Cognitive Behavioral Therapy Improves Outcomes in Patients With Dermatologic Conditions

Patients who received cognitive behavioral therapy plus standard of care experienced improvements in quality of life and severity of skin disease.

Quality of life (QOL) and severity of skin disease improved among patients with dermatologic conditions receiving standard of care treatment who also underwent cognitive behavioral therapy (CBT) vs those receiving standard of care only, according to study findings presented at the 2023 Annual Meeting of the American Academy of Dermatology (AAD), held from March 17 to 21, 2023, in New Orleans, Louisiana.

CBT is effective combined with medication when indicated for chronic pain, diabetes, eating disorders, attention-deficit/hyperactivity disorder, anxiety, and depression. Investigators sought to summarize the findings on the utility of CBT for improving skin status and QOL among patients with dermatologic conditions.

They conducted a narrative review searching the PubMed and Google Scholar databases from inception through mid-October 2021, ultimately including 30 studies (11 on atopic dermatitis, 10 on psoriasis, 4 on acne, 4 on vitiligo, and 1 on alopecia areata).

The investigators found several of these studies supported the effectiveness of CBT (typically administered in 5 to 20 short therapy sessions aimed to increase self-awareness with a goal of transforming negative thoughts and feelings to make future responses more effective) for a number of dermatologic conditions, with patients who completed CBT courses less likely to rely on dermatologic health care during follow-up.

Patients who completed CBT courses were less likely to rely on dermatological healthcare during follow-up periods.

They noted that CBT improved QOL, disease severity, and/or mental health, and in some studies QOL and mental health improved without objective disease improvement. Specifically, they found that CBT improved the severity of acne lesions and self-esteem among patients with vitiligo, and QOL among patients with alopecia areata.

Researchers also found that patients with psoriasis showed significantly improved QOL and lower anxiety scores in some studies. Patients with atopic dermatitis who underwent CBT self-reported significant reduction in scratching in some studies and significant improvement in anxiety, stress, and catastrophizing in other studies.

Limitations of this study include the design nature of the review and the limited number of studies discussing implementation of CBT for acne, vitiligo, and alopecia.

“Patients who underwent CBT in addition to skin care had greater improvement in mental health and severity of skin disease as compared to standard of care treatment alone,” the investigators concluded. They added, “Patients who completed CBT courses were less likely to rely on dermatological healthcare during follow-up periods.”


Patel HA, Revankar RR, Revankar NR, Balogh EA, Kaplan SG, Feldman SR. Cognitive behavior therapy as dermatological treatment. Abstract presented at: AAD 2023 Annual Meeting; March 17-21, 2023; New Orleans, LA. Poster 44109.