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Have you ever heard of MBSR (Mindfulness-Based Stress Reduction)? My guest today is going to tell us all about it, as well as research into why a mindfulness practice could be beneficial for those with chronic skin issues (such as eczema, psoriasis, and alopecia areata).
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Jessica completed her BSc at York University in Toronto, ON and has completed her Doctor of Naturopathy degree from the Canadian College of Naturopathic Medicine. Her passion for integrative medicine and research led her to a postdoc position at UC Davis’ Department of Dermatology and now more recently, to work with Integrative Skin Science and Research.
Her research interests include nutrition, the microbiome, mindfulness, and quality of life in various dermatological conditions.
Join us as we discuss research surrounding the benefits of mindfulness for chronic skin rashes.
Do you have a regular stress reduction and mindfulness practice? Let me know in the comments!
In this episode:
- Can our state of mind affect our skin?
- What do the terms “itch intensity” and “itch catastrophizing” mean?
- Can a mindfulness practice help people with alopecia areata?
- What is MBSR (Mindfulness Based Stress Reduction)?
Quotes
“You can think of mindfulness as the practice of paying attention on purpose to the present moment without judgment.” [5:40]
“Itch catastrophization could be thoughts along the lines of this itch is only going to continue to get worse and worse and it's never going to go away. And so seeing maybe the extremes of the negatives and the anticipation of it becoming gradually worse. And itch intensity is more so about the physical sensation of it really increasing and how you feel the itch.” [7:51]
Links
Follow Jessica on Instagram
Articles highlighted in this episode:
Alopecia
– Gallo R, Chiorri C, Gasparini G, Signori A, Burroni A, Parodi A. 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(4):757-759. doi:10.1016/j.jaad.2016.10.012
Psoriasis
– Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a Mindfulness Meditation-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients With Moderate to Severe Psoriasis Undergoing Photo Therapy (UVB) and Photochemotherapy (PUVA): Psychosom Med. 1998;60(5):625-632. doi:10.1097/00006842-199809000-00020
– Fordham B, Griffiths CEM, Bundy C. A pilot study examining mindfulness-based cognitive therapy in psoriasis. Psychology, Health & Medicine. 2015;20(1):121-127. doi:10.1080/13548506.2014.902483
Atopic Dermatitis
– Lüßmann K, Montgomery K, Thompson A, et al. Mindfulness as Predictor of Itch Catastrophizing in Patients With Atopic Dermatitis: Results of a Cross-Sectional Questionnaire Study. Front Med. 2021;8:627611. doi:10.3389/fmed.2021.627611
230: {RESEARCH} Mindfulness Stress Reduction Benefits For Chronic Skin Problems Like Eczema + Psoriasis w/ Jessica Maloh FULL TRANSCRIPT
Jennifer: Thank you so much, Jessica, for being here. I am super excited to talk to you about. It's kind of how mindfulness and whatnot is related and tied into skin issues and how we can really use it to our benefit. But I'm kind of curious, this is the first time for you being here on the show. We met at the Integrative Dermatology Symposium. What are you really excited about and why does this area excite you about this like intersection between the scientific and… I don't even know what to call this. There is a lot of science here, but it's also slightly more abstract in the way that we're looking at solving health problems like skin issues.
Jessica: Totally. And I'd like to say I'm so excited to be here. I'm so grateful that we had the lucky chance to meet at IDS and I think this is a wonderful opportunity to share some of the research there is on the connection between the mind and the body specifically and skin. And I think it's really important to do so because of course we have these fantastic modalities, whether it's nutrition and supplements and pharmaceuticals that can do really wonderful things to a variety of conditions, but I think it's equally important to look at what's happening to the mind, how we're feeling on a day-to-day basis or a narrative about what we're going through and of course what that means for quality of life. And so to take some time to review the research and from there maybe talk practical ways we can implement it to see the benefits, I think that's a really important thing to do.
Jennifer: Can I ask you because maybe someone might not even realize this, is there a connection between one's state of mind and their quality of life when they're in this situation? So for all of my listeners who have chronic skin issues.
Jessica: Absolutely. There is research to suggest that our state of mind can impact us on a physiological level and that it can affect us based on our mood. And so there's one study that looked into our tendency to have our minds wander, and this study found that our minds tend to wander approximately 50% of the time. That's huge. And then further than that, they went and found that it seems that a wandering mind is associated with an unhappy mind. And so if we can pay more attention to things like what's happening in the present moment, what we're feeling right now, regardless of the pleasantness or unpleasantness of it, it can certainly affect our mood and quality of life.
Jennifer: And some of these research papers we're going to talk about today, I was just like super fascinated by them because it feels like at least from my experience and my perception that there is finally some data that really shows the value and benefits of what it would be considered like a mindfulness practice for… And these studies, by the way, everyone who's listening were done for people who had alopecia areata, eczema, psoriasis, and I'm sure there's more out there. We're going to talk about these three today, but there is a huge benefit here, correct?
Jessica: Yep, there is. So there is research growing in this field and there is one program in particular that we can describe more fully later on, but it's called mindfulness-based stress reduction. And if you search this program's name now on something like PubMed where it's a hub for a lot of different research, over 1,000 different articles pop up. And so this certainly is an emerging area of science and there seem to be a lot of benefits. And I think what's even more important to highlight with this is some of the studies have shown that you don't need to be meditating for an hour a day for years on end.
Jessica: So for example, with psoriasis, the study that they had done on the patients there was they took a group of people who had psoriasis. Half of them did light therapy alone, the other half did the light therapy with an audio recording of a meditation used in MBSR (Mindfulness-Based Stress Reduction). And they would just list into this recording for a few minutes before entering the light booth and during the light booth. And they weren't required to do any sort of meditation outside of this period of time. And at the end of the study, they found that there was a significant difference between how long they needed to reach clearance from the psoriasis and in the direction that those who did the light therapy with this audio recording of a meditation needed less treatments to reach improvement. And so that's a huge win and something that's really easy to implement in the clinical setting.
Jennifer: Can I ask because somebody listening to this who may be… Like I have some listeners who are of all different faiths, right? And so they might go, “Ooh, meditation, that might not be something that is in line with my faith that I practice.” From your experience with this, is this universal experience that… I mean, that's been my experience is that pretty much every, even just a faith has some form of almost like a mindfulness meditative practice. So can you speak-
Jessica: A tuning in.
Jennifer: Yeah. So can you speak a little bit to that? Like is this something that someone who might have a very specific faith that they believe in very strongly and it really is like the principle that guides their life, does this mean that this mindfulness activity or practice could be like something that they can't do because it's not in line with their faith?
Jessica: I think that's a great question. I think the most simple definition of mindfulness that can maybe answer this would be that you can think of mindfulness as the practice of paying attention on purpose to the present moment without judgment. And so there doesn't have to be any sort of element of spirituality or religion involved. It's just tuning in to what's happening right now, to what you're feeling right now, to what you're seeing right now. I think that's the simplest definition of it and doing it in a way where, again, there isn't so much judgment, maybe more curiosity and compassion. But if religion is important and you want to tie in some of your religious beliefs and practices, you absolutely can, but if it's something that you don't want to bring the two together, you absolutely don't have to. It can be open to all faiths.
Jennifer: I love that. And that is really, I think it's one of the important things that I've tried to stress to clients is that there's no reason why you can't bring prayer or a mantra or something that is really sentimental to you that means something-
Jessica: Absolutely.
Jennifer: Or that helps you find peace. It's just going to look different for every single person.
Jessica: Of course.
Jennifer: So let's talk a little bit about that one eczema study that you sent me because I think that one of the biggest challenges is the itch. Let's be honest. There are other factors. I'm not going to say that the itch is worse than the burning or whatever you're experiencing. Sometimes it's just this like one big bubble of hell that you're living in and it is what it is. But most people, their general complaint is about how itchy they are, whether they're in the midst of eczema. I would say also psoriasis, there's an itch factor as well for some individuals. And even those who are in TSW, one of the common complaints is about itchiness. So let's talk a little bit about what the terms itch intensity and itch catastrophizing are.
Jessica: Yes, there was a study that looked at something that is very important to address because it could cause a severe impairment in quality of life and psychological and emotional wellbeing. And so this study wanted to look into people's tendencies to practice mindfulness and then their tendency to catastrophize the itch. And so itch catastrophization could be thoughts along the lines of this itch is only going to continue to get worse and worse and it's never going to go away. And so seeing maybe the extremes of the negatives and the anticipation of it becoming gradually worse. And itch intensity is more so about the physical sensation of it really increasing and how you feel the itch.
Jessica: And what was interesting about this study was they found that if you had a higher tendency to catastrophize the itch, it was correlated with a higher tendency of itch severity. And so that itself within the study seems to suggest that our narrative and the mind does play an important role in how we physically feel. And then one step beyond that was in this study, they found if we had a tendency to practice mindfulness and specifically being aware of how we're feeling in the present moment and specifically having more of an attitude of acceptance for how we're feeling right now, there was an inverse correlation, meaning you were less likely to catastrophize itch. And so in turn, maybe less likely to have severity of itch.
Jessica: And so I think that's a really powerful thing, just the way that we're able to bring attention to physical sensations, again, pleasant or unpleasant, could really shift our narrative and in turn can affect us on a physiological level. And so this is one study that I think is really interesting. And it'll be really interesting for me to keep up with this research and learn more about the mechanism of action and how we could implement it alongside other treatments for eczema.
Jennifer: I think what I found most fascinating about this was it also shows your mindset does really matter here. So as you said, if you hold the belief that the itch is going to get worse, it's just going to keep getting worse. Any number of feelings that are coming up about it and the fears that you have about them, if they are not in a sense vocalized, right? That might be a part of the process is having say a journal and writing out how you feel, the thoughts that are running through your head in that very moment without judging them. Like you're not a bad person or a weak person and you're not weak for giving into the scratching, right? It's a judgment. It's about-
Jessica: No, it's normal for the mind to wander. It's always in motion.
Jennifer: Right. And if someone could potentially start to use that tool as a way to take a step back and almost become the narrator of this scene that they are in, I know that sounds a little bit like depersonalizing the situation that you're in, but if you could take a step out of the chaotic, right? Because it's essentially what catastrophizing is. Everything snowballs. It gets worse and worse and worse and you are wrapped up in the middle of it. If you could take a step back as if you were sitting in a movie theater watching this happen, that's a much different experience.
Jessica: Absolutely. And I think you raise a really good point because sometimes if you're new to meditation, you sit down and meditate, there could be maybe a feeling of frustration if these kinds of thoughts pop up and then it's maybe easy to think I'm doing this wrong or I'm bad at this. But the purpose of mindfulness and meditation is to be aware of what's happening. And so if these thoughts are running through your mind, the first step to acceptance is to be aware. And then from there on is how we can work on managing them. So I think you raise an excellent point of that's a great practical way of paying attention on purpose to what's happening.
Jennifer: Yeah. And I'll also share this too. I used to have a lot of judgements, like you were mentioning about how many thoughts I would have and how I would become so distracted. And at one point when I was working on a meditation practice, a teacher of mine had said, “This is a practice. It's not about being perfect. No one shows up to this perfect. It's actually just about the act of bringing yourself back to center, bringing yourself back to where you are. That's the whole process. And with time you become more skilled at it. And it's little by little, every practice.” Like you don't show up… If you're playing the piano, you want to learn how to play the piano. You're not going to show up and play like a Vivaldi piece or a Beethoven piece from day one. It takes sometimes years of practice, day after day of being consistent. And that's a really important part is a consistency is important here.
Jessica: Yeah, absolutely. It really is a practice. And there are programs that are out there and can help you walk through it step by step and to provide you with the support needed and some guidance and instruction or if concerns about am I doing this right come up, there could be someone there to help you with that. And that's where programs like MBSR, mindfulness-based stress reduction, come into play. And there's a variety of ones out there and there's also great apps as well that have awesome guided meditations. And as we mentioned, there's no one-size-fits-all. Different types of practices will look different to different people. And you might have comfort levels with maybe a seated meditation versus a body scan. But I think the most important part is that consistency, bringing awareness on purpose and then doing it without judgment.
Jessica: And I also want to mention with this study and bringing awareness to the physical sensations and doing so in a way of acceptance, that relates to some research by somebody by the name of Dr. Norman Farb. And he's found that when we are able to bring attention to our physical sensations, again, whether they're pleasant or unpleasant, we're actually able to shift neural networks in the brain. And there's going to be a shift from areas involved in more cognitive appraisals, so that's where maybe some of the negative self-talk and the narratives are, to areas that are involved in more immediate sensory experiences.
Jessica: And it's fascinating because his research suggests that when we're able to have this shift, we see an increase for things like pain and discomfort. We see an increase in things like self-compassion. And so just having that accomplished I think could be such a huge win alongside other treatments that can maybe target eczema and its itch on more of a physical level. And the beauty of it is it's something that can be so accessible to us to tap back into the present moment and a quick way to maybe do it that doesn't have to be such a formal meditative practice. It could be just find your feet. Wherever you are, whatever you're doing, just find your feet and pay attention to maybe some of the temperature sensations. Are you feeling warmness or coolness? Or maybe you feel your shoes around your feet or the contact points at the ground.
Jessica: Small things like that can help you tap into these physical sensations and actually shift neural connections and then maybe in turn help to decrease catastrophization, decrease itch intensity, or a breath. It's with us everywhere you go. So paying attention to what an inhale feels like. Where do you feel it the most? Maybe you feel it in the expansion of your tummy, maybe you feel it in the rise of your chest, the airflow in your nostrils. That's something that we have access to at any given moment. We just have to remember to do it.
Jennifer: So true. We do have to remember to do it. That's why you practice, right? Practice makes-
Jessica: Yeah, that's why the practice.
Jennifer: We always say practice makes perfect.
Jessica: Exactly.
Jennifer: So you got to show up to the practice and you got to do it. Let's talk a little bit about alopecia because that can be really traumatizing for an individual. I'm not saying that hair loss is any more or less traumatizing than skin issues for everybody listening, but I just know that one of the constant comments I have heard from clients is, “I could deal with the rashes, but when I started to lose my hair, I felt like that was just the breaking point.” So talk a little bit about this interesting study. And this was with patients with moderate to severe alopecia.
Jessica: Yeah, I think it's a really important area to do some research in to bring this awareness to because like you said, it could be a condition that is associated with so much psychosocial burden. It could be so difficult to be with this condition. And this study looked at, as you said, people with alopecia areata, and there were two groups. So some of them had their conventional treatments continue and the other group also had their conventional treatments continue, but they coupled that with MBSR (Mindfulness Based Stress Reduction). And that's the eight-week mindfulness-based stress reduction program that we've talked about.
Jessica: And it was a really interesting study. So even though they didn't find any significant changes in hair growth or the clinical outcomes of alopecia areata, they did find that those who did the MBSR program alongside their conventional treatments had significant improvements in their social relationships, in anxiety, in phobia. And what's even more interesting and impressive is that some of these improvements were maintained six months after the MBSR program. And so even though we weren't able to have these clinically significant improvements, improving somebody's quality of life is still such a huge win and still so important for us to keep at the back of our minds when we're making recommendations for patients because it can be incredibly supportive in this condition.
Jennifer: May I just ask in case someone isn't sure what quality of life means, I mean, I think we take for granted what that phrase means, but just from a more medical standpoint, what is quality of life?
Jessica: Yeah. So quality of life can range from how you feel on a day-to-day, what you're able to do day-to-day, whether you are able to give the best of yourself and your efforts to loved ones or work. I think overall it's just how you feel on a day-to-day level and your ability to partake in the things that are important to you.
Jennifer: That makes sense. Quality of life is so important.
Jessica: It is.
Jennifer: I always think of it as in terms of like my elderly relatives and their quality of life as we age. My experience has been having worked for my father who saw mostly people in their 70s and 80s and 90s, that unfortunately the quality of life tends to diminish as we age, but I also find that in this area of people who are really struggling with whatever skin issues that they may have, a lot of times the quality of life can get pretty grim. The outlook gets pretty grim.
Jennifer: I even have said before I really thought in the midst of like the worst flares and I almost think the winter time was slightly worse because my skin would dry out and all of the little areas in my fingers where the skin would bend would break because it was so dry. I literally was like, “Is God punishing me? Did I do something wrong? Is there like the Maloika someone put on me?” This is how you feel.
Jessica: Absolutely.
Jennifer: You start to feel like you're being punished or damned or you did something and you don't know how to make it stop. And so knowing that there are some ways that, like you said, you could get out of this state of catastrophizing. What a crazy word, catastrophizing.
Jessica: Yeah. And I think it's so important because of course, if we can bring a sense of ease or more comfort mentally and emotionally while we work on the physical, it's incredibly important, but also if we're able to equip people with these skills, then we're able to help them with the physical symptoms, then having this anchor to come back to, they can bring towards so many other things that will come up in life. So many other challenges that they might experience down the line. And so not only could it be helpful for their given condition here and now, but also maybe mentally more resilient for other things that can come up down the line.
Jennifer: I actually love that you said this skill because it's a skill that we're not taught. No one teaches us the coping skills of how to deal with what feels like in our body extreme situations. No one generally in our culture teaches us how to develop resiliency. So let's talk a little bit about this. You've mentioned it already. The mindfulness-based stress reduction. So for somebody who doesn't know what that is, what does this look like? Is this like an online program? Can you do it at home? Do you have to find a teacher locally? Do you have to travel? What's this about?
Jessica: Great question. I love the program. So for my personal experience, I've actually done it twice. I've noticed tremendous improvement in how I go about my day-to-day, how I'm able to manage my stress, how I've been able to shift my self-talk or just be more aware of my narratives. So very interesting. It was founded by somebody by the name of Dr. Jon Kabat-Zinn. At the time when this first started, he was a PhD in molecular biology and he happened to be working at this hospital where there were a lot of chronic pain patients and patients with mental health concerns and some of them didn't seem to be responding to some of the conventional treatments.
Jessica: And at the time he was very passionate about mindfulness and meditation and yoga and had his own practice. And so he decided what if I can create a workshop and they actually started doing this in the basement of the hospital and just see how it goes. I can teach patients these skills and hopefully there will be some improvement. And so year after year, it's grown and it's become much more of a structured program.
Jessica: So again, it's eight weeks and it's done in the setting of a group, which is really nice as well because you have people from all different walks of life with all different struggles coming together to learn the skill. And so there's support involved and there's also the guidance of a teacher. And each week we'll slowly walk you through different meditative practices because some you might gravitate with more so or gravitate to more so than others. So whether it's a seated meditation or a walking meditation or a body scan, week by week you're taught about these and given the opportunity to practice. And whether it's online or in-person, COVID kind of shifted that. So now it is available virtually, which is fantastic.
Jennifer: Great.
Jessica: Yeah. And I've done it virtually. And even with the virtual setting, I was so impressed by how deeply I was able to connect with my fellow participants. So there's a lot of different institutions that offer this program. You can just search MBSR and depending on your time zone or location, you might find one that best works for you. But UCSB has got one, Brown University has one. There's very reputable institutions that offer this mindfulness program.
Jessica: And it seems to be the program that as of right now has the most amount of research as well. And not just for dermatology, but it's also been studied in things like fibromyalgia, anxiety, sleep, hypertension. And the thought is that it has an effect on our immune system and that it can be anti-inflammatory. And then as we've mentioned as well, mindfulness practices seem to also shift neural activity in different regions of the brain. And so mindfulness has also been shown to decrease the size of a part of our brain called the amygdala. And that's the part of our brain involved in fear and the fight or flight response. And so over time, perhaps we're less likely to jump to that fearful state in that fight or flight state with practicing mindfulness.
Jennifer: Just because you had mentioned this, any research that you know of around its use for those who've experienced trauma of any sort or like traumatic brain injuries?
Jessica: That's a great question. Not to my knowledge, but it would be a very important area to have some research in.
Jennifer: Interesting.
Jessica: Yeah, I'd love to look into that. That's very important.
Jennifer: You have to dig into that. I have really appreciated this conversation.
Jessica: Me too.
Jennifer: First of all, I have wanted to start having more conversations about tools like this, but at the end of the day, when you really develop that skill, this is a free skill, everyone. It is a life skill. I would argue it's just as important as knowing how to drive, knowing how to wash the dishes, taking out the trash. Because if you cannot learn that resiliency with time, we start to lose it, right? One little thing happens in your day and it's a disaster and then it's just downhill from there. And having tools and skills to actually depend on like this can make a huge improvement, not just in, I think the itch and other factors going on, which was fascinating. You talked about the itch. And I also saw in this study, they were saying that the itch intensity, that itch and pain in some respects, there's like some similarities or connections between the two and how we experience them.
Jessica: And again, I think it can go back to tapping into these physical sensations. And as with Dr. Norman Farb's studies, he's found that if we're able to tap into our physical sensations with awareness and acceptance, we can increase our tolerance for things like pain and discomfort. So it's fascinating that there is growing research and evidence for this. And again, yes, I think it's easy for our minds to wander. Our minds want to be in motion and it's human nature to sometimes prepare for the worst. And that's maybe why we catastrophize. And so we should give ourself compassion for that as well, but to have these tools to come back to this present moment, that way, whether we are washing the dishes or taking out the trash or going for a drive, we can come back to the present moment and wherever we are, we can be there. And that itself I think simply put seems to be the practical takeaway. And I think the benefit comes from wherever you are just being there.
Jennifer: Yeah, exactly. So thank you so much for-
Jessica: Thank you so much. Cheers.
Jennifer: Having this conversation here because I think for many people it will land well. I actually want to have more conversations, especially this year in regards to-
Jessica: So important.
Jennifer: Mental health, how do we start looking at things? Can we start to shift mindset? Because this is partially mental and emotional resiliency, but it's also mindset. There is some mindset along in with this and it's just so important. So thank you so much for being here. I really appreciate-
Jessica: It's so important. Oh my goodness, thank you so much for the opportunity. I'm so grateful to have had the chance to speak with you, to meet you at the Integrative Derm Symposium and to share this knowledge. I hope it can be helpful to your listeners.
Jennifer: Well, thank you so much for being here. I appreciate it, Jessica.
Jessica: Thank you so much, Jennifer.
