Although atopic dermatitis (often called eczema) is a skin problem, this physical disorder can also be affected by a person’s state of mind: The chronic inflammatory skin disease can worsen depending on stress levels and poor emotional health, according to the National Eczema Association.
Tapping into that connection, a recent study found that psychological interventions involving mindfulness and self-compassion reduced atopic dermatitis symptoms like scratching, helped people keep up with proper skin treatments, and significantly enhanced their day-to-day well-being.
“Integrating mindfulness and self-compassion into usual dermatological care could help people with eczema’s quality of life, symptoms, and psychological well-being,” says lead study author Sanae Kishimoto, MHS, MPH, a clinical psychologist at Kyoto University’s School of Public Health in Japan.
“We did not direct participants to use any medical treatment during intervention sessions, but by learning how to be kind and nice to themselves, they built wise and compassionate behavior [including better adherence to their medical treatments],” Dr. Kishimoto says. “So I am very confident that mindfulness and self-compassion approaches and medical standard care can work together nicely.”
Modest Amounts of Therapy Can Have Significant Benefit for Atopic Dermatitis
For the analysis, published May 10 in the journal JAMA Dermatology, Kishimoto and colleagues recruited 107 adult patients in Japan with moderate to severe eczema. A total of 51 were placed in a control group and did not receive the psychological intervention. The remaining 56 received training that involved the following:
- Weekly 90-minute interactive online sessions over eight weeks
- An optional, silent five-and-a-half-hour meditation retreat
- An optional 120-minute video-conferencing booster session
Both groups received their usual dermatological care.
Sessions included meditation, as well as talks and exercises about how to take care of oneself “wisely and kindly.” This focus on self-compassion was a unique aspect of the research.
“Self-compassion is essentially helping people learn to treat themselves the same way that they typically treat dear friends when they suffer, fail, or fall short,” says study coauthor Steven Hickman, PsyD, a clinical psychologist and founding director of the University of California San Diego Center for Mindfulness.
“It involves [practicing mindfulness by] recognizing that we are struggling or suffering, reminding ourselves that these struggles are a part of any imperfect human life, and then [practicing self-kindness by] responding to the question ‘What do I need in this moment?’”
By teaching these strategies, Dr. Hickman says, “We are essentially helping people to be willing to encounter difficult feelings and remain present, rather than reacting and going into self-criticism, shame, and self-blame, which is more typical for many people.”
Although therapy sessions stopped after eight weeks, patient assessment continued for 13 weeks. To measure the effects of receiving the psychological and behavioral therapy, participants were asked to complete the Dermatology Life Quality Index (DLQI), a simple self-evaluation of physical symptoms (such as itchiness and soreness), emotional effects (such as embarrassment and self-consciousness), interactions with others, and ability of carry out daily tasks. The questionnaire is evaluated on a score of 0 to 30; the higher the score, the lower a person’s quality of life.
In the intervention group, the average DLQI score started at 14.75 but dropped by more than half to about 6 by week 13.
Those not receiving therapy started with an average score of 12.75 and ended at week 13 with a score of 11.
Compared with the control group, those receiving the psychological and behavioral training also showed marked improvements in intensity of itching, intensity of scratching, itch bothersomeness, anxiety, depression, shame, self-esteem, and self-compassion.
RELATED: How to Break the Itch-Scratch Cycle if You Have Severe Eczema
“Even just 60 to 90 minutes per week of regular contemplative training can yield measurably improved outcomes,” says Hickman.
A Widespread Problem That Is More Than Skin Deep
One out of 10 Americans have some form of this inflammatory chronic condition, which can cause itchiness, dry skin, rashes, scaly patches, blisters, and skin infections, according to the National Eczema Association.
For Golara Honari, MD, a clinical associate professor of dermatology with Stanford Health Care, the results confirm the importance of the “mind-body connection” with eczema. The findings underscore that psychological stress can affect the skin, while at the same time, the skin condition can fuel emotional distress.
“Eczema is way more than just that itchy, dry skin — it’s a multifactorial disease that can be really debilitating,” says Dr. Honari, who was not involved in this study. “A lot of psychological comorbidities have been associated with atopic dermatitis, such as ADHD [attention-deficit hyperactivity disorder], depression, and anxiety. This study emphasizes a holistic approach to patient care, which I think is important.”
She adds, however, that the study did not include “objective” measures of eczema severity, but relied on self-reported details regarding skin condition. Future research should consider this factor, she says.
For those with eczema, Dr. Hickman suggests that the study validates the physical benefits of self-reflection.
“Being able to be present and aware of one’s struggles, in any form, and able to meet oneself with the same kindness we extend to others when they struggle, can lead to marked improvement in our quality of life, mood, outlook, and capacity to cope with the bumps and hiccups of daily life,” he says.
“This is true of atopic dermatitis the same way it is true with chronic pain, cancer, general stress, and many other conditions.”
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