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Mindfulness for the patient and the dermatologist

DII small banner By Warren R. Heymann, MD
March 28, 2017

While meditation has been present for millennia, the concept of mindfulness has recently come into vogue. Conceptually, mindfulness aims to have a person focus their attention on the present moment by developing coping strategies, such as meditation or deep breathing.

Severe forms of alopecia areata (AA) have a major impact on the psychosocial well being of patients. Aside from medical treatments, educational and psychological support may improve long-term physical outcomes (1). In a prospective pilot study to determine whether a mindfulness-based stress reduction (MBSR) program could improve quality of life (QoL), Gallo et al enrolled 8 patients with moderate/severe AA and compared then with matched controlled AA patients treated with standard therapies alone. The MBSR program used techniques such as sitting meditation and yoga. The AA-QoL, the Brief Symptom Inventory, and Perceived Stress Scale were measured for both groups. Significant improvement of QoL and of several psychometric parameters was seen in in MBSR participants, but not in control groups. This improvement partly persisted at 6 months follow-up. Importantly, the psychological status and QoL improved in the absence of significant clinical improvement (2).

AA is one of many dermatologic illnesses associated with psychosocial stress and diminished QoL. Psoriasis, atopic dermatitis, lupus, etc. are a few cutaneous representatives of a host of other systemic chronic maladies with the same effect. MBSR therapy has been used for treating other chronic illnesses such as depression, anxiety, pain, cancer, diabetes mellitus,  HIV/AIDS, hypertension, skin diseases and immune disorders. A systematic review of 18 studies (Cochrane, Embase, Medline) showed improvement in the condition of these patients following MBSR therapy.  Although research on MBSR is sparse, results suggest that MBSR improves the condition of patients suffering from chronic illnesses and helps them cope with a wide variety of clinical problems (3).

I have many AA patients — some cope rather well, and others are rather stressed (understandably). Some of these patient encounters are difficult and I can feel my blood pressure rise. Work-related stress, which may be patient-related, (not just because of frustrating electronic records and other administrative demands) has been associated with physician burnout. In a study of 42 physicians (21 participants 21 controls), a randomized, controlled mindfulness intervention was performed measuring outcomes of the Five Facets of Mindfulness Questionnaire, the Maslach Burnout Questionnaire, measurements of heart rate and blood pressure. After the initial 8 weeks of treatment, significant improvements for the experimental group in mindfulness levels and reductions in emotional exhaustion, HR, and BP were obtained. The authors concluded that these “outcomes are significant in terms of practical consequences for reducing and controlling risks of developing burnout and cardiovascular disease in this population and enhancing well-being in life.”(4)

In a brilliant essay, Elaine Siegfried states: “Nomophobia” is caused by a name that evokes vague discomfort. This sensation usually marks difficult personalities or problems. Anyone using this word should be aware that is an alternate cyberspace definition (less user-friendly, in my opinion): a fear of being outside the range of mobile phone contact.” (5) One of my long-standing coping techniques is to read through the list of patients before I start my session. I can recognize the potential stressful encounters. Forewarned is forearmed. I use one of the oldest mindfulness techniques before entering the room. I take a deep breath and compose myself so I can focus calmly. If it is a new patient causing strife, I will try to breathe slowly during the appointment. Who can benefit from mindfulness? Patients, physicians, and basically — everyone!

1. Al-Mutairi N, Eldin ON. Clinical profile and impact on quality of life: seven years experience with patients of alopecia areata. Indian J Dermatol Venereol Leprol 2011; 77: 489-93.
2. Gallo R, et al. Can mindfulness-based interventions improve the quality of life of patients with moderate/severe alopecia areata? A prospective pilot study. J Am Acad Dermatol 2017; 76: 757-9.
3. Niazi AK, Niazi SK. Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses. N Am J Med Sci 2011; 3: 20-3.
4. Amutio A, et al. Acceptability and effectiveness of a long-term educational intervention to reduce physicians’ stress-related conditions. J Contin Educ Health Prof 2015; 35: 255-60.
5. Siegfried E. There ought to be a word. Dermatology Times. October 10th, 2016.

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