Anyone who has had acne knows that the red spots and scars it leaves are more than skin-deep. And while most acne treatments focus on resolving the damage seen on the outside, a growing body of research argues that it is equally important to address the issues within.
Among the many psychological treatments, it seems that cognitive behavioral therapy is a particularly useful approach for those suffering from acne-based mental health problems.
What is Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a form of psychological treatment that targets self-destructive patterns of thinking and behavior that we may engage in. It helps us be more aware of our thought patterns that may make matters worse for ourselves, and helps us figure out how to change such thoughts.
CBT departs from the therapy that many people are familiar with in several important ways. Instead of delving into the past, CBT focuses on the present.
Traditionally, what’s referred to as Freudian therapy focuses on the traumas we may have experienced as children, in order to understand the psychological distress we are experiencing as adults. On the other hand, CBT focuses on changing how we think and act in the present to better react to the stresses we feel every day.
CBT gives us homework. That’s right, there may be worksheets and skills to practice outside of the therapist’s room. The thoughts and behaviors that lower our quality of life happens as we get through our day, and it is during this time that they should be dealt with.
This form of therapy has been gaining popularity because it has proven effective at addressing a wide range of psychological problems. CBT has been known to improve the quality of life of many people struggling with problems as diverse as depression and anxiety to substance abuse, psychiatric disorders to marital issues. While the number of sessions depends on several factors concerning both the patient and the therapist, there is evidence that significant improvement can be seen in as few as eight 1-hour sessions.
How CBT can help acne sufferers
If you’ve ever suffered from panic attacks about your appearance, felt depressed about your breakouts, or feel like your life is dictated by the condition of your skin, join the club. Scientific research shows that the be-pimpled are significantly more likely to experience stress, anxiety, depression, and body dysmorphia as compared to their clear-skinned counterparts.
There may be few studies on the effect of CBT in acne management, but there have been many studies about its effect on people who suffer from stress, anxiety, depression and body dysmorphia. Overwhelmingly, the scientific literature shows that CBT significantly improves the quality of life of those coping with these disorders. And in short--it may just work for you!
CBT can help you challenge cognitive distortions
A meta-analysis of studies (ie a big scientific summary of published studies) analysing the effect of CBT in relieving anxiety disorders, found that this form of therapy consistently produces results. This finding applied regardless of where the anxiety stemmed from.
This makes sense. Anxiety is often caused by what in CBT-linggo are called “cognitive distortions”. Basically, these are statements we think are true, but are actually irrational and serve no other purpose than to breed panic and negative emotions.
You’d think people would recognise when they tell themselves something irrational, but you might just be surprised how often you do it yourself.
If you’ve ever seen someone laughing and assumed they were laughing at you, you’ve engaged in the cognitive distortion called “jumping to conclusions”. If you’re ever told yourself that you must become clear-skinned in order to be loved and successful, you’ve just made a “should statement”. If you’ve ever railed at how unfair it is that you were born with bad skin, you’ve engaged in the “fallacy of fairness”.
These are just examples of the cognitive distortions identified in CBT. Sessions are geared towards recognising these false statements and challenging them. By thinking rationally, we become more objective about reality rather than seeing a version of it distorted by our own biases (usually against ourselves). And when we see reality as it is, we can respond to it more appropriately.
CBT helps keep you on routine
One of the major reasons why people get depressed about acne is because they feel like it will never go away. No matter what cream they apply, no matter what skin regimen they follow, no matter how many dermatologists they’ve consulted, nothing seems to work. The more zits pop up, the less control they feel they have over the situation, the more dejected they feel.
But as any dermatologist will tell you, acne cannot be cured overnight. It is a long process that requires consistency, patience and sustained effort.
Let’s repeat that, consistency, patience and sustained effort.
CBT is particularly effective at helping you develop skincare habits because it’s a goal-oriented approach to dealing with mental health issues.
CBT works best on goals that are very specific (“I want clear skin” vs “I want to stick to a regimen for 3 months). Therapists typically ask patients to identify the problem as clearly as possible (“The routine is too hard” vs. “I’m too tired at night to finish the last 6 steps”), and asks them to think of possible doable solutions (“I can switch to a regimen that has fewer steps” or “I can decrease the time spent scrolling on my phone by 15 minutes”).
Once patients learn to identify the problem and think of possible solutions, they are taught the ways they can keep track of their progress, and tweak things as they go along.
CBT can help you face your fears
People who suffer from severe acne may have fears that others don’t have. Most of them revolve around social gatherings. It’s easy to see why. Sometimes it’s near impossible to hide acne, and not being able to hide insecurities can make anyone extremely uncomfortable. That’s why people with acne shy away from having their pictures taken or being in situations wherein they have to meet new people.
CBT commonly uses exposure therapy to challenge the worst-case scenarios that often play in our heads when it comes to socialising. Exposure therapy is hinged on the premise that we avoid our fears because we think something terrible is going to happen. But if we are exposed and then find that nothing terrible happens, our fear of it lessens.
But exposure therapy isn’t about leaving someone scared of meeting new people in a room of twenty strangers. Therapists take into account the comfort level of their patients and usually go for gradual exposure.
There are also many ways to expose people to their fears. In vivo is the one that most people think about. This means direct exposure to the thing or situation that the patient fears. But there are other “beginner-friendly” means of exposure. Imaginal exposure may involve vividly visualising being in a scary situation. Interception is about feeling physical sensations associated with the fear.
No matter how exposure therapy is performed, it’s geared towards facing our fears and understanding that it’s usually not as terrible as we make it out to be.
CBT helps you take control of your treatment
When you’re dealing with a multifactorial condition like acne, it’s easy to think that there’s no rhyme and reason to it. It’s something that just happens. Worst still, you may actually think that there’s something really wrong with you and there’s nothing you can do about it.
But the underlying principle behind this form of therapy is giving control back to the sufferer. CBT isn’t about delving into the unchangeable past, it’s about adjusting thinking and behavior in the very real present. Professionals trained in this type of therapy don’t tell you what to do, they help you figure it out on your own. More than a deep analysis about why the problem exists, it’s about understanding it enough to fix it yourself.
Conclusion
If you think your quality of life is impaired by your acne, consider seeking the help of a CBT-trained therapist. You may ask your GP or dermatologist to refer you so the goals of your physical treatment and that of your overall wellbeing are aligned.
Remember: the effect of acne on your mental health is just as real as its effect on your skin. Just as there is no shame in seeking the help of doctors to heal the outside, there should be no shame in talking to a therapist to heal the inside.
Unaffiliated External Mental Health Links:
https://www.headtohealth.gov.au/
https://www.blackdoginstitute.org.au/
https://www.beyondblue.org.au/
The information presented in this article is for general information and example purposes only, does not contain health advice specific for users and must not be relied on for that purpose. SkinKitz does not provide any mental health advice or treatment. If you are experiencing any mental health concerns, please see your GP or mental health professional.
