Rosacea and Psychology: Peter D. Drummond, PhD, & Daphne Su, DPsych

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We put some questions on the psychology of rosacea to Professor Peter Drummond, Ph.D., from the School of Psychology at Murdoch University in Perth, Western Australia, and his colleague Daphne Su, D.Psych, Clinical Psychologist (Registrar) with the Department of Health in Western Australia.

Professor Drummond's research into the clinical psychophysiology of health-related conditions (pain, emotions, headaches including migraines, cardiovascular disorders) includes the neural control of facial blood flow, and the role of the sympathetic nervous system (SNS) in pain and inflammation. (See also Rosacea and the Sympathetic Nervous System: Dr. Peter D. Drummond, PhD )

Dr Su's doctoral thesis entitled "Psychological stress and vascular disturbances in rosacea" can be accessed electronically from the Murdoch University library catalogue using the above link.

The Rosacea Support team would like to express our warmest thanks to Professor Drummond and Dr Su for generously sharing their time and knowledge with us.


Questions & Answers

Q: Many rosaceans have flushes triggered by emotional factors such as anger, sadness, and especially stress. Can you advise on how to manage stress and other emotions to avoid them inducing a flush? One particularly stressful situation is job interviews, so it would be great to have advice on how to prevent a flush then, and how to cope if a flush has already begun.

A: Management of stress and negative emotions requires habitual effort. Practising relaxation strategies such as deep breathing exercises, progressive muscle relaxation and reframing negative thoughts "I am going to flush" to positive ones were reported to be helpful by participants in Daphne's "Psychological Stress and Rosacea" study. They reported that daily practice of these strategies enabled them to use these tools effectively when they anticipated stressful moments. For instance, one participant practised deep breathing and holding a positive image of her being confident and not flushing before entering an interview/meeting situation. She would also rehearse an explanation of her flush or use humour so that she would not be caught out in these stressful situations. Another participant practised "Mindfulness" which is the art of being aware of surroundings and accepting the moment that has occurred.

Q: Some rosaceans get no support from people who regard rosacea as trivial and express resentment if someone won't eat certain foods or wants to turn down the thermostat. Can you comment on the possibility of trying to change such attitudes? Is there a good way to ask close family and friends to help us out with things like adjusting the house temperature, if they say we're selfish for asking for it to be cool enough for us to avoid heavy flushing?

A: Some family and friends may not be aware of the social and psychological impact of rosacea on individuals. A good way to start would be to provide easy to read information from websites such as www.rosacea.org. to interested family and friends. Brochures and forums are also a good way to expose people to this information. This may lead to discussions on how family and friends can assist a rosacean to cope with their condition.

Q: Do you have any advice on how to prevent and/or cope with warm room flushes?

A: It is difficult to prevent warm room flushes. Participants in Daphne's study reported that a cool towel and/or having a cold bottle of water on hand assisted in coping with these flushes. Prior explanation to people in the room may also assist.

Q: Some rosaceans find that the strain of trying to explain their condition, and the problems it sometimes causes, sets off a flush. Any suggestions on how to tell people about rosacea without flushing even more?

A: A possible way is to rehearse your explanation of the problem in front of the mirror and then to someone you trust. Once you feel confident about what you would like to say, you could then explain your condition to someone else. Again, habitual practice of calming strategies such as progressive muscle relaxation or mindfulness may assist.

Q: Do you have any advice on how to cope with flushing caused by crippling shyness and social anxiety? What do you think of using anti-anxiety drugs or beta blockers to lower the blood pressure slightly and reduce social blushing? Do you have any comments on drugs such as Ativan, Lexapro, Atenolol, Metoprolol, and Clonodine?

A: Flushing caused by shyness and social anxiety can be managed by cognitive behavioural therapy (CBT) or mindfulness. The use of strategies such as thought restructuring, relaxation therapy and behavioural therapy may also help. Speak to your doctor about anti-anxiety medication. Some drugs (such as beta blockers) reduce facial flushing in addition to having more general effects on the cardiovascular system and mood.

Q: Rosacea can have a major impact on self-esteem. Have you any advice for single people who fear dating in case they are rejected because of their rosacea? What about the (few) married people who have told us that their husbands don't want to be seen with them, saying they are ashamed of the wife's appearance?

A: As public knowledge about this disorder can be limited, one possible way is to provide simple and short explanations about the condition to their potential or current partners. For those who have partners, an appointment with an understanding doctor to explain the situation may assist. Alternatively, couples counselling with a clinical psychologist may address the situation further.

Q: Professor Drummond, your work seems to support Darwin's contention that "attention closely directed to any part of the body tends to interfere with the ordinary and tonic contraction of the small arteries of that part". What are the likely physical consequences of the rosacean, with hyper-reactive blood vessels, obsessively thinking upon his skin, and/or zealously attending to his face in the mirror? More broadly, what are your thoughts on mirrors? Might those with unsightly skin conditions be better off avoiding them, although not to the point of phobic avoidance?

A: In one of my studies staring at one side of the face increased blushing on that side of the face (Drummond PD, Mirco N. Staring at one side of the face increases blood flow on that side of the face. Psychophysiology 2004;41:281-287), so it's possible that just thinking about blushing could make blushing (and flushing in rosacea) worse. But equally, imagining that your face feels cool and comfortable could actually help to make it so. There are two schools of thought about how best to cope with concern about blushing (and appearance in general). The first is through "task concentration training" or developing skills to focus your attention on the task in hand rather than worrying about what's happening in your body and what others might think. The second is to develop a "mindful" attitude which involves acceptance of bodily responses such as blushing without becoming distressed. Both of these approaches are helpful and can be learnt fairly easily with the help of a clinical psychologist. In fact, a mirror could be quite useful when developing mindfulness skills, so I would encourage you to keep looking in mirrors rather than avoiding them.

Q: If someone has obsessive compulsive disorder (OCD) and/or body dysmorphic disorder (BDD), it can be hard to be objective about rosacea. Have you any advice on ways of gaining perspective despite such conditions?

A: Seeking professional help to cope with these disorders can be a first step in gaining perspective of the condition. It is also important to reframe those thoughts as "that is the OCD or BDD speaking" rather than to personalise it.

Q: Some rosaceans also suffer from depression and suicidal thoughts. At what stage should professional help be sought?

A: Anyone suffering from symptoms of hopelessness, helplessness, decrease in mood, decrease in motivation, increase/decrease in sleep and appetite for more than 2 weeks should seek assistance from a professional. In particular, if you have a motive and action plan to commit suicide, professional help should be sought immediately.

Q: Could you comment on the types of counselling or other therapies that you think are particularly helpful for people with the kind of issues many rosaceans suffer from, and what kind of therapist might someone look for?

A: Cognitive Behavioural Therapy (CBT) and Mindfulness would be two particular therapies that could be helpful to rosaceans. There are individual preferences on what kind of therapy is useful but the therapist should have appropriate qualifications in psychology or counselling, preferably with an understanding of the impact of stress on rosacea.

Q: Can you recommend any online or offline self-help resources?

A: Self-help websites do not replace professional advice that is usually tailored to individuals. However, here are some good resources you might wish to consult:

http://www.beyondblue.org.au/

http://www.blackdoginstitute.org.au/

http://www.cci.health.wa.gov.au/

The CCI website has a lot of good worksheets and information about anxiety, self-esteem, and depression, written from a CBT perspective.

For their section on depression:

http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=37

On using Mindfulness to counter anxiety, perhaps start here:

http://www.cci.health.wa.gov.au/resources/minipax.cfm?mini_ID=21

http://www.mindfulrecovery.com/new_site/index.html

A study examining the effects of mindfulness-based stress reduction in patients with social anxiety disorder:

http://findarticles.com/p/articles/mi_7600/is_200910/ai_n39229485/

To learn more about Cognitive Behavioural Therapy, see the earlier sites, or:

http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx

An article on the fear of blushing:

http://www.eetonderzoek.nl/publikaties/mulkens_fearofblushing_jad.pdf

Information about obsessive compulsive disorder (OCD):

http://www.nimh.nih.gov/health/publications/anxiety-disorders/obsessive-compulsive-disorder.shtml

http://www.nlm.nih.gov/medlineplus/obsessivecompulsivedisorder.html

Information about body dysmorphic disorder (BDD):

http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559