here to read Dowling's Dissertation Abstract
with focus on Stigma
posted March 2003
interest in my dissertation topic "A Coping Skills Short-Term
Psychotherapy Group for Psoriasis Patients: Understanding and Coping with
the Psychological and Physical Effects of Psoriasis" originates from
personal struggle, and success, with my own battle with psoriasis.
afflicted with psoriasis at the age of ten with very few treatment
options, and little understanding of the disease. Having reached a point
of desperation and hopelessness in my late teens, I looked to the National
Psoriasis Foundation for support, comfort, and understanding. Through
educating myself about psoriasis and my own perseverance, I returned to
school to finish my bachelor’s degree. Several years later, with the
mentoring of a wonderful supervisor, and the support of family and
friends, I finally found the courage to pursue my doctorate, hoping to
make a contribution where I recognized there was a deficit.
I wish to work
towards improving the quality of life of those with chronic illness,
particularly those with psoriasis, partially by helping to educate those
who are ignorant of the overall impact of the disease. Empathy and
understanding are essential in helping people with psoriasis learn to help
themselves. Education of medical providers, both physicians and
psychologists, is necessary regarding the true nature of psoriasis, its
impact on the lives of patients, and treatment difficulties. If I can make
even a small contribution, I will feel rewarded on many levels.
I would be
pleased to see others gain confidence that they may have once known, or
may never have known before.
support group, not a psychotherapy group, sponsored by the National
Psoriasis Foundation is what really turned me in a more positive
direction. I hope that participating in a psychotherapy group will achieve
positive results for others suffering from psoriasis. My hope is that
through a group experience, members will begin to recognize the
universality of their psoriasis, and feel more hope for improving their
overall quality of life.
I am aware that
my personal experience with psoriasis enhances the likelihood for my
personal bias to be reflected in this study. However, I intend to utilize
supervision to assist with potential issues and attempt to be even more
cognizant of this since I acknowledge this issue. I believe also that my
personal struggles with the disease give me greater empathy and
understanding. Though I do intend to reveal that I have psoriasis to
participating group members, my disclosure will be limited, keeping the
consideration of group members’ needs primary.
emotions do not appear to
cause psoriasis, they do seem to affect the etiology and severity of the
disease. Because the ramifications of psoriasis vary widely both
physically and emotionally from one individual to another, and from one
episode or flare to another within the same individual, it can impact the
lives of some patients quite significantly while affecting others
minimally and/or very differently.
emphasize that "very little is known about how physical,
psychological, social and environmental factors interact either to protect
patients or place them at higher risk for negative impact."
oriented group experiences have the potential to positively affect the way
in which people with psoriasis make appraisals and respond to physical and
emotional effects of psoriasis, other people, and their own lives in
general. Through group interaction, people with psoriasis may become
cognizant of how they relate to others, learn new coping skills, feel less
alone, and may have suggestions that offer relief to others. Group
participation facilitates learning and growth.
group therapy has its beginning in medicine, amongst patients with
tuberculosis. Group psychotherapy for medically ill patients places
emphasis on increasing quality of life, while recognizing both
interpersonal and intrapersonal strengths of individual members. In
addition to the anticipated cohesion of a more homogeneous group in
general, my hope is that in the event that an individual member’s
psoriasis flares, that group acceptance and understanding will further
bond the group, normalize feelings of anxiety and depression, and provide
concrete support to the member. Group psychotherapy may even be more
effective for some than individual psychotherapy.
only three studies to
date have examined the effects of group settings with individuals with
psoriasis, many more studies have been done examining the effects of group
psychotherapy with a wide variety of illnesses, including AIDS, arthritis,
cancer, heart disease, irritable bowel syndrome, and multiple sclerosis
amongst others, with positive and significant results.
Only one of the
three studies with psoriasis patients was actually facilitated by a
clinical psychologist. One was co-facilitated by a dermatologist and
psoriatic patient who trained together, and the other was simply a support
group for individuals participating in a day treatment center for people
with psoriasis. Both facilitated groups combined educational and
experiential components, and found positive results that were maintained
at follow-ups of six months for one and two years for the other. Though
each looked at slightly different variables, both facilitated groups
supported the overall increase in quality of life. The support group
emphasized the importance of social support in facilitating coping with
interest in focusing primarily on stigma,
social support, and coping and appraisal originates from the frequency of
these issues being raised in both the academic and lay literature, as well
as the topics of discussion in support groups such as the ones I attended
in my earlier years, and the one I facilitated before returning to
graduate school. Each of these predictors has the potential to affect
anxiety and depression, or the worsening of psoriasis, and become part of
a vicious cycle, as they are invariably interconnected. Each of these can
affect treatment compliance, which in and of itself can become part of a
cyclical downward spiral.
Though I will
following Yalom’s group psychotherapy model and emphasizing his curative
factors, my interest in exploring existential issues relates to the
concerns that many suffering from psoriasis may have regarding meaning and
quality of life, just as individuals with any chronic and/or terminal
illness may have. Many of the curative factors from Yalom’s group
psychotherapy model have the potential to impact feelings of stigma,
social support and coping. Hope, universality, altruism, cohesion,
interpersonal learning, and existential factors may be particularly useful
in this time-limited approach.
is anticipated that this study
will contribute to a greater awareness of the inseparable mind-body
connections of those suffering from psoriasis, and promote significant
improvement in ability to cope with psoriasis and life in general through
group psychotherapy, thereby improving overall quality of life.
It is further
hoped that participants will gain enough confidence and self-esteem to
better communicate their concerns and needs to family, friends, and
medical practitioners, subsequently educating the general public and
getting their needs met.
of the academic literature
specifically related to psoriasis and its emotional effects comes from
nursing and dermatology rather than psychology. This lack of psychological
literature is one of the reasons I have chosen to contribute further to
this particular field of study. Furthermore, through my professional
experience leading a support group for people with psoriasis, I repeatedly
observed the importance of having the support of group members in a safe
arena to discuss feelings around coping with psoriasis.
empirical research of the psychological effects of psoriasis is limited,
and mostly less clinical in nature. It is anticipated that participation
in the proposed psychotherapy group will improve the overall mental, and
in turn physical, health of its members, thereby supporting the necessity
of more widely available and accepted psychotherapeutic treatment for such
individuals. This recognition is important by those suffering from the
illness as well as those capable of providing therapeutic services. It is
also hoped that the results of the proposed study will encourage continued
clinical research in the arena of group psychotherapy for those with
closing, my interest lies
in emphasizing the inseparable mind-body connections of those suffering
from psoriasis, and providing a relatively safe environment and some tools
to make more effective appraisals and better cope with this chronic,
stigmatizing, and discouraging disease.
examined qualitative responses from women with psoriasis participating in
short-term, time-limited group psychotherapy, utilizing Irvin Yalom’s
psychotherapy approach. The group was both psychoeducational and
process oriented, utilizing existential/interpersonal and
cognitive-behavioral styles to facilitate coping, utilization of
relaxation techniques, and interpersonal interaction. This study
examined some psychosocial consequences of psoriasis (anxiety, depression,
self-esteem, and quality of life) in relation to some psychosocial
predictors of adjustment to psoriasis, including stigmatization, social
support, coping, and appraisal through a ten-week group experience.
provides a comprehensive qualitative analysis of participant responses and
group changes as an exploratory approach for future experimental studies
by assessing changes in both individual group members and the group as a
whole from the beginning to the end of the study, focusing on the
presence, absence and changes in Yalom’s therapeutic factors. The
data revealed that psychotherapy group participation was beneficial for
all members. Participants became more cognizant of how they related
to others, learned new coping skills, and developed a better understanding
of the importance of social support. Most group members indicated
one or more of the following benefits: decreased feelings of anxiety and
depression; an increase in quality of life and feelings of self-esteem;
and a greater ability to cope.
research focused primarily on individual differences in feelings of
anxiety, depression, self-esteem and coping rather than examining the
powerful group process itself. This study supports the findings of
five previous studies regarding the benefits of social support and
educational training to people with psoriasis, but additionally,
acknowledges the significance of the group process itself.
Recommendations for future clinical and empirical research are made.