CBT and Psoriasis

Cognitive Behavioural Therapy (CBT) is a commonly used psychological approach to treating a wide variety of conditions such as depression, anxiety, phobias and more recently has been used in physical health conditions. The basic idea behind this therapy is that the way we think affects how we feel and our behaviour (what we do or don’t do).

For example:

Situation A

It’s the second week of July and so far it has been a great summer. Up until this point Rebecca has been wearing long sleeves and trousers to hide her psoriasis but today she can take the heat no longer and has decided to wear a skirt and t-shirt to her friend’s house. She catches a bus there and on the way a group of school children behind her start laughing. Rebecca thinks, “Those kids are laughing at my skin. It looks so awful. They must think I’m disgusting. I shouldn’t have worn a skirt and short sleeves.” She blushes and feels hot and embarrassed. She jumps off at the next stop, walks home in tears and changes into trousers.

 

Situation B

It’s the second week of July and so far it has been a great summer. Up until this point Rebecca has been wearing long sleeves and trousers to hide her psoriasis but today she can take the heat no longer and has decided to wear a skirt and t-shirt to her friend’s house. She catches a bus there and on the way a group of school children behind her start laughing. Rebecca thinks, “Teenagers seem to find everything so funny. I wonder what they are laughing about. I bet they are talking about boys. I can remember being like that.” Rebecca starts to daydream and remember happy times from her youth. She arrives at her friend’s house feeling happy.

 

Situation C

It’s the second week of July and so far it has been a great summer. Up until this point Rebecca has been wearing long sleeves and trousers to hide her psoriasis but today she can take the heat no longer and has decided to wear a skirt and t-shirt to her friend’s house. She catches a bus there and on the way a group of school children behind her start laughing. Rebecca thinks, “I wonder if they are laughing at me. I doubt it. They wouldn’t even see my legs from the back of the bus and anyway I don’t suppose psoriasis is that funny.” She turns on her MP3 player, reads her book for the rest of the journey forgetting all about the girls at the back. She arrives at her friend’s house feeling relaxed.

It’s the same situation but because the thoughts are different, the feelings and behaviour are different too. Who knows what the teenagers were laughing at? They might have found the sight of Rebecca’s arms and legs hilarious. They might not have.

Which one of those examples would have been most like you? If it is A, then is there anything you can do about it? CBT could be the solution.

We all think all the time. It’s often boring stuff, thinking about what to cook for dinner or who said what to whom at the office. One thought leads to another and to another. Suddenly you find yourself thinking about someone you met on holiday ten years ago and you don’t know what led you there. There would have been a chain of thoughts that led to this one but it’s often hard to back-track as we don’t plan the thoughts. They just pop up, unbidden, automatically, one after another. The first step in CBT is learning to identify these automatic thoughts, spot the unhelpful ones and challenge them. Rebecca in situation A didn’t stop to question her thoughts. She believed her thoughts as if they were the truth. If she had been able to stop her thoughts and challenge them with something like this – “hang on a minute am I jumping to conclusions, could they be laughing at something else?” then she might have been able to carry on with her journey without feeling so ashamed and bad about herself.

This is a very brief outline of CBT but it seems to me to make sense that this kind of an approach would be helpful to people with psoriasis. Some hospitals have started to use CBT with people with psoriasis and a few research papers have been published. You can read more about this in a future post.

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