How Cognitive-Behavioral Therapy Can Support Acne Treatment
Anyone who has had acne knows that the scars it leaves are more than skin-deep. And while most acne treatments focus on resolving the damage that people can see 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 engage in. It helps us realize that the many subtle ways we inadvertently make matters worse for ourselves, and helps us figure out how to change.
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.
- Traditional and usually Freudian therapy focuses on the traumas we 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 everyday.
- CBT gives homework. That’s right, there are worksheets and skills to practice outside of the therapist’s room. The thoughts and behaviors that lower our quality of life happens as we through our day, and it is during this time that they should be dealt with. CBT shifts the heavy-lifting to the patient, while providing guide and support in the form of the therapist.
This form of therapy has been gaining popularity in recent years because it has proven effective at addressing a wide range of psychological issues. CBT has been known to improve the quality of life of many people struggling with problems as diverse as depression 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 treat acne-associated disorders
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 on specifically people who suffer from acne, but there have been many studies about its effect on people who suffer from stress, anxiety, depression, body dysmorphia.
And overwhelmingly, the literature shows that CBT significantly improves the quality of life of those coping with these disorders. In short--it works!
CBT can help you challenge cognitive distortions
A meta-analysis of studies analysing the effect of CBT in relieving anxiety disorders found that this form of therapy consistently produces results. This finding applied regardless of the anxiety stemmed from phobias, social interactions, or post-traumatic stress disorder.
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 recognize when they tell themselves something irrational, but you might just be surprised how often you yourself do it.
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 recognizing 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 self-respecting dermatologist, aesthetician, or beauty influencer will tell you, acne cannot be cured overnight. It is a long process that requires 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 6 weeks). 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 4 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 have fears that others don’t have. Most of them revolve around social gatherings. It’s easy to see why--it’s near impossible to hide bad skin, 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 socializing. 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 to 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 involves vividly visualizing being in the scary situation. Interoception is about feeling physical sensations associated with the fear.
However exposure therapy is done, 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 disease like acne, it’s easy to think that there’s no rhyme and reason to it. It’s something that just happens, and there’s nothing you can do about it.
But the underlying principle behind this form of therapy is giving agency to the patient. 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.
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 dermatologist to refer you so the goals of your physical treatment and that of your psychological treatment 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 dermatologist to heal the outside, there should be no shame in talking to a therapist to heal the inside.
This content is for general information only and is not a substitute for medical advice.
Resources:
Dunn, L. K, O'Neill, J. L, & Feldman, S. R. (2011). Acne in Adolescents: Quality of Life, Self-Esteem, Mood and Psychological Disorders. Dermatology Online Journal, 17(1). Retrieved from https://escholarship.org/uc/item/4hp8n68p
Hazarika, N., & Archana, M. (2016). The Psychosocial Impact of Acne Vulgaris. Indian journal of dermatology, 61(5), 515–520. https://doi.org/10.4103/0019-5154.190102
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346.
