Stress & The Effects on the Skin

stress

It has been established in recent years that the skin is a direct target of psychological stress via a cascade of hormones, neuropeptides, and neurogenic signals (causing nerve hypersensitivity and inflammation). The skin has been shown to be capable of launching its own local response to stress as well by producing many of the same substances that the brain produces, further enhancing the local effect at the skin level when someone is under acute or prolonged stress. It is no surprise that the skin can perceive and respond to stress similar to the brain and nervous system, since the two systems have evolved from the same germ layer during embryonic development.

The main skin cells (keratinocytes), mast cells (involved in allergy type reactions and inflammation), immune cells, and peripheral nerve endings all will have an effect on various cell behaviour and processes within the skin under stress that can lead to skin disruption, premature ageing and disease development.

The skin is rich in nerve endings, so when an individual is stressed the peripheral nerve endings secrete numerous substances such as Substance P and Nerve growth factor that contribute to hypersensitivity, inflammation, and allergic reactions.

Due to the impact of stress related hormones and peptides, and growth factors on the skin, stress can play a role in the development and exacerbation of skin disorders such as Eczema, Acne, Psoriasis, and Rosacea.

Psychological stress activates the autonomic nervous system to trigger release of catecholamines [e.g. epinephrine and norepinephrine] from the adrenal glands, and in situations of chronic stress corticotrophin releasing hormone [CRH] and ACTH (adrenocorticotropic hormone), mediate a release of glucocorticoids (Cortisol) from the adrenal cortex.

Here is a brief outline of some key stress mediators and the effect that they have on the skin:

Glucocorticoids:

Excess levels can cause atrophy and impaired wound healing by interfering with keratinocyte and fibroblast function. Keratinocytes are the primary skin cells that form the epidermis of the skin, and fibroblasts are responsible for collagen and elastin formation.

This manifests as atrophy and thinning of the skin, increased trans-epidermal water loss related to disruption to the skin permeability barrier, and easy bruising with impaired wound healing.

The skin barrier is also negatively impacted by excess cortisol as this effects the lamellar bodies in the skin cells which are responsible for lipid synthesis; the lack of essential lipids weakens the barrier resulting in dry skin, allergies and sensitivity, delayed healing and infections.

Insulin:

Excess glucocorticoids stimulate Insulin production and lead to insulin excess and Insulin resistance. Elevated Insulin stimulates IGF2 (Insulin growth factor) which increases growth of keratinocytes, and stimulates abnormal keratinocyte growth, (exacerbates Psoriasis and Acne) and increases androgens and testosterone release.

Substance P:

This is neuropeptide released in times of stress. Substance P stimulates sebaceous germinative cells and proliferation of sebaceous glands which results in excess oil production and blockage of the oil ducts and the development of acne. Substance P also activates mast cells, increasing histamine release and itch sensation. Substance P induces vascular permeability and inflammation, which aggravates conditions like Eczema and Rosacea.

Corticotropin Releasing Hormone (CRH):

CRH stimulates release of MSH (melanocyte stimulating hormone) causing hyperpigmentation and blotchy skin.

Catecholamines (Adrenaline, Noradrenaline)

Decrease blood perfusion to skin reducing availability of oxygen and nutrients resulting in poor texture and sallow / pallor. Catecholamines have also been shown to cause immune suppression, interfere with DNA repair and contribute to ageing.

Managing stress

While the effects of stress on the skin are only briefly outlined above, it illustrates the significant impact this can have on individuals predisposed to skin conditions. It is therefore imperative to minimise stress where possible in order to avoid any exacerbation of skin disorders.

There are some straight forward tips to reduce stress such as getting a good night’s sleep, exercising and following some simple dietary guidelines (listed below).

stress_2

Reduce salt intake

Avoid alcohol

Avoid caffeine

Avoid skipping meals

Avoid refined, processed foods.

Avoid high fat foods

Do eat high fibre, low glycaemic index diet

In the following blogs we will present some relaxation techniques that are easy to implement and will have a direct effect in reducing the side effects of stress.

 

References

  1. Dunn, Jeffrey HKoo, John; Psychological Stress and skin aging: A review of possible mechanisms and potential therapies; Dermatology Online Journal 19 (6): 1 University of Colorado, School of
  2. Medicine, 2 University of California, San Francisco, Department of Dermatology 2013 Permalink: http://escholarship.org/uc/item/3j0766hs
  3. Jessica M. F. Hall, desAnges Cruser, Alan Podawiltz, Diana I. Mummert, Harlan Jones, Mark E. Mummert; Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis; Dermatology Research and Practice Volume 2012, Article ID 403908, doi:10.1155/2012/403908
  4. Ying Chen, John Lyga; Brain – Skin Connection: Stress, Inflammation and Skin Aging; Inflammation & Allergy – Drug Targets, 2014, 13, 177-190
  5. Theoharis C. Theoharides, Jill M. Donelan, Nikoletta Papadopoulou, Jing Cao, Duraisamy Kempuraj, Pio Conti; Mast cells as targets of corticotropin releasing factor and related peptides; TRENDS in Pharmacological Sciences Vol.25 No.11 November 2004

Itch (Pruritus) & Eczema

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Scratching is the natural response to itch (Pruritus) and, by definition, inseparable from it. The act of scratching not only diminishes itch, but it has been found to be rewarding and addictive. The itch-scratch cycle is a complex phenomenon involving sensory, motor and emotional components. The urge to scratch can be remarkably intense because the reward provided by scratching brings such intense relief and may also be associated feelings of pleasure and enjoyment. Recent studies have shown that rating scratching as a pleasurable experience is correlated with the intensity of the underlying itch, both in patients with chronic itch and healthy individuals.1 Various functional brain imaging studies have discovered that the itch-scratch cycle in humans can be tracked to specific regions of the brain, including areas related to reward, pain sensation, and addiction.1,2

The Itch-Scratch-Rash cycle is commonly used to describe this ongoing, never ceasing, always constant itch that makes eczema very different from many other skin condition. Eczema has often been called the “Itch that Rashes” rather than the “Rash that Itches”.3 

Itch_1

The itchier a patient feels, the more scratching of the skin that occurs and which ultimately lead to skin damage and the appearance of a red rash. Often, in chronic presentations it becomes a completely unconscious habit and patients are often not even aware that they are scratching. When a patient scratches, the skin becomes inflamed, this inflammation then causes the skin to itch even more, thus making it even harder for the patient to resist the urge to scratch. This vicious circle can become so severe that it causes sleeplessness, irritability, anxiety and stress. In extreme cases it can lead to significant excoriations (open, bloody and deep scratch wounds) on the skin or even severe lichenification (thickening of the skin) and pain. 

The Practitioner and Patient need to recognize and address various aspects of itch, including:

(1) Identification and elimination of trigger factors;

(2) Maintaining the skin barrier through emollients – Oil based and Water Based;

(3) Targeting inflammation through topical medications and systemic (oral) medications

(4) Addressing psychological and behavioural components; and

(5) Education – understanding the condition.

The sensation of pruritus can be triggered by endogenous (internal) and exogenous (external) stimuli, which activate specific peripheral nerve endings in the epidermis and dermis layers of the skin.3

Trigger Factors3

Allergies                                   House dust mites, food allergens, air-born contact dermatitis (pollen, etc.), animals (e.g. cat                                                        dander), jewellery, certain cosmetic ingredients.

Infections                                 Staphylococcus aureus, viral infections (herpes, molluscum), yeasts (eg, Trichophyton,                                                                malassezia).

Exogenous                               Soaps, solvents, wool, sweat, chemicals, toxins, cigarette smoke, smog.

Physical stimuli                       Temperature: humidity, cold dry air, clothes rubbing on the skin.

Emotional                                Anxiety/Stress /Anger/ Depression.

How to rate your Itch4

Based on the Eppendorf  Itch Questionnaire.

Rate each of the following from 0 to 4

The following describes your Itch………

  0 1 2 3 4
  Painful          
  Pulsating          
  Throbbing          
  Prickling          
  Hurting          
  Tickling          
  Stinging          
  Worse when Cold          
  Less when Cold          
  Worse when Hot          
  Less when Hot          
  Dull          
  Sharp          
  Burning          
  Feels like ants          
  Comes in waves          
  Unbearable          
  Annoying          
  Physical urge to scratch          
  Numbing          
  Relentless          
  Cruel          
  Tormenting          
  Tiring          
  Numbing          
  Severe          
  Uncontrollable          
  I only can think of the Itch          

When do you feel the need to Itch?

  0 1 2 3 4
  In the Morning          
  In the Evening          
  At night          
  At rest          
  Worse in Bed          
  After a hot shower          
  After exercise          
  After being outside          
  After being in the Sun          
  After gardening          
  After Dusting, Sweeping/Vacuuming/ Changing beds          
  After eating certain foods

  Specify

         

How would you describe the need to Scratch?

  0 1 2 3 4
  I find it enjoyable          
  It is a physical urge          
  It is compulsive          
  I forget when I do it          
  I always want to scratch          
  I find it satisfying          
  I find it pleasurable          
  It hurts but I cannot stop          
  Other –          

What action do you take when you feel the urge to scratch?

  0 1 2 3 4
  I rub          
  I scratch with my nails          
  I scratch with my fingertips          
  I scratch with my knuckles          
  I use a pencil/pen/ruler/stick          
  I rub          
  I pinch          
  I use a cold pack          
  I use a heat pack          
  I take a cold shower          
  I take a warm shower          
  I take a hot shower          
  I put the air conditioner on          
  I turn down the ducted heating          
  I dig my fingernails in          
  I bite my lip          
  I scratch until I bleed          
  I apply pressure          
  Other –          

Which areas of the body do you scratch the most?

                              Front                                                           Back

What distracts you from the urge to scratch?

  0 1 2 3 4
  Company distracts me          
  Watching Television          
  Reading a Book          
  Using a Computer/IPhone/IPad          
  Listening to music          
  Applying heat pack          
  Applying ice pack          
  Exercising          
  Doing something with my hands   (hobby)          
  Other –          

When you understand your itch, when you itch, what you do when you scratch and what distract you from scratching, you may be able to plan your approach to your itch more methodically and with more control. You may decide that you need to start a meditation or behavioural therapy class to help you control the need to scratch. You may find that you will learn the best times to apply your creams so that you circumvent the urge to scratch e.g. applying creams before gardening or mowing the lawn or doing housework etc.

What can a Patient do to avoid or control the urge to itch?

Scratching is difficult to resist because it gives the mental impression of easing the itch – but this is only for the short-term. Eventually the sensation to itch comes back – even worse that before you scratched. 

Basic tips to control the urge to itch:- 

  • Keep nails short to avoid tearing the skin when scratching. 
  • Keep cool. Over-heating can trigger the itch. Try to keep your body temperature as constant as you can, wear light layers of cotton clothes.
  • Avoid overheated rooms, keep ducted heating to a minimum, and at night keep the bedrooms cold.
  • Avoid heavy blankets and doonas – use cotton blankets if possible. 
  • Gently rub with the back of the fingers, place pressure or gently pinch the area instead of scratching. 
  • Use a cold compress 

Parents of children often ask “How can I stop my child from scratching?” And as scratching is an instinctive reaction to itching which can become a compulsive/unconscious habit, that question is not an easy one to answer. Parents can help by keeping their child’s nails short and, especially at night, by covering their hands with cotton mittens. 

With older children, it is important that you explain to them how scratching will actually make them feel worse, not better. And that their skin will become redder, more cracked and feel itchier and sorer. 

Become aware of any habits of scratching that your or your child may be developing and take especial note as whether it is at a particular time of day, or during a particular activity, such as playing sport or just watching television. If you or the parents of a child become aware of these types of habits then it is important to try to break the habit.

Nonpharmacological Treatments for the Management of Atopic Dermatitis Itch

 Cognitive-behavioural methods3,5,6

Cognitive-behavioural methods alter dysfunctional habits by interrupting and altering dysfunctional thought patterns (cognitions) or actions (behaviours) that damage the skin or interfere with dermatologic therapy. e.g. Itch-coping Training Programme or Habit Reversal Training, cognitive-behavioural methods for the reduction of itch and scratching behaviour, including self-monitoring, guidance in skin care and coping skills to manage itch- and scratch-triggering factors, stress-management methods with relaxation techniques and habit reversal. The habit reversal technique teaches patients to recognize the habit of scratching, identify situations that provoke scratching, and train them to develop a competing response practice, for example, a child who unconsciously scratches can be taught to recognize the early signs of the sensation of itch and instead of scratching be taught to clench his/her fists or place his/her hands underneath his/her legs as soon as they feel the sensation of itch.

Biofeedback5,7

Biofeedback can enhance the patient’s awareness of tension and help them to relax; improving skin disorders that flare with stress or that have an autonomic nervous system aspect. Biofeedback is a mind-body therapy that uses electronic instruments to assist patients to gain awareness and control over psychophysiological processes. The patient is connected to a machine that measures muscle activity, skin temperature, electrodermal activity, respiration, heart rate, heart rate variability, blood pressure, brain electrical activity, and brain blood flow and visually gives the patient feedback as they go through various “game” like tasks. Chronic itch, which may be somatic, emotional and cognitive, may be treated with therapies that can modulate the autonomic nervous system stress response. Behavioural biofeedback techniques that reduce stress and anxiety have been used to treat chronic pain and itch and could potentially alter the sympathetic over-activity noted in patients with AD.

Hypnosis / Meditation8

With proper training, an individual can intensify this trance state in himself or herself and use this heightened focus to induce mind-body interactions that help alleviate suffering or promote healing. The state of altered consciousness known as a “trance state” may be induced using guided imagery, relaxation, deep breathing, meditation techniques, self-hypnosis or by a trained medical practitioner. Researchers have used relaxation, stress management, direct suggestion for non-scratching behaviour, direct suggestion for skin comfort and coolness, ego strengthening, posthypnotic suggestions, and instruction in self-hypnosis. Their results were statistically significant for reduction in itch, scratching, sleep disturbance, and tension. Reported topical corticosteroid use decreased by 40% at 4 weeks, 50% at 8 weeks, and 60% at 16 weeks. For milder cases of atopic dermatitis, hypnosis along with moisturization can suffice as a primary alternative treatment. For more extensive or resistant atopic dermatitis, hypnosis can be a useful complementary therapy that reduces the amounts required of other conventional treatments.

Read also our Blogs for Psoriasis …. The same techniques can be used for Eczema

Simple Mental/Mind Relaxation Techniques Part 1 – For Psoriasis Patients

Simple Mental/Mind Relaxation Techniques Part 2 – For Psoriasis Patients

Itch_4 Itch_5 Itch_6

References

 

  • Papoiu A. D. P. et al.; Brain’s Reward Circuits Mediate Itch Relief. A Functional MRI Study of Active Scratching; PLOS ONE, www.plosone.org 1 December 2013, Volume 8, Issue 12, e82389
  • Mochizuki H. et al.; Chapter 23Brain Processing of Itch and Scratching; http://www.ncbi.nlm.nih.gov/books/NBK200933/?report=printable
  • Hong J. et al.; Management of Itch in Atopic Dermatitis; Seminars in Cutaneous Medicine and Surgery; Elsivier; doi:10.1016/j.sder.2011.05.002; Pg 71-88
  • Darsow U. et al.; New Aspects of Itch Pathophysiology: Component Analysis of Atopic Itch Using the ‘Eppendorf Itch Questionnaire’; Int Arch Allergy Immunol 2001;124:326–331
  • Shenefelt PD.; Psychological interventions in the management of common skin conditions; Psychology Research and Behavior Management 2010:3 51–63
  • Evers Et al.; Effectiveness of a Multidisciplinary Itch-coping Training Programme in Adults with Atopic Dermatitis; Acta Derm Venereol 2009; 89: 57–63
  • Tran BW. Et al.; Effect of Itch, Scratching and Mental Stress on Autonomic Nervous System Function in Atopic Dermatitis; Acta Derm Venereol 2010; 90: 354–361
  • Shenefelt PD. ;Hypnosis in Dermatology; Arch Dermatol / VOL 136, MAR 2000

 

What triggers Psoriasis?

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Psoriasis is a chronic inflammatory skin disorder and whilst the exact causes of psoriasis have yet to be discovered, the immune system and genetics are known to play major roles in its development. The immune system is somehow mistakenly triggered, which speeds up the growth cycle of skin cells among other immune reactions1.

Researchers show that whether a person develops psoriasis or not may depend on a “trigger”2. These Primary Triggers activate the condition.

Possible Primary triggers include:

Koebner Phenomenon Skin Injury e.g. animal bites, burns, electrodesiccation, excoriation, freezing, friction, gunshot wounds, insect bites, lacerations, nail manicuring, Poor fitting shoes, pressure, shaving, surgical grafts, surgical incision, tape stripping, thumb sucking, x-rays, sunburn, tattoos (injury).

……. burned-skin-1556804 FreeImagesmosquito-bite-3-1410910 FreeImagestattoo-in-flame-1187558 FreeImages injury-1182660 FreeImages

Stress anxiety, depression, psychological illnesses e.g. Post-Traumatic Stress Disorder.

Certain medicines e.g.:-pills-1422509 Free Images
Anti-malarial– e.g. Doxycycline, chloroquine
– Lithium– depression or psychiatric disorders
– ACE Inhibitors- High blood pressure medication
– Anti-inflammatory medicine – e.g. ibuprofen or Indomethacin
– Beta blockers – taken by patients with heart failure
– Corticosteroids– Prescribed for a variety of health conditions. Sudden discontinuation of  relatively high   doses can be a trigger.

Infectionsin some people, usually children and young adults, a form of psoriasis called guttate psoriasis develops after a streptococcal throat infection (note: most people who have streptococcal throat infections will not develop psoriasis), upper respiratory infections such as such as streptococcal pharyngitis or sinusitis. People with weakened immune systems; such as HIVpatients, are more susceptible to psoriasis.

There are also a number of Secondary Triggers, and these exacerbate the condition once it has been activated, and will continue to worsen the condition. They are:-

Triggers

  • Consumption of alcohol
  • Smoking
  • Chemical exposure 
  • Hormones
  • Weather – exposure to cold
  • Adverse foods 

Not all psoriasis sufferers will react to all of the above triggers, so the best thing to do is to record consumption of foods, liquids etc., how you slept, what stresses you were under and any exposure to chemicals and other environmental triggers and at the same time monitor your symptoms e.g. increases itch, irritability, new lesions or worsening of existing lesions etc. Note that some triggers e.g. skin injuries may not show a flare-up up for up to 10 to 14 days after a triggering event, so if you noticed that you were bitten by mosquitos or insects record it with the date and then take note of any subsequent delayed flare ups.

REFERENCES

  1. Višnja Milavec-Pureti? et al.; Drug Induced Psoriasis; Acta Dermatovenerol Croat 2011;19(1):39-42
  2. Kuchekar A.B. et al.; Psoriasis: A comprehensive review; Int. J. of Pharm. & Life Sci. (IJPLS), Vol. 2, Issue 6: June: 2011, 857-877 857

PSORIASIS – the Relationship with Drugs

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Cutaneous drug eruptions are one of the most common types of adverse reaction to drug therapy, with an overall incidence rate of 2–3% in hospitalized patients. Almost any medicine can induce skin reactions, and certain drug classes, such as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics and anti-epileptics have drug eruption rates approaching 1–5%.1

Drug Relationship

Psoriasis & Drugs

Drug ingestion may result in several different responses:-

  1. a) Drugs may trigger the condition in a Patient who is genetically predisposed to psoriasis.
  2. b) Drugs may trigger the condition “de novo”, in a Patient non–predisposed.
  3. c) Drugs may exacerbate existing psoriatic lesions in a Patient.
  4. d) Drugs may trigger a psoriatic flare up in “clinically normal” skin in patients with psoriatic 2

In view of their relationship to psoriasis, therapeutic agents may be classified as follows:

(1)     Drugs with strong reported case evidence for a causal relationship to psoriasis including lithium, beta blockers, and synthetic antimalarial drugs;

(2)     Drugs with a considerable number of studies but insufficient data to support induction  or aggravation of the disease;

(3)     Drugs occasionally reported to be associated with aggravation or induction. 2.3

Drug-provoked psoriasis can be divided into two categories:-

1]       Drug-INDUCED psoriasis – where discontinuation of the causative drug stops the further progression of the disease. This form tends to occur in a “de novo” fashion in patients with no family or previous history of psoriasis. The clinical presentation of   these lesions  may often mimic the pustular variant of psoriasis, often with no nail involvement or associated arthritis. 2

2]       Drug-AGGRAVATED psoriasis – where the disease progresses even after the discontinuation of the offending drug and usually occur in patients with a history of  psoriasis or with a genetic predisposition for the disease. Patients can have exacerbation of pre-existing psoriatic lesions or develop new lesions in previously   uninvolved skin. Histological examination reveals features that are more characteristicof psoriasis vulgaris. 2

These two reactions are not to be confused with “Psoriasiform drug eruption”. This is a broad term that refers to a group of disorders that clinically and/or histologically simulate psoriasis at some point during the course of the disease. This type of eruption is usually associated with seborrheic dermatitis, pityriasis rubra pilaris, secondary syphilis, pityriasis rosea, mycosis fungoides, and some malignancies. 2

Some Drugs that Trigger or Exacerbates Psoriasis

Although a several drugs have been implicated in provoking psoriasis, the strongest evidence is for lithium, beta-blockers, anti-malarials, non-steroidal anti-inflammatory drugs and tetracyclines. In addition, angiotensin-converting enzyme inhibitors, interferons, digoxin, clonidine, carbamazepine, valproic acid, calcium-channel blockers, granulocyte-colony stimulating factor, potassium iodide, ampicillin, penicillin, progesterone, morphine and acetazolamide have been reported to exacerbate psoriasis. 4

 DRUG  Mechanism of Action Comments
 Beta-blockers  A delayed type hypersensitivity reaction, an immune mediated response and a decrease in intraepidermal cAMP and a consequent increase in peidermal cell turnover Both cardioselective and non-cardioselective drugs have been implicated but the frequency is higher with the latter.

Also with topical timolol, reported to induce psoriasis and to transform psoriasis vulgaris (Plaque) into psoriatic erythroderma.

 Lithium       Acts directly by blocking cell differentiation and leading to dysregulation of inflammatory cytokines and indirectly by decreasing cAMP levels Provokes or induces chronic plaque psoriasis, localized or gnerealized pustular psoriasis and even psoriatic erythroderma.
 Antimalarials  May trigger psoriasis by inhibiting the enzyme transglutaminase Does not induce psoriasis although they are known to trigger psoriasis in 18% of patients.
 NSAIDs  Inhibits the cyclo-oxygenase pathway, leading to accumulation of leukotrienes and hence may exacerbate psoriasis  
 Tetracyclines  May provoke psoriasis either by inhibiting cAMP or by inducing Koebner’s phenomenon due to their photosensitizing potential  

It is important for the patient to supply information to their GP or Practitioner as to all medications being used and when the lesions were first noticed, or when they noticed their existing lesions worsening. In some instances the eruption of new lesions may take several weeks or even months to occur, when this happens it may be difficult to determine the exact causal relationship between a drug and an eruption. The following chart may be of assistance in determining if one of your medications may be involved.

 Date  Time  Medication  Name  Dose  Reason for Medication Symptoms Experienced When Symptoms

First Noticed

  e.g. 15/2  8.00am  Carvedilol   25mg  Blood Pressure New lesions on skin not affecting old lesions 2 weeks after first taking it.
 Or e.g. 15/2  8.00am  Bisoprolol  10mg  Cardiomyopathy Worsening of old lesions After 72 hours, burning red skin, lesions rapidly spread
             
             
             

REFERENCES

  • Lee A. Thomson J.; Drug-induced skin reactions; Adverse Drug Reactions, 2nd edition (ISBN: 0 85369 601 2) Pharmaceutical Press 2006; http://www.pharmpress.com/files/docs/ADRe2Ch05.pdf
  • GRACE K. KIM, DO; b JAMES Q. DEL ROSSO, DO ; Drug-Provoked Psoriasis: Is It Drug Induced or Drug Aggravated? Understanding Pathophysiology and Clinical Relevance; J Clin Aesthetic Dermatol. 2010;3(1):32–38.
  • Milavec-Pureti? V. et al.; Drug Induced Psoriasis; Acta Dermatovenerol Croat; 2011;19(1):39-42
  • Mahajan R, Handa S. Pathophysiology of psoriasis. Indian J Dermatol Venereol Leprol 2013;79, Suppl S1:1-9

 

Simple Mental/Mind Relaxation Techniques Part 2

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Are you having trouble controlling your thoughts and finding it difficult to let yourself float in the Full Body Scan Meditation or the Releasing Troubles and Worries Exercise?

simple_mental_part1_5

WELL DON’T WORRY!!!!!!!

Here is a “Thought-Stopping” Exercise that can be used during either the Full Body Scan Meditation or the Releasing Troubles and Worries Exercise or when trying to get to sleep.

In thought-stopping, you would do this exercise FIRST. So lie on a yoga bed for the exercises or in bed to get to sleep.

Think about something that you know is worrying you and will keep you awake …… something troubling you that you will know your mind will churn over and make it difficult to relax or go to sleep.  Force your mind to concentrate on that issue or person e.g. the project at work is in trouble and you know your boss is going to get angry at you and the team. Turn this over in your mind again and again and then suddenly in your mind “Shout Out” STOP!!!!!!. Breath easily and try to relax …… if you feel the issue creeping back into your mind ….. repeat the STOP exercise again and again until your mind releases the thought.

This STOP exercise basically is forcing your brain to recognize when to stop thinking about something …. It abruptly interrupts the thought process and makes the brain shift its focus … this is where the relaxation technique, that you have chosen should now be used.

A number of sites on the internet offer some wonderful guided meditations, and alternative Relaxation Techniques. Below we have listed some of the techniques and their links:-

SAFE HAVEN” – VISUALIZATION – Page 19 http://www.mirecc.va.gov/visn16/docs/Franklin_Relaxation_Therapist_Manual.pdf

QUICK RELAXATION STRATEGIES

https://www.k-state.edu/paccats/Contents/Stress/Quick%20Relaxation%20

Strategies.pdf

 

ABC GUIDED AUDIO MEDITATIONS

http://www.abc.net.au/radionational/programs/lifematters/features/meditation-toolkit/audio-practice/4326674

 

Also read our blog “Stress, Anxiety, Depression and Psoriasis, Stressed about Psoriasis – Identify Your Stressors and Yours Stress Responses, Simple Physical Relaxation Techniques for Psoriasis Patients, Simple Mental/Mind Relaxation Techniques Part 1 – For Psoriasis Patients, Simple Mental/Mind Relaxation

 

REFERENCES

  1. National Center for Health Promotion and Disease Prevention (NCP); Manage Stress Workbook; http://www.prevention.va.gov/mpt/2013/docs/managestressworkbook_dec2013.pdf
  2. Relaxation Techniques for Health: What You Need To Know; National Institutes of Health; U.S. Department of Health and Human Services; https://nccih.nih.gov/sites/nccam.nih.gov/files/Get_The_Facts_Relaxation_Techniques_02-06-2015.pdf
  3. Progressive Muscle Relaxation; http://www.cci.health.wa.gov.au/docs/ACF3944.pdf
  4. Manzoni G.M. et al.; Relaxation training for anxiety: a ten-years systematic review with meta-analysis ; BMC Psychiatry 2008, 8:41 doi:10.1186/1471-244X-8-41
  5. Franklin C.L. et al.: Relaxation Enhancement Therapist Manual; http://www.mirecc.va.gov/visn16/docs/Franklin_Relaxation_Therapist_Manual.pdf

Simple Physical Relaxation Techniques

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It is important that you and you alone take control – find the solution that best helps you and ensure that you keep doing it – remember it comes down to your adherence to not only your treatment plan but also in your efforts to control your stress and increase your emotional resilience.

The next step is to test some simple Physical Relaxation Techniques and find the one that works for you:-

Use the following to help you release muscle tension.

YOGA STRETCH

 1.         Stand relaxed with your arms hanging at your sides and place your feet comfortably apart.

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2.       Tilt your head back and count slowly to five.

3.       Roll your head forward and count slowly to five.

4.       Exhale as you curl your body forward and bend at the waist; arms dangling down and slowly count to five.

5.       Inhale slowly through your mouth as you slowly straighten up whilst raising your arms overhead – stretching as far as you can. Then            drop your arms slowly to sides as you exhale though your mouth.

Repeat several times.

CONTROLLED BREATHING

1.        Use a yoga mat or a folded blanket – lie down with your back flat on the floor and place a book or large magazine on your                          stomach.

2.        Bend your knees (you can close your eyes if this makes your more relaxed).

3.        Inhales and push your stomach upwards (but not you upper chest) as far as you can and slowly count to five, then exhale slowly.                You may also use the affirmative “I am relaxed” as you exhale.

Repeat several times.

Use the following after a physical reaction to a stressful situation to allow the physical changes of your stress reaction to subside and return to a non-stress state.

RELAXATION RESPONSE

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1.        Sit (or lie) in a comfortable position in a quiet environment with eyes closed.

2.        Start with your feet and mentally relax each muscle group moving up to the head—calf, thigh, waist, stomach, arms, chest, neck,              face, and forehead.

3.        Breathe in through your nose gently pushing your stomach out (but not your upper chest).

4.        Breathe out through your mouth and let your stomach relax.

Repeat this exercise for 10-20 minutes.

When finished, open your eyes but remain seated or lying for several more minutes.

PROGRESSIVE RELAXATION

1.        Lie flat on a yoga mat or a folded blanket – with your eyes closed and knees bent.

2.        Beginning with your right foot, press foot firmly to the floor and count slowly to five, then relax for the count of five; repeat with the              left foot.

3.        Straighten legs out and press back of lower right leg firmly to the floor and count slowly to five, then relax for the count of five;                    repeat with left leg.

4.        Press each of the following areas firmly to the floor and count slowly to five, and then relax for the count of five. (one at a time):

             a.      Back of thighs and buttocks

             b.       Lower back and shoulder blades

             c.       Arms

             d.      Back of head

REMEMBER: – to breathe normally as you press and relax. Repeat several times.

There are many other forms of Relaxations Techniques including, exercise, meditation, yoga, Tai Chi etc. On the internet there are many sites that offer other tips for relaxation exercises and meditation techniques…

Walking is an excellent form of exercise that will cost you nothing.

And of course other activities e.g. gyms and swimming pools will require membership fees to be paid.

Also read our blog “Stress, Anxiety, Depression and Psoriasis, Stressed about Psoriasis – Identify Your Stressors and Yours Stress Responses, Simple Mental/Mind Relaxation Techniques Part1, and Simple Mental/Mind Relaxation – Part 2

 

REFERENCES

 

  • National Center for Health Promotion and Disease Prevention (NCP); Manage Stress Workbook; http://www.prevention.va.gov/mpt/2013/docs/managestressworkbook_dec2013.pdf
  • Relaxation Techniques for Health: What You Need To Know; National Institutes of Health; U.S. Department of Health and Human Services; https://nccih.nih.gov/sites/nccam.nih.gov/files/Get_The_Facts_Relaxation_Techniques_02-06-2015.pdf
  • Progressive Muscle Relaxation; http://www.cci.health.wa.gov.au/docs/ACF3944.pdf
  • Manzoni G.M. et al.; Relaxation training for anxiety: a ten-years systematic review with meta-analysis ; BMC Psychiatry 2008, 8:41 doi:10.1186/1471-244X-8-41
  • Franklin C.L. et al.: Relaxation Enhancement Therapist Manual; http://www.mirecc.va.gov/visn16/docs/Franklin_Relaxation_Therapist_Manual.pdf

 

Stress, Anxiety, Depression and Psoriasis

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A rapid heartbeat, headache, stiff neck, backache, rapid breathing, sweating and upset stomach are a few of the everyday physical symptoms of stress, anxiety or depression. There is a growing medical consensus of opinion that many skin diseases are strongly associated with psychological stress and illness. The relationship of stress, anxiety, depression, not to mention feelings of stigma, shame, embarrassment, and low self-esteem all impact upon a person who is suffering from psoriasis. 1, 2

The interplay between stress and multiple biologic systems in our bodies can trigger the onset of psoriasis. For many anxiety or depression is a symptom after the event, especially if the condition is chronic and especially visual and/or painful.

Regardless of how stress is defined, studies conducted show a consistent relationship between stress and psoriasis.  The majority of psoriasis sufferers, themselves, also consider stress to be the main cause for or exacerbation of their psoriasis, ranking it above infections, trauma, medications, diet, or weather.

Studies have defined stress into three general categories:                                                     sorrow-and-worry-1434793 FreeImages

1) Major stressful life events (e.g., employment or financial problems,

    death of a spouse, major personal illness),

2) Psychological or personality difficulties, and

3) Lack of social support.

In one study patients were questioned as to what types of stressful life events that had occurred in the previous 12 months, that could have triggered their skin condition.

Stressful life events were seen in 26% of the psoriasis patients, the most common stressful life event seen was financial loss or problems (8%), death of close family member (4%), sexual problems (4%), family conflict (2%), major personal illness or injury (2%), change in working conditions (2%), failure in examinations (2%), family member unemployed (2%), illness of family member (2%), getting married or engaged (2%) and miscellaneous (2%). 5

 It is important to recognize that psoriasis is a lifelong disease that affects patients not only physically but also socially and emotionally. As seen from the patients’ perspective, the most severe negative effects of their skin condition do not result from physical symptoms alone, but rather from the interaction of their physical symptoms and their mental/emotional state. Researchers have found that the stress of having psoriasis, in itself can initiate or exacerbate depression in depression-prone individuals.

The challenge for sufferers of skin conditions is, with the aim of improving their quality of life, to help themselves to find, together with their practitioner, the best personal treatment plan and then sticking to it. The main challenges in the effective management of skin conditions, comes down to patient adherence to the treatment plan and their emotional resilience.

 

References

  1. Biljan D. et al.: Psoriasis, Mental Disorders and Stress, Coll. Antropol. 33 (2009) 3: 889–892
  2. Buske KIrschbaum Hellhammer et al.,; Endocrine and immune responses to stress in chronic inflammatory skin disorders; 992. 231-240 (2003)
  3. Gerhard Schmid-Ott et al.,; Patient considerations in the management of mental stress in psoriasis; Patient Intelligence 2012:4 41–50; 2012 publisher and licensee Dove Medical Press Ltd.
  4. Malhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria.; Indian J Dermatol Venereol Leprol 2008;74:594-9.
  5. Madhulika A. Gupta. Et al.; A Psychocutaneous Profile of Psoriasis Patients, Who Are Stress Reactors, A Study of 127 Patients; Gen Hosp Psychiatry;11, 166-173, 1989
  6. Jafferany M. Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders.Primary Care Companion to The Journal of Clinical Psychiatry. 2007;9(3):203-213.