By Simon Oates, CEO at Mind & Skin
In this article I will discuss resilience, how “typical” life stressors may differ for dermatology patients and recommend personal skills to help people living with skin conditions, such as psoriasis, to better cope and manage.
What is resilience?
Resilience is a process of positive adaptive thinking and behaviour when we may encounter negative, unfavourable or highly stressful life situations. Stressful situations could occur at any time or place and it is important that we understand that life stressors are unique to each and every person.
Daily struggles for dermatology patients
On a daily basis dermatology patients have to manage the physical symptoms of their condition, for example a patient with psoriasis would experience inflamed skin with grey-white scaly patches, sometimes covering the whole body, accompanied with itching, swelling and pain.
Accompanying the physical discomfort of a skin condition, dermatology patients may experience increased levels of stress, which may trigger or worsen psychological conditions such as depression, anxiety, especially social anxiety and obsessive compulsive disorder (OCD).
On a psychosocial level a very common issue is the feeling of “loss” and its resulting consequences from having a skin condition. Patients report on deterioration in personal relationships, including family, friendships and social engagements.
In addition to experiencing loss, an added concern is the lack of “control” in managing their condition which can stimulate and worsen anxiety. This absence of control can be experienced with all skin conditions; psoriasis patients may fear when a new “flare up” might occur, fluctuating and new moles on a melanoma patient may prompt relentless physical examination and vitiligo patients could develop new white patches of de-pigmented skin.
I once met a patient whose skin camouflage concealer was being discontinued and they were increasingly worried about sourcing a new one and whether it would conceal as well as the old one
I have met patients who state it is less the major life stressors (e.g. losing a job) and more the “smaller” ones that can be detrimental to a person’s mental well-being. For example, I once met a patient whose skin camouflage concealer was being discontinued and they were increasingly worried about sourcing a new one and whether it would conceal as well as the old one. Some dermatology patients have encountered negative social interactions where they have been verbally abused and refused service from some businesses. People I have met have been rejected from health treatment centers, hairdressers and exercising in leisure centers. The resulting consequences are that the individual may withdraw and avoid further social engagements.
What was once a normal activity e.g. going for a swim or having a coffee, may now have a negative effect on a person’s mental well-being. Generally, dermatology patients manage their condition well, but if something intervenes or disrupts “normal” daily activities the consequences can be dramatic. This is why for dermatology patients we must not “frame” a particular set of factors such as death of a loved one for initiating increased levels of stress. Such a saying goes “The small things are actually the big things”.
We must also recognise and understand that if a dermatology patient appears mentally resilient, it does not mean that they are free from negative emotions or thoughts.
1) Accept the diagnosis and skin condition
It is what it is. The reality is that we have to manage and accept it and in doing so we can lead to having a better adjustment period in managing a new phase of our life.
2) Ask for help
Do not be afraid to ask for help for anything. Whether it is asking your doctor for different treatment possibilities or seeking mental health support. It is normal and perfectly acceptable to admit when we are struggling with life.
3) Daily appreciation
One beneficial technique can be ending each day by listing three things that happened that day for which you are grateful. By doing this practice of writing we focus on positive thoughts where we can momentarily overlook long and hard working hours at work and recognise other areas in our life that we may often ignore, such as communicating with family and friends. You are probably coping much better than you may realise. Raising a family, studying or working two jobs all while managing a skin condition is not easy. Give yourself praise for managing and coping on a daily basis.
4) Embrace change
Particular life circumstances are something that we do not always have control over. Instead, focus on circumstances that you can control or alter. Also, by experiencing something new it gives us the chance to in meet new people, have new challenges, and it can also give us freedom in “resetting” our lives and starting again positively.
Accepting help and support from those who care about you and will listen to you strengthens resilience. If you have less of a support network, I advise you to become more social in your local community. This could be joining a sports team or a hobby club with mutual interests. It’s important to communicate face to face in addition to electronic socialisation like social media, forums and online communities.
The winter holidays can predictably be stressful. Emotional stress from study examinations and Christmas can trigger or worsen a skin condition. We should also be aware that Seasonal Affective Disorder (SAD) might be prevalent for some patients, otherwise known as “winter blues” and “winter depression”. Symptoms may include:
- Oversleeping and overeating
- Consistent lack of energy and low mood
- Loss of pleasure or interesting in everyday activities
- Feelings of guilt and worthlessness
Here is some advice I have been given by dermatology patients to help cope with the holiday season:
- Shorter and warm showers to reduce dry, irritated skin
- Be attentive on clothing fabrics. Choose loose fitted cotton over fabrics such woolens and polyester
- Drink plenty of water
- Ask your G.P. about the flu vaccination (NHS patients)
- Reach out for support via your doctor, support groups, charities, family and friends
Future developments in resilience training
A study by Dr Maclaren and Dr Thomson, in partnership with North West London Hospitals NHS Trust and Barts Health NHS Trust, implies that people with greater resilience will experience less distress as a result of having a skin condition. The study used questionnaires to survey 42 patients visiting dermatology outpatient clinics. Results found that 41% of patients who completed the Hospital Anxiety and Depression Scale questionnaire had above threshold scores for depression or anxiety while they had significantly lower resilience scores than those with below threshold scores.
Dr Alex Thomson said “The study provided some really fascinating insight. We already know that skin conditions have a significant emotional impact. Our findings suggest that psychological resilience is associated with a lower degree of distress”.
There is some evidence to suggest active coping and resilience training may be helpful and beneficial for dermatology patients. By focusing on other positive aspects of living with a skin condition it may improve their daily quality of life. We must also remember that resilience based training has a more individual focus and that some patients may require additional support in helping them to be active within their local community. This is because isolation and loneliness are unfortunately usually prevalent in this group of patients.
I believe that resilience and coping training should be further assessed and if merited be part of any future psychotherapy based treatment.
Simon is a guest writer for LEO Pharma and is CEO of psychodermatology charity Mind & Skin.
This content is not intended to advise you about your health. Always seek advice from your doctor or other qualified healthcare professionals.
UK/IE MAT-05836. Date of Prep: November 2016