Mindfulness can be integrated in dermatology management and has been demonstrated in research to improve clearance of conditions for patients and to improve anxiety and depression that patients experience associated with their skin conditions.
Incorporating mindfulness in practice can be beneficial to both the dermatologist and to patients, according to the Psychiatrist-in-Chief at the University of Toronto.
Speaking here at the annual meeting of the Canadian Dermatology Association about mindfulness, Susan Abbey M.D., F.R.C.P.C., described how mindfulness can be employed adjunctively to improve dermatological conditions like psoriasis.
"Dermatology was actually the first area to show an impact of mindfulness," Dr. Abbey says.
Because the skin has been regarded as an organ that responds to emotional stimuli and psychological influences, mindfulness has been used in some dermatological interventions. A study where mindfulness-based cognitive therapy was used in addition to phototherapy (ultraviolet B or psoralen ultraviolet A) to treat moderate-to-severe plaque psoriasis (L40.0) experienced a significant improvement in their skin clearance and in quality of life compared to patients were not exposed mindfulness as adjunctive therapy to phototherapy.1
"If tapes about mindfulness were played while patients were in the light box (getting treated for psoriasis), then they cleared it (psoriasis) more quickly," Dr. Abbey says.
Dr. Abbey notes that mindfulness is not just positive thinking or emptying one's mind of thoughts, but that it has been come to mean paying attention in a particular way, which is purposeful, in the moment, and without judgment.
Jon Kabat-Zinn has been a pioneer in the development of various mindfulness programs. There are books that people can read or compact discs that people can listen to or group sessions that people can attend to learn about mindfulness and integrating mindfulness in daily life, Dr. Abbey explains.
Mindfulness-based cognitive therapy and mindfulness-based stress reduction are two popular forms of mindfulness exercises, Dr. Abbey says. Mindfulness can accomplish numerous objectives including changing the relationship with that which is difficult in life, to see difficulty clearly and calmly rather than avoiding it or pushing it away, learning to work with the difficulty, learning to be aware of pleasure which increases quality of life and buffers stress.
Mindfulness helps patients to better cope with difficulties in their life, Dr. Abbey explains.
"It (mindfulness) helps people to manage stress more effectively," Dr. Abbey says. "They learn to suffer less with difficulties that that they may be facing. It can be helpful with some of the challenging skin conditions."
An example of incorporating mindfulness in dermatology would be creating a different perspective on treatment. Instead of a treatment being applied to get rid of a skin condition that is bothersome and aesthetically unpleasing, mindfulness would bring a perspective of being compassionate to one's self by applying the treatment, Dr. Abbey says.
A study found that elevated levels of mindfulness are associated with lower distress in patients suggesting the value of mindfulness approaches in the management of dermatology patients. The study involved 120 outpatients in an adult dermatology practice, and it was hypothesized that elevated levels of mindfulness were associated with decreased levels of social anxiety, anxiety, depression, skin shame, and better quality of life amongst patients.2
Mindfulness has not been part of the medical school curriculum, but numerous medical schools are now offering it as an elective that students can take, Dr. Abbey says.
Some research has pointed to the benefits of medical residents using mindfulness as a way to avoid burnout and stress. One prospective investigation found a mindfulness-based resilience intervention reduced stress and burnout in female residents in their first and second years of residency.3 Indeed, not only can patients benefit from mindfulness as a strategy to help manage their dermatology condition, but physicians can benefit from mindfulness as well, Dr. Abbey says.
A study of 70 primary care physicians showed that mindfulness was associated with short-term and sustained enhancements in well-being and attitudes linked to patient-centered care. Investigators noted that randomized trials should be conducted to confirm the findings from the study. 4
"It can help to lower stress after a difficult encounter (with a patient)," Dr. Abbey says. "It helps you go on with the rest of your day. You may anticipate seeing a difficult patient and learning mindfulness techniques helps to ground yourself and be more present in the interaction (with the patient)."
If dermatologists are incorporating mindfulness in their work, this will also benefit patients, Dr. Abbey says.
"If they have satisfaction in their communication with patients, this increases patient satisfaction," she says. "Patients feel that they (physicians) are more present and focused."
It may not seem intuitive, particularly in a culture that values multi-tasking and where glancing at mobile devices while in face-to-face conversation is becoming the norm, but mindfulness can offer time-saving in a busy clinical practice, according to Dr. Abbey.
"If physicians appear more focused and on point with a patient, they have shorter interactions (with a patient), rather than appear to have divided attention and have patients feel that they are not being heard," Dr. Abbey says.
Disclosure: Dr. Abbey reports no relevant disclosures.
1Fordham B, Griffiths CE, Bundy C. A pilot study examining mindfulness-based cognitive therapy in psoriasis. Psychol Health Med. 2015;20(1):121-7.
2Montgomery K, Norman P, Messenger AG, Thompson AR. The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. Br J Dermatol. 2016 May 12.
3Goldhagen BE, Kingsolver K, Stinnett SS, Rosdahl JA. Stress and burnout in residents: impact of mindfulness-based resilience training. Adv Med Educ Pract. 2015;6:525-32.
4Kraser MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-93.