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Do you recommend psychotherapy to your psoriasis patients? While there is a well-established connection between psoriasis and mental health, there is little data available on the impact of psychological interventions on psoriasis. These study authors look to fill that gap.
Several studies have linked anxiety, depression and other psychological comorbidities to skin disease, and have even found that skin disease can be alleviated or exacerbated by psychological factors.
To determine the impact of psychological treatments on psoriasis, a study published in April in The American Journal of Clinical Dermatology examined evidence based psychological treatment options for patients with psoriasis.
Authors sought out studies regarding the use of psychological therapy in the management of psoriasis published from 1990 through 2018. Ultimately, 28 articles were included in their review. Articles were then assigned levels of evidence based on the Scottich Intercollegiate Guidelines Network (SIGN) Level of Evidence. The categories of studies included:
Cognitive Behavioral Therapy (CBT)
CBT is a time-oriented, structured psychotherapy focused on finding current solutions and teaching skills that modify dysfunctional behavior and/or thoughts. In the studies conducted using CBT, direct influence on disease severity improvement is unclear from the present literature, and studies are limited by high mean attrition of 26.4 ± 4.8% in the six trials included.
However, the authors note, “Mean post-intervention follow-up was 4.6 months for the eight included studies and 4.2 ± 1.2 months for the subset of six trials.” They conclude that “CBT and its variants as adjunct therapy confer benefits to patients with psoriasis, particularly in terms of psychological parameters and QoL.”
Therapies incorporating mindfulness are commonly used as psychological interventions. The studies investigating the impact of mindfulness on psoriasis were limited due to implementation of a variety of protocols, small sample sizes, and high dropout rates. Trials in this category encountered a mean attrition rate of 32.4 ± 3.8%, whereas mean post-intervention follow-up was not possible to calculate.
Emotional disclosure involves writing or talking about tense life events. This intervention offers a less intense, time-limited therapy that may be effective in patients who are unable to participate in more extensive, time-consuming psychological interventions. In these studies the mean attrition rate was 39.4 ± 12.6%, and mean post-intervention follow-up was 5.7 ± 3.2 months for all three included studies investigating emotional disclosure in the management of psoriasis.
Studies investigating educational and multidisciplinary psychological interventions proved promising. The mean attrition rate of 17.1 ± 5.2% is relatively low, with results suggesting improved QoL and disease severity. However, mean post-intervention follow-up was only 3.3 ± 1.1 months.
“Although promising evidence has been produced with a growing number of [randomized controlled trials], work in this area is largely limited by study quality,” the authors conclude. They also note that it is important for clinicians to remain aware of psychological interventions that may aid psoriasis patient as awareness of therapies may lead to larger improved studies that can further help guide therapy in patients with psoriasis.
Qureshi, Azam A., et al. "Psychological Therapies in Management of Psoriatic Skin Disease: A Systematic Review." American journal of clinical dermatology (2019): 1-18.