Department of Dermatology, Royal Free NHS Trust, London NW3 2QG, UK.
Br J Dermatol. 2012 May;166(5):986-93. doi: 10.1111/j.1365-2133.2011.10799.x.
The role of ingrained cognitive and emotional patterns (schemas) in patients with psoriasis and eczema has not previously been investigated. High levels of psychiatric morbidity and psychological distress observed in these populations suggest the presence of maladaptive schemas and therefore a possible target for future successful psychological intervention.
To investigate the presence of early maladaptive schemas (EMS) in patients with psoriasis and eczema and to explore their links with psychological distress.
A sample of 185 adults (psoriasis n = 55, atopic eczema n = 54, chronic disease control n = 23, normal control n = 53) completed validated, self-administered questionnaires.
Differences were found between dermatology patients and control groups. Patients with psoriasis differed on seven EMS from the normal control group: emotional deprivation (P = 0·011), social isolation (P < 0·001), defectiveness (P < 0·001), failure (P < 0·001), vulnerability to harm (P < 0·001), subjugation (P = 0·009) and emotional inhibition (P = 0·002). They differed from the chronic disease group on vulnerability to harm (P = 0·002) only. Patients with eczema differed from the normal control group on eight EMS: emotional deprivation (P < 0·001), social isolation (P < 0·001), defectiveness (P < 0·001), failure (P < 0·001), dependence (P = 0·010), vulnerability to harm (P = 0·002), subjugation (P = 0·006) and insufficient self-control (P = 0·010). EMS were strongly positively related to psychological distress experienced by dermatology patients. Hierarchical regressions demonstrated two schemas, vulnerability to harm (P < 0·001) and defectiveness (P = 0·029), to be predictive of anxiety, and social isolation (P = 0·012) and vulnerability to harm (P = 0·018) to be predictive of depression, irrespective of age and years of coping for dermatology patients.
The findings have important theoretical and clinical implications for psychological management of patients with psoriasis and eczema. Treatment protocols may benefit by targeting schemas. Further studies are needed to investigate the benefits of schema-focused therapy in patients with skin disease.
先前并未研究过根深蒂固的认知和情感模式（图式）在银屑病和湿疹患者中的作用。这些人群中观察到的高精神发病率和心理困扰表明存在适应不良的图式，因此可能是未来成功心理干预的目标。
调查银屑病和湿疹患者早期适应不良图式（EMS）的存在情况，并探讨其与心理困扰的关系。
对 185 名成年人（银屑病患者 n=55、特应性皮炎患者 n=54、慢性疾病对照组 n=23、正常对照组 n=53）进行了样本调查，他们完成了经过验证的自我管理问卷。
与对照组相比，皮肤科患者存在差异。与正常对照组相比，银屑病患者在七个 EMS 上存在差异：情感剥夺（P=0.011）、社会孤立（P<0.001）、缺陷（P<0.001）、失败（P<0.001）、易受伤害（P<0.001）、受支配（P=0.009）和情感抑制（P=0.002）。与慢性疾病组相比，他们仅在易受伤害方面存在差异（P=0.002）。与正常对照组相比，湿疹患者在八个 EMS 上存在差异：情感剥夺（P<0.001）、社会孤立（P<0.001）、缺陷（P<0.001）、失败（P<0.001）、依赖（P=0.010）、易受伤害（P=0.002）、受支配（P=0.006）和自我控制不足（P=0.010）。EMS 与皮肤科患者的心理困扰呈强烈正相关。层次回归显示，在皮肤科患者中，两个图式，易受伤害（P<0.001）和缺陷（P=0.029），可以预测焦虑，社会孤立（P=0.012）和易受伤害（P=0.018）可以预测抑郁，无论年龄和应对年限如何。
这些发现对银屑病和湿疹患者的心理管理具有重要的理论和临床意义。治疗方案可能受益于针对图式的治疗。需要进一步研究以调查在皮肤病患者中进行图式聚焦治疗的益处。
