If you’ve never heard of psychodermatology, you aren’t alone. Although the conversation around skin diseases and mental health is slowly picking up, it’s not at the foreground just yet – but it should be.
Combining psychology and dermatology, psychodermatology is used to treat skin disorders using psychological techniques. Matt Traube, licensed clinical psychotherapist, specializes in this area and frequently sees patients with vitiligo among many other skin diseases. Working with those who feel like their skin is a massive barrier to living and functioning, Matt helps patients change their perspective and build a more positive, healthy mindset.
“Our attitude, the way we relate to our skin, is subjective – not objective,” said Matt, who works out of offices in both California and Massachusetts. “Three different people can have identical vitiligo and have completely different experiences with it. You might not be able to change your skin, but you can absolutely change your experience with your skin and your perception of what it is.”
That’s why his work is so important.
Building awareness of you feel and think about your skin
According to Matt, a key first step in this process is awareness. You need to be aware of how you feel and think about your skin. Since the human brain is set to protect us, people often begin to overthink and overanalyze situations. However, that behavior is learned and can also be un-learned.
“We often confuse feelings for facts,” said Matt, who used the example of scrutinizing yourself in the mirror and allow self-defeating thoughts to become facts. “We have these feelings repeatedly that no one will like us. Over time, we cement those as facts, but they aren’t true; they’re just feelings that we convince ourselves are true.”
That’s where cognitive behavioral therapy comes in. Your thoughts are not always accurate – although that might be hard to accept. Therapy can help patients question their personal beliefs about what they look like and how others perceive them. Instead of taking their feelings as facts, patients will learn to come back to a place where what they’re feeling and thinking about their skin is more accurate.
Changing perceptions with exposure therapy
For some with vitiligo, the idea of another person seeing their spots can be paralyzing – and detrimentally so. Matt’s goal is to uncouple the idea that vitiligo is threatening and awful and that someone might perceive them negatively. One way he does this is through exposure therapy, in which the patient slowly exposes more of his or her body in public and gauges the reaction.
“It can be life-changing for people,” said Matt, who might have a patient wear three-quarter sleeves instead of long sleeves one day. “Some people are living in fear, worried about what others will say. We begin to demystify that fear and little by little, the stress is lifted.”
It also gives patients a chance to see results first-hand. While talking about your skin is helpful, says Matt, patients need to experience people’s reactions to their skin to change their belief system. By taking small steps towards showing their skin, patients can practice implementing the change and build up to monumental progress.
Creating social support with therapeutic alliances
Skin disease aren’t uncommon – and yet so many people feel alone in dealing with them. Yet as Matt likes to remind his patients, your skin is another human experience, and one that others are going through too.
“This is so powerful for people to hear,” said Matt, who recognizes his role in helping patients feel less alone. “It changes the thought process from ‘what’s wrong with me’ to ‘maybe it’s more normal than I thought.’”
That’s why social support is critical to reducing psychological stress for those dealing with a skin disease. A key part of that support is building sympathy and a deep sense of understanding for what someone is going through. That can be difficult for families and friends alike – and it’s something Matt tries to address by guiding loved ones through a simple exercise. He asks parents or family members to describe what it would be like to live with vitiligo, then he asks the patient with vitiligo to evaluate how they did and try to explain it again. The process repeats until each side is telling the same story.
“The result is that the child will feel heard by their parent, and the parents will have a deeper sense of what the child is going through,” said Matt, who enjoys bringing families together in this way. “It’s a really healing experience and builds sympathy and empathy.”
Erika Page is the Founder and Editor of Living Dappled. After getting vitiligo at the age of seven, she lost 100% of her pigment to the condition and today lives with universal vitiligo.