Schemas and psychological distress in skin disease: a preliminary investigation into the role of schemas in UK patients with psoriasis and eczema

Psoriasis and atopic eczema are chronic skin disorders with a disfiguring component that present the patient with many challenges. Studies have already addressed some fundamental questions with regards to variability in the psychological impact of skin disease. Present studies have sought to provide some preliminary understanding of the core cognitive content of skin disorders and the role of schemas in psychological distress in patients with psoriasis and atopic eczema. A cross-sectional design with four groups was employed. Eighty-eight dermatology outpatients (psoriasis n= 55 and atopic eczema n=33) and seventy-six comparison participants (normal n=53 and chronic disease n=23) completed a package of questionnaires. Results suggest that the combined group of dermatology outpatients can be differentiated in terms of schemas and those beliefs are predictive of their symptoms of anxiety and depression. These findings have a clear relevance to the theoretical underpinning of psychological impact in skin disorders and to counselling practice. Implications for the psychological management of skin disorders are discussed. Further studies are needed to investigate the implicating role of schemas in dermatological conditions

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

Background: Mindfulness, defined as purposively and non-judgementally paying attention in the present moment, could be used within psychosocial interventions to reduce the distress associated with social anxiety and avoidance found in many skin conditions. However, little is known about the relationship between naturally occurring levels of mindfulness and distress in dermatology patients. Objective: This study sought to examine the relationship between mindfulness and psychosocial distress in a dermatological sample. It was hypothesised that higher levels of mindfulness would be associated with lower levels of social anxiety, anxiety, depression, and skin shame, and with better quality of life. Method: Adult dermatology outpatients (N=120) from one hospital completed items assessing subjective severity, skin shame, fear of negative evaluation (BFNE), anxiety and depression (HADS), quality of life (DLQI), and levels of mindfulness (FFMQ). Results: Considering depression, 14% reported mild, 5% moderate and 2.5% severe symptoms. For anxiety, 22% reported mild, 23% moderate and 6% severe symptoms. In addition, 33.4% reported clinically significant social anxiety. After controlling for subjective severity, mindfulness explained an additional 19% of the variance in depression, 39% in anxiety, 41% in social anxiety, 13% in skin shame, and 6% in dermatological quality of life. One specific facet of mindfulness (acting with awareness) was found to be the most consistent predictor of distress. Conclusions: The findings indicate that higher levels of mindfulness are associated with lower distress. This suggests that facilitating mindfulness may be helpful in reducing distress in dermatology patients and the use of mindfulness techniques warrants further investigation

The role of parenting experiences, rather than age of onset or presence of the skin condition, in the development of maladaptive schemas in a community sample of patients with atopic dermatitis

The relevance of personality in atopic dermatitis (AD) has long been a focus of research. Patients with atopic dermatitis (AD) appear to show a distinct cluster of traits that may increase susceptibility to development or exacerbation via the stress pathway of AD. Mizara et al. found that people with AD presented with a maladaptive schematic (personality) profile that predicted anxiety-and-depression. This article is protected by copyright. All rights reserved

Psychological differences between early and late onset psoriasis: A study of personality traits, anxiety and depression in psoriasis.

BACKGROUND: Onset of psoriasis may occur at any age. Early negative experiences often influence personality development, and may lead to physical disease, anxiety and depression in adulthood. Knowledge about onset of psoriasis and psychopathology is limited. OBJECTIVES: To examine whether patients with early onset psoriasis differ psychologically from patients with late onset, regarding personality traits, anxiety and depression. METHODS: A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires; Swedish universities Scales of Personality (SSP), Spielberger State-Trait Anxiety Inventory (STAI, Form-Y), and Beck Depression Inventory (BDI-II). Psoriasis severity was assessed by the Psoriasis Severity and Area Index (PASI). RESULTS: Patients with early onset psoriasis (< age 20) were significantly more anxious and depressed than patients with late onset. In multiple linear regression models, younger age at onset of psoriasis was a significant determinant of higher scores of four personality traits, i.e. SSP-Embitterment, -Trait irritability, -Mistrust and -Verbal trait aggression. CONCLUSIONS: Our results indicate that early detection of psychological vulnerability when treating children and adolescents with psoriasis seems to be of great importance. Traits of psychological vulnerability and pessimistic personality traits were found to be significantly associated with early onset of psoriasis, but not with disease duration in this study. These traits may be seen as a consequence of psoriasis, and / or as individual traits modulating and impairing clinical course and efforts to cope with psoriasis. This article is protected by copyright. All rights reserved