The role of adult attachment orientation and coping in psychological adjustment to living with skin conditions.

BACKGROUND: Skin conditions can be associated with significant psychological distress. Investigation of attachment orientation and associated use of coping strategies is a promising perspective from which to investigate psychological adjustment to skin conditions. OBJECTIVES: To examine the role of adult attachment orientation, conceptualized as two dimensions - attachment avoidance and attachment anxiety - in psychological adjustment [appearance-related distress and skin-related quality of life (QoL)], and the mediating role of two coping strategies - defeatism and activity. METHODS: Attachment avoidance and attachment anxiety, use of coping strategies, appearance-related distress and skin-related QoL were assessed via a cross-sectional online survey in 207 adults with skin conditions. Multiple mediation analyses were performed using PROCESS pathway analysis. RESULTS: Overall, higher attachment avoidance and higher attachment anxiety were associated with higher appearance-related distress and greater impact on emotions and functioning aspects of QoL. For attachment anxiety, the relationship was fully explained by more frequent use of defeatism coping. For attachment avoidance, the relationship was partially explained by more frequent use of defeatism coping (and in the case of appearance-related distress also more frequent use of activity coping), and higher attachment avoidance was also associated with poorer psychological adjustment in a way that could not be explained by use of assessed coping strategies. CONCLUSIONS: Insecure attachment orientation (high attachment avoidance or high attachment anxiety) is linked to poorer adjustment. People with insecure attachment might benefit from psychological interventions that target underlying attachment orientation.

Experiences of rosacea and its treatment: an interpretative phenomenological analysis.

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.

A meta-analysis of the effectiveness of psychological interventions for adults with skin conditions.

Skin conditions can be associated with heightened levels of psychological morbidity, suggesting the need for psychological interventions. A number of specific interventions (such as habit reversal) have been developed. However, to date, there has not been a systematic review of the effectiveness of psychological interventions. We sought to systematically evaluate the effectiveness of psychological interventions designed to improve the severity of and adjustment to skin conditions in adults. Database, archival and citation searches were conducted. Studies were included if participants were allocated to either a psychological intervention (excluding educational interventions and complementary therapies) or a comparison condition, and if they measured outcomes relevant to the skin condition. Twenty-two studies met these inclusion criteria. Effect sizes for each intervention were computed and we also coded a number of potential moderators of intervention efficacy. Psychological interventions were found to have a medium-sized effect on skin conditions (g = 0·54). The type of skin condition, age of sample, nature of the intervention, time interval between the end of the intervention and follow-up, and type of outcome measure all moderated the effect of interventions on outcomes. For example, interventions had a medium effect on the severity of the condition (g = 0·40) and psychosocial outcomes (g = 0·53), and a medium-to-large effect on itch/scratch reactions (g = 0·67). Psychological interventions are beneficial for people with skin conditions. However, more research is needed to extend the variety and focus of the psychological interventions that are available. Studies are also needed to explore the longer-term benefits of such interventions.