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Doolan BJ, Ali R, Baron SE. Optimizing treatment of compulsive hair pulling in children and young people: A case series from a pediatric psychodermatology service. J Dermatol 2024; 51:612-613. [PMID: 38445800 DOI: 10.1111/1346-8138.17136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/29/2023] [Accepted: 01/20/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Brent J Doolan
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Rukshana Ali
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Susannah E Baron
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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2
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Powell LD, Vasiliou VS, Thompson AR. An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. Body Image 2023; 47:101637. [PMID: 37839287 DOI: 10.1016/j.bodyim.2023.101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population.
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Affiliation(s)
| | - Vasilis S Vasiliou
- South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew R Thompson
- University of Sheffield, School of Psychology, Sheffield, UK; South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK.
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3
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Massoud SH, Alassaf J, Ahmed A, Taylor RE, Bewley A. UK psychodermatology services in 2019: service provision has improved but is still very poor nationally. Clin Exp Dermatol 2021; 46:1046-1051. [PMID: 33713350 DOI: 10.1111/ced.14641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychodermatology is an emerging subspeciality of dermatology. Psychodermatology clinics use a multidisciplinary approach to deal with psychological or psychiatric elements related to skin disease. Two previous studies in 2004 and 2012 highlighted the deficiency of psychodermatology services in the UK, despite the evidence that these services have high demand and are cost-effective. AIMS To reassess psychodermatology service provision in the UK and outline the developments that have been made. METHODS In conjunction with BBC Radio 5 Live, a survey questionnaire was distributed via email to the UK membership of the British Association of Dermatologists (BAD) and Psychodermatology UK. The survey consisted of 13 questions asking about the availability of psychodermatology services. RESULTS Basic percentages were used to analyse quantitative data, and content analysis was used for qualitative data. Our results showed that less than a quarter of the respondents (24%) have access to a nearby dedicated psychodermatology service. Additionally, the psychodermatology units do not have a unified configuration and clinical provision model differs nationally. Only around 5% of the clinicians have access to a clinic that provides psychology-dermatology-oncology service, and even fewer have access to a paediatric psychodermatology (4.8%). Engagement in psychodermatology research was reported by around 12% of the participants. CONCLUSIONS The psychocutaneous services in the UK have improved to some extent over the past decade; the service has become more widely available nationally, and the investment in research is promising. However, it is still insufficient and unable to fulfil patient demand, especially for vulnerable individuals such as children and dermato-oncology patients.
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Affiliation(s)
- S H Massoud
- Departments of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Alassaf
- Departments of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Ahmed
- Departments of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - R E Taylor
- Psychiatry, Royal London Hospital, Barts Health NHS Trust, London, UK.,Department of Dermatology and Psychology, Queen Mary University London, London, UK
| | - A Bewley
- Departments of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Department of Dermatology and Psychology, Queen Mary University London, London, UK
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Iftikhar U, Jafferany M, Khawaja AR. Awareness and knowledge toward psychodermatology in South Asia: a Pakistani perspective. Int J Dermatol 2019; 59:e219-e221. [PMID: 31876288 DOI: 10.1111/ijd.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
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Hudson MP, Thompson AR, Emerson LM. Compassion-focused self-help for psychological distress associated with skin conditions: a randomized feasibility trial. Psychol Health 2019; 35:1095-1114. [DOI: 10.1080/08870446.2019.1707829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mark P. Hudson
- Department of Psychology, Clinical Psychology Unit, Western Bank, The University of Sheffield, Sheffield, UK
| | - Andrew R. Thompson
- Department of Psychology, Clinical Psychology Unit, Western Bank, The University of Sheffield, Sheffield, UK
| | - Lisa-Marie Emerson
- Department of Psychology, Clinical Psychology Unit, Western Bank, The University of Sheffield, Sheffield, UK
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Markabayeva A, Ospanova S, Jafferany M. Psychodermatology: knowledge, awareness, and attitude of dermatologists in Kazakhstan. Int J Dermatol 2019; 59:e105-e109. [DOI: 10.1111/ijd.14608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 05/11/2019] [Accepted: 07/12/2019] [Indexed: 12/15/2022]
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Johnston SA, Krasuska M, Millings A, Lavda AC, Thompson AR. Experiences of rosacea and its treatment: an interpretative phenomenological analysis. Br J Dermatol 2017; 178:154-160. [PMID: 28667759 DOI: 10.1111/bjd.15780] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND While rosacea is a chronic skin condition, it can often have a large psychosocial impact on the individual. There is therefore a need to understand the experience of living with rosacea from the patient perspective. OBJECTIVES To examine the experience of living with rosacea and the experience of seeking and receiving treatment. METHODS Nine participants took part in semistructured interviews, which were analysed using interpretative phenomenological analysis. RESULTS Three superordinate themes were identified within the data: 'self-consciousness', which focused on the fear of others assigning blame to participants for having caused symptoms; 'avoidance, concealment and hiding emotions', referring to the coping strategies participants employed in response to rosacea; and 'inconsistencies in general practitioner treatment and guidance', which focused on the need for medical professionals to assess the psychosocial well-being of patients with rosacea. CONCLUSIONS Rosacea can have a negative impact on the daily life of people with the condition, contributing to lowered self-esteem, embarrassment and feelings of shame. Engaging in emotion-focused and behavioural/avoidant-focused coping strategies increased participants' confidence and reduced their avoidance of social situations. However, such strategies might still serve to maintain underlying unhelpful cognitive processes. Consequently, it is important for medical professionals to assess for the presence of cognitive factors that might contribute to maintaining distress in patients with rosacea, and where unhelpful thoughts or beliefs are reported, patients may need to be referred for psychological support.
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Affiliation(s)
- S A Johnston
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Floor F, Sheffield, S1 2LT, U.K
| | - M Krasuska
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Floor F, Sheffield, S1 2LT, U.K
| | - A Millings
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Floor F, Sheffield, S1 2LT, U.K
| | - A C Lavda
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Floor F, Sheffield, S1 2LT, U.K
| | - A R Thompson
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Floor F, Sheffield, S1 2LT, U.K
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Impact of collaboration between psychologists and dermatologists: UK hospital system example. Int J Womens Dermatol 2017; 4:8-11. [PMID: 29872670 DOI: 10.1016/j.ijwd.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 11/23/2022] Open
Abstract
There is a strong known link between the mind and the skin, with studies indicating that some individuals who live with skin disorders can exhibit high levels of psychological distress. Historically, the psychological impact of skin conditions has often been disregarded by health professionals, friends, and family members. However, more recently, clinicians are becoming aware of the benefits of combining medical and psychological treatment for these patients. Within the United Kingdom, this is becoming more popular within dermatology due to a recent study that measured clinical utility and cost savings. Understanding the theory behind psychocutaneous medicine enables dermatologists to work alongside psychologists to provide holistic treatment by meeting the medical and psychological needs of our patients.
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Zhou S, Mukovozov I, Chan AW. What Is Known About the Psychodermatology Clinic Model of Care? A Systematic Scoping Review. J Cutan Med Surg 2017; 22:44-50. [DOI: 10.1177/1203475417719045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Psychodermatology focuses on the interaction between skin and mental health. Existing research discusses the recognition and treatment of these disorders. However, little is known about the operational structure of subspecialised psychodermatology clinics. Objective: To identify literature on the structure and logistics of delivering a psychodermatology service. Methods: A systematic search of MEDLINE, PsycINFO, Embase, and Google Scholar was performed. Articles were included if they discussed the concept and organisation of a psychodermatology practice. Results: We identified 693 studies; after screening titles and abstracts, 35 full-text articles were assessed, and 17 were included in the scoping review. Most articles discussed aspects of clinic organisation in general; others discussed management of a clinic in the context of specific diseases or made recommendations on incorporating psychotherapeutic techniques in a solo practitioner setting. A weekly multidisciplinary clinic or resident teaching clinic with joint dermatologist-psychiatrist consultation is the most commonly reported model. Specifically, a stepped level of care approach is often used, where patients in increasing level of distress are stratified to the appropriate team of trained professionals. A corresponding curriculum to supplement practitioners’ knowledge is recommended. Conclusions: Various clinic models have been described to provide specialised psychodermatology care in specific settings. Research is needed to assess the impact of these multidisciplinary models of care on patient outcomes and health care costs.
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Affiliation(s)
- Stephanie Zhou
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ilya Mukovozov
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - An-Wen Chan
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Aguilar-Duran S, Ahmed A, Taylor R, Bewley A. How to set up a psychodermatology clinic. Clin Exp Dermatol 2015; 39:577-82. [PMID: 24934911 DOI: 10.1111/ced.12360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychodermatology is a recognized subspecialty, but lack of awareness among dermatologists and limitation of resources make the management of these patients challenging. Clinicians are often unsure about the practicalities of setting up a psychodermatology service. There is confusion about which model is best suited to which service, and about the development of a psychodermatology multidisciplinary team. AIM To identify the necessary steps in setting up a psychodermatology clinic. METHODS The study was based on the experience of a UK-based psychodermatology unit and the recently published standards by the UK Psychodermatology Working Party. RESULTS The type of service provision will depend on the type of patients seen in the unit. The core team will be composed of a psychodermatologist and a psychologist. Access to a psychiatrist is essential if patients present with primary psychiatric conditions or primary cutaneous conditions with suicidal or other psychiatric risks. Adequate training of the healthcare staff is advised. The premises and time allocation should be adequate, and this translates into higher tariffs. Using business care tariffs for people with mental health conditions might be more appropriate, as the consultations are longer and involve more members of staff; however, the overall cost remains lower than if these patients were seen in a general dermatology service or in the community. CONCLUSIONS Psychodermatology services are globally limited, and yet the demand for psychodermatology care is high. There is evidence that dedicated psychodermatology services are cost-effective. Healthcare professionals need to be aware of the steps necessary to establish and maintain psychodermatology services.
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Affiliation(s)
- S Aguilar-Duran
- Dermatology Department, Whipps Cross Hospital, Barts Healthcare NHS Trust, London, UK; Psychiatry Department, Royal London Hospital, Barts Healthcare NHS Trust, London, UK
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Shah R, Bewley A. The importance of integrated psychological interventions and dedicated psychologists in dermatology. Clin Exp Dermatol 2014; 39:428-30. [DOI: 10.1111/ced.12282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R. Shah
- Department of Dermatology; Whipps Cross University Hospital; Barts Health NHS Trust; Leytonstone London UK
| | - A. Bewley
- Department of Dermatology; Whipps Cross University Hospital; Barts Health NHS Trust; Leytonstone London UK
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