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Cognitive behavioral therapy effective for psoriasis

Cognitive behavioral therapy (CBT) can successfully treat the physical symptoms of psoriasis and systemic treatment doesn’t seem to provide an extra boost to its effectiveness, a new systematic review and meta-analysis finds.

Cognitive behavioral therapy (CBT) can successfully treat the physical symptoms of psoriasis, a new systematic review and meta-analysis finds – and systemic treatment doesn’t seem to provide an extra boost to its effectiveness.

However, the authors of the report aren’t ready to suggest that CBT become a mainstay of psoriasis treatment. “Although the results show that CBT is effective, we cannot draw the simplistic conclusion that CBT is a universal effective therapy to all psoriasis patients because CBT is tailored for individual patients and there is heterogeneity in the delivery of this method,” write the authors, whose findings appeared online Feb. 9 in Psychology Research and Behavior Management.1

The report, led by dermatologist Yi Xiao, MD, MPH, of Central South University in Changsha, China, notes that mental conditions such as anxiety and depression appear to be more common in psoriasis.

According to a 2016 review, previous research has suggested psoriasis and psychiatric disorders are highly correlated compared to other dermatologic diseases, and “patients may have specific psychopathologic features that are not commensurate with the extent of skin lesions.” In addition, the review reported that “studies have shown that these patients suffer from the same deterioration in health-related quality of life as patients with cancer and cardiovascular diseases.”

The researchers of the current review examined 8 randomized controlled trials of psychological interventions for psoriasis. The trials, published in English and Chinese, were small – with intervention and control groups ranging from 20 to 83 people – and included a total of 765 subjects.

Five of the trials tested various types of CBT (including 1 that applied it with biofeedback). The other 3 trials examined “telephone-based emotional disclosure,” “group multiprofessional education” and “telephone-based motivational interviewing.”

Most of the trials lasted 6 or 12 weeks; 2 lasted 6 months.

The researchers found a statistically significant improvement for CBT only: The pooled estimate was −1.80 (combined Psoriasis Area and Severity Index [PASI] and Self-administered Psoriasis Area and Severity Index [SAPASI], 95% CI: −2.57 to −1.03; P<0.001). The studies measured PASI, SAPASI or both.

“The subgroup analysis shows that CBT, rather than other specific psychological interventions, is effective in PASI reduction with a moderate effect size,” the researchers write.

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