Psychologic interventions in patients with the chronic dermatologic itch in atopic dermatitis and psoriasis: A step forward with family constellations seminars

Abstract

Chronic itch is a complex psychophysiological sensation, which can severely affect the quality of life in patients with atopic dermatitis and psoriasis. Itch depends on the irritation of receptors in the skin and the processing of sensory information in the central nervous system. Severe itch leads to activation and later on to disruption of the stress response, resulting in disorders of skin repair, functional and microstructural changes in the areas of the central nervous system that are responsible for the perception of itch. Psychosocial stress can be an essential factor, activating neurohumoral mechanisms which lead to increased itch and scratch, exacerbating skin damage. Patients with chronic itch often have sleep disorders, increased irritability, and depletion of the nervous system. They are characterized by disrupting social relationships, high incidence of anxiety, depressive disorders, and suicidal tendencies. Psychological methods of intervention can effectively influence various mechanisms in the pathogenesis of itch and scratch and improve social functioning in patients with chronic dermatological itch. In this mini-review, we discuss family constellation seminars as an effective method of psychological intervention that can reduce the intensity of itch, and improve sleep and performance in patients with atopic dermatitis and psoriasis. This method is insufficiently described in previous reviews of psychological interventions in atopic dermatitis and psoriasis patients. The positive impact of family constellations seminars in patients with chronic dermatological itch may be related to reducing stress by improving understanding of the family situation, appropriate management of family secrets, and enhancing interactions with the social environment.

Keywords: atopic dermatitis; chronic itch; family constellations; psoriasis; psychological distress.

FIGURE 1

Interaction of stress and itch, key points of psychologic interventions in patients with itch. The perception of itch and the reaction to it depend on the interaction of sensory impulses from the skin, attention to these stimuli, and the state of the autonomic nervous system. Attention is modified under the influence of other external stimuli, including psychosocial, sleep, state of mental functions, etc. After the attention filter, sensory information is processed, and the general adaptation syndrome (stress reaction) is triggered in the case of a threat to survival. The stress reaction modifies endocrine, behavioral, and immune reactions. It can lead to changes in the function of keratinocytes, immune cells, and nerve structures, worsening the skin condition and increasing itching. With the help of psychological methods, it is possible to influence attention, interpretation of stimuli, methods of behavioral reactions, and improve the psychosocial adaptation of patients with chronic pruritus. The psychological techniques discussed in the article and the key points of their influence are indicated in italics. HRT, habit reversal training; RT, relaxation training; CBT, cognitive behavioral therapy; FCS, family constellations seminars.

FIGURE 2

Scheme of the family constellation session. Family constellations are usually held in groups of 20–25 participants. A client who wants to solve his problem (active participant) chooses representatives from other participants for the roles of himself, his symptom, and his family members. After the roles are assigned, the client places the representatives according to the roles in the room as real family members. Subconsciously, representatives experience various emotions, bodily sensations, and thoughts similar to those of real members of the client’s family system with reasonable accuracy. After that, the facilitator helps interpret the participants’ psychological interactions in the constellation and makes interventions to improve the interactions between the client, his symptom, and his family members. As a result of the constellation, the client receives a new model of more harmonious interaction in the family. Gray arrows show interactions. Representative of a symptom often looks at the stressful event. Seminar participants (square figures–males, circles–females) observe what is happening in the client’s family system. Some of them (marked in pink) can respond emotionally and take models for solving their family problems. R-Client, representative of a client; R-CL, daughter–representative of the client’s daughter; R-CL-Husb, representative of the client’s husband; R-CL-Son, representative of the client’s son; R-Sympt, representative of the client’s symptom.