It is crucial for dermatologists and primary care providers to recognize when a patient's skin condition may be influenced by psychological factors. If they suspect that a psychological component contributes to the patient's symptoms or overall experience, referring the patient for psychotherapy can be highly beneficial.

 

Cognitive Behavioural Therapy (CBT)

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CBT is one of the most widely used therapies in psychodermatology. It helps patients address and modify unhelpful thoughts and behaviors related to their skin condition:

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• Identifying and Challenging Negative Thoughts: Patients with visible skin conditions often struggle with negative self-image and anxiety about social interactions. CBT helps them identify these thoughts (e.g., “Everyone is staring at my acne”) and replace them with more balanced, realistic thinking.

• Behavioral Techniques: Many skin conditions, such as psoriasis and eczema, worsen with stress. CBT teaches relaxation techniques, including deep breathing and progressive muscle relaxation, to help control stress-related exacerbations.

• Exposure and Response Prevention (ERP): This is useful for skin-picking disorders (excoriation) or hair-pulling (trichotillomania). It involves gradually exposing patients to situations that trigger their behavior while helping them resist the urge through alternative actions.

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Research​ Articles

Revankar, R. R., Revankar, N. R., Balogh, E. A., Patel, H. A., Kaplan, S. G., & Feldman, S. R. (2022). Cognitive behavior therapy as dermatological treatment: a narrative review. International journal of women's dermatology, 8(4), e068. https://doi.org/10.1097/JW9.0000000000000068

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Mindfulness-Based Cognitive Therapy (MBCT)

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Mindfulness therapies focus on increasing awareness of thoughts and emotions without judgment. They’re especially helpful for patients with stress-exacerbated skin conditions, such as acne, eczema, and psoriasis.

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• Mindful Awareness of Body Sensations: By becoming more aware of sensations and impulses (like itching or the urge to scratch), patients can learn to manage their responses consciously rather than reactively.

• Acceptance Techniques: Mindfulness encourages patients to accept their skin condition without letting it define their self-worth, helping to alleviate feelings of shame and frustration. Patients are taught to focus on the present and reduce rumination on past flare-ups or anxiety about future ones.

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Research Articles

Kishimoto, S., Watanabe, N., Yamamoto, Y., Imai, T., Aida, R., Germer, C., Tamagawa-Mineoka, R., Shimizu, R., Hickman, S., Nakayama, Y., Etoh, T., Sahker, E., Carnie, M. B., & Furukawa, T. A. (2023). Efficacy of Integrated Online Mindfulness and Self-compassion Training for Adults With Atopic Dermatitis: A Randomized Clinical Trial. JAMA dermatology, 159(6), 628–636. https://doi.org/10.1001/jamadermatol.2023.0975

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Fordham, B. A., Nelson, P., Griffiths, C. E. M., & Bundy, C. (2015). The acceptability and usefulness of mindfulness-based cognitive therapy for people living with psoriasis: a qualitative study. British Journal of Dermatology (1951), 172(3), 823–825. https://doi.org/10.1111/bjd.13333

 

Acceptance and Commitment Therapy (ACT)

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ACT is beneficial for patients struggling with chronic skin conditions who may feel demoralized or distressed by their symptoms.

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• Acceptance and Psychological Flexibility: ACT teaches patients to accept uncomfortable sensations (e.g., itching or pain) and emotions rather than trying to avoid or control them. This is useful for chronic conditions like psoriasis, where complete symptom relief may be unrealistic.

• Value-Based Living: Patients learn to focus on what’s meaningful to them despite their condition. This approach can improve their overall quality of life and reduce the psychological impact of skin disorders.

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Research Articles

Asplund, M., Rück, C., Lenhard, F., Gunnarsson, T., Bellander, M., Delby, H., & Ivanov, V. Z. (2021). ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: A feasibility study. Journal of clinical psychology, 77(7), 1537–1555. https://doi.org/10.1002/jclp.23147

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Alikhah, S., Akbari, B., & Abolghasemi, A. (2023). The effectiveness of acceptance and commitment approach on quality of life and body image in patients with skin disorders by modulating emotional reactivity. Journal of Adolescent and Youth Psychological Studies (JAYPS), 4(7), 88-97. https://doi.org/10.61838/kman.jayps.4.7.10

 

Habit-Reversal Training (HRT)

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HRT is a highly effective approach for patients with body-focused repetitive behaviors, such as skin-picking (dermatillomania) or hair-pulling (trichotillomania). It involves three core components:

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• Awareness Training: Patients are taught to become acutely aware of the situations and emotions that trigger their behaviors. This awareness is critical to changing patterns.

• Competing Response Training: Patients learn alternative actions that are incompatible with the harmful behavior. For example, instead of picking, they might clench their fists, use a stress ball, or perform another action.

• Social Support: Support from family or friends reinforces these alternative behaviors and encourages patients to stick with the therapy.

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Research Articles

​Rahman, S. M., Jafferany, M., & Barkauskaite, R. (2023). Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders. Clinical and Experimental Dermatology, 48(12), 1310–1316. https://doi.org/10.1093/ced/llad247

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Psychoeducation

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Educating patients about the psychological aspects of their condition and helping them develop coping skills is a key part of treatment.

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• Education on the Skin-Mind Connection: Understanding how stress and psychological factors affect skin conditions can empower patients and motivate them to engage in therapy.

• Supportive Counseling and Validation: Many patients feel isolated and misunderstood due to their skin conditions. Supportive counseling offers emotional validation and helps patients process feelings of shame, frustration, and low self-esteem.

• Social Skills Training: For patients who struggle with social anxiety due to their appearance, social skills training and exposure to social situations can improve their comfort in public and reduce social withdrawal.