Cognitive behavioral therapy (CBT), motivational interviewing, mindfulness-based therapies, and educational and interdisciplinary interventions represent potential adjunctive approaches for the psychological management of psoriasis, according to a systematic review published in the American Journal of Clinical Dermatology.
Researchers performed a systematic review of published studies that investigated psychological management strategies for psoriasis. Studies published between 1990 and 2018 met the criteria for inclusion if they enrolled patients with psoriasis who received psychological monotherapy or in combination with an additional therapy as well as studies that reported clinical treatment outcomes. Management approaches included CBT, biofeedback, mindfulness-based cognitive therapy, mindfulness-based stress reduction, hypnosis, music resonance therapy, motivational interviewing, and educational and interdisciplinary interventions. The studies included in the review were graded with a level of evidence (LOE) based on the Scottish Intercollegiate Guidelines Network levels of evidence.
A total of 1522 patients with psoriasis were identified in 27 studies, including 3 case reports and series and 24 trials. Overall, the majority of studies had sample sizes of <50 patients. Psychological approaches that demonstrated some form of efficacy in psoriasis management included CBT (LOE: 1+, 2+, and 3), meditation and mindfulness-based therapy (LOE: 1- and 2+), motivational interviewing (LOE: 1++), education (LOE: 1- and 2-), and multidisciplinary programs (LOE: 1+ and 2-). Studies found improvements in self-reported depression symptoms as well as in psoriasis area and severity.
Limitations of the review were the inclusion of studies with small sample sizes and short follow-ups (≤12 months).
The researchers concluded that additional “work should address questions regarding the cost effectiveness of these interventions, while ensuring greater consistency between studies in terms of methodologies, protocols, samples, outcomes, and statistical analyses.”
Disclosure: Olabola Awosika, MD, has received fellowship support from Janssen Pharmaceuticals.
Qureshi AA, Awosika O, Baruffi F, Rengifo-Pardo M, Ehrlich A. Psychological therapies in management of psoriatic skin disease: a systematic review [published online April 2, 2019]. Am J Clin Dermatol. doi:10.1007/s40257-019-00437-7