stress and depressive symptoms were found to have a significant statistical correlation with an increase in psoriasis flare-ups and pruritus severity along with a more clinically disfiguring disease. In addition, studies have shown that a decrease in depression/depressive symptoms due to medication or therapy is associated with a decrease in psoriasis severity and vice versa [20,21,22,23,24,25,26]. The question now remains: is this correlation merely due to the negative psychological effects inherent in any clearly discernible skin disorder, or any disorder in general, such as social anxiety, low self-esteem, shame/embarrassment etc., or is there an underlying pathophysiological mechanism involved?…”