Does Guided Written Disclosure Reduce Distress and Improve Psychological Functioning in Patients with Skin Diseases?

Rossella Mattea Quinto,Luca Iani,Francesca Russo,Piero Porcelli,Damiano Abeni,Francesco De Vincenzo

doi:10.3390/ijerph19052943

Abstract

Background. Skin diseases (e.g., psoriasis and systemic sclerosis) are generally associated with negative psychosocial outcomes. Although different psychological interventions have been used to improve the quality of life of dermatological patients, the effects of the guided written disclosure (GWD) protocol have not been previously examined in these patients. Moreover, little attention has been paid to positive psychology constructs. Methods. This study investigates the effectiveness of GWD on positive and negative functioning in dermatological patients. Pre- and 1-month post-intervention measures included emotion regulation, sense of inner peace, skin-related symptoms and functioning, sense of coherence, and psychological distress. Results. A total of 196 consecutive outpatients were randomly assigned to GWD and active control groups, of whom 60 (30.6%) completed the study and 45 (GWD: n = 24; AC: n = 21) provided complete data. Our results did not show any significant difference between the experimental and control groups in the outcome variables, whereas non-completers reported higher levels of distress, unpleasant skin-related emotions, and lower cognitive reappraisal compared to completers. Conclusions. These findings show a poor compliance, and suggest that expressive writing is not well accepted by patients and is not effective in improving positive and negative psychological functioning in dermatological patients.

Highlights

Skin diseases, such as psoriasis and systemic sclerosis, are associated with negative psychosocial outcomes, including low psychological well-being and high psychological distress [1], psychiatric morbidity [2], alexithymia and emotion dysregulation [3], quality of life (QoL) impairment [4], and low levels of spiritual well-being [5]
Researchers paid little or no attention to clinically relevant constructs based on the positive psychology framework [7], even though previous observational studies have suggested the importance of focusing on positive resources
The aim of the present study was to examine the effects of guided written disclosure (GWD) in reducing psychological distress and expressive suppression, and improving peace, sense of coherence, cognitive reappraisal, and skin-related quality of life in patients with psoriasis and systemic sclerosis

Summary

Introduction

Skin diseases, such as psoriasis and systemic sclerosis, are associated with negative psychosocial outcomes, including low psychological well-being and high psychological distress [1], psychiatric morbidity [2], alexithymia and emotion dysregulation [3], quality of life (QoL) impairment [4], and low levels of spiritual well-being (i.e., meaning and sense dimensions) [5]. Various psychological interventions were aimed at reducing disease severity, skin-related symptoms, and different types of psychosocial distress, as well as improving health-related quality of life in dermatological patients [6,7]. Iani et al [10] found that higher cognitive reappraisal, sense of coherence, and positivity predicted higher spiritual well-being and lower psychological distress in patients with psoriasis and systemic sclerosis after controlling for negative functioning (i.e., physical symptoms, type of disease, and expressive suppression). These findings suggest that clinicians may facilitate spiritual.

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